INTRODUCTION BREAST CANCER CARE
|
|
- Zoe Ann Hamilton
- 5 years ago
- Views:
Transcription
1 INTRODUCTION Breast Cancer Care welcomes the HFEA s consultation on embryo selection for inherited cancer. This is an extremely important and complex issue. Because of this, Breast Cancer Care has encouraged people affected by breast cancer to respond directly to the consultation, in addition to our formal submission that follows. BREAST CANCER CARE Breast Cancer Care is the UK's leading provider of information, practical assistance and emotional support for anyone affected by breast cancer. Every year we give direct support to over 22,000 people with breast cancer or breast health concerns through our helpline, peer support and other direct services. In addition, we respond to 2 million requests for support and information about breast cancer or breast health concerns through our publications, website and outreach work. All our services are free. We are committed to campaigning for better treatment and support for people with breast cancer and their families. BREAST CANCER CARE S RESPONSE PGD represents a major breakthrough for inherited genetic conditions because when carried out with IVF, it offers high-risk couples a pregnancy with no chance of genetic disorder transmission. Testing for some genetic conditions, such as sickle cell anaemia, is relatively uncontroversial as there are significant benefits to be derived from early diagnosis and medical treatment. However, genetic diagnosis for PGD becomes more controversial when the benefit derived in terms of prevention and treatment is more difficult to determine, as is the case for inherited breast cancer. Inherited Breast Cancer The consultation deals with inherited cancer, in particular breast cancer, which is the most common cancer in the UK and accounts for almost one in three of all cancer cases in women. About 1 in 9 women in the UK will develop breast cancer by the time they are 80 years old. 1 1 NHS Cancer Breast Screening Programme, 2002.
2 Inherited breast cancer represents a very small percentage of breast cancer cases. Whilst people who inherit faults in these genes have a higher chance of developing breast cancer, these faults are rare accounting for less than 1 in 20 breast cancer cases. 2 Over 85% of women who have a close relative with breast cancer will never develop the disease, and more than 85% of women with breast cancer have no family history of it. 3 Lower penetrance of breast cancer Faults in known high-risk breast cancer genes such as BRCA1 and BRCA2 account for fewer than 5% of breast cancer cases, and because of the lower penetrance nature of the condition, not everyone carrying the faulty gene will develop breast cancer. The risk of developing breast cancer in a person carrying either of the BRCA1 and BRCA2 gene faults is not clearly defined, with reports ranging from %, and variations between BRCA1 and BRCA 2 carriers. Whilst it is estimated that half of all women (50%) who carry a faulty BRCA1 or BRCA2 gene will have developed breast cancer by the time they are 50 years old, the risk to carriers of BRCA1 mutations have been estimated to be 60-80% by age 70 while the risk to carriers of BRCA2 mutations is lower. 4 As a result, in contrast with other genetic conditions in which a gene carrier will always develop the particular condition, not everyone carrying a faulty BRCA1 or BRCA2 gene will develop breast cancer. At the same time, over this lifetime, many people who do not have an identified gene will go on to develop breast cancer. Age of onset In contrast with some genetic conditions which affect a person at an early age (childhood), inherited breast cancer is an adult genetic condition. Whilst in women with a genetic susceptibility, breast cancer tends to occur at an earlier age than in sporadic cases, the mean age of breast cancer diagnosis among women carrying BRCA1 or BRCA2 mutations is in the 40s 5 compared to 50s-60s in sporadic cases (80% of breast cancers occur in women over the age of 50). 6 2 Cancer Research UK. 3 Collaborative Group on Hormonal Factors in Breast Cancer (2001) Familial breast cancer: collaborative reanalysis of individual data from 52 epidemiological studies including 58,209 women with breast cancer and 101,986 women without the disease. Lancet; 358; 9291; NICE, Familial breast cancer: The classification and care of women at risk of familial breast cancer in primary, secondary and tertiary care, May 2004, page Rebbeck TR, Levin AM, Eisen A, et al., Breast cancer risk after bilateral prophylactic oophorectomy in BRCA1 mutation carriers, Journal of the National Cancer Institute 91(17): , 1999; l. c. Hartman et al., Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer, New England Journal of Medicine 340; 77-84, Cancer Research UK, 2004.
3 Definition of high risk and eligibility Breast Cancer Care would like to emphasise the issue of PGD for people identified as high risk but who do not have an identified inherited gene. The consultation document states that the person seeking PGD will have a confirmed faulty copy of the gene. In terms of breast cancer there may be some confusion about people classified as being at high risk of inherited breast cancer but who do not have an identified gene, and therefore would not be eligible for PGD. As a result, Breast Cancer Care would like to draw the HFEA s attention on the potential need to make a judgment about whether is necessary to consider patients who are identified as high risk as well as patients who are known to have an identified inherited gene. If patients who are identified as high risk but do not carry an identified gene were to be excluded from PGD, clear information would need to be available about why they do not qualify. Further to this point, potentially people with lower (moderate rather than high) risk of inherited breast cancer may request PGD. The NICE clinical guidelines on familial breast cancer state that genetic testing for breast cancer is appropriate only for a small proportion of women who are from high risk families. This means that the majority of people with a family history do not fall into a high risk category. This may cause confusion from those not considered at high enough risk to be eligible for genetic testing and therefore PGD and it is crucial that clear information around this issue be available. These points raise interesting questions about the definition of high risk. Not all those classified as high risk of breast cancer by genetic services currently choose to have a genetic test in fact only small numbers actually go on to be tested. Importantly, of the 5-10% in whom breast cancer is truly hereditary, only about one third will have a faulty gene detected. 7 In some cases where people receive a negative genetic test result because technology cannot find the gene, geneticists may inform people that they are probably still gene carriers because the family history is so strong. It is already the case that some people who have risk reducing mastectomy will not be confirmed gene carriers but will be deemed at high enough risk (usually 2 ½ times population risk) to be eligible for surgery anyway. Therefore the notion of confirmed gene carriers becomes blurred. The NICE clinical guidelines on familial breast cancer 8 estimating the risk of developing inherited breast cancer: highlight the complexity of In most instances it is unlikely that a family history of breast cancer will be due to known high-risk genes such as BRCA1 or BRCA2 and we are only beginning to appreciate the contribution of other lower risk genes that may account for more breast cancer overall. (at page 23) 7 See fn.4. 8 Ibid.
4 Impact of other factors on breast cancer The activity of faulty genes can also be affected by other genes, hormones and environmental factors. Current research has identified links between cancer and a host of non-genetic factors including some chemicals, pesticides, radiation, bovine growth hormone, diet and exercise, which impact on the evolution of faulty genes. Risk of developing sporadic breast cancer There is an important difference between children born from breast cancer PGD and those with other inherited conditions: the children from selected healthy embryos can still go on to develop sporadic breast cancer. Conditions, such as Huntingdons are only inherited, so if one is clear of faulty genes, you will not get the condition. Breast cancer occurs most frequently outside of an inherited line, and therefore even if a child was born using PGD, this would not remove the risk of them developing sporadic breast cancer later in life. Risks of PGD As mentioned in the consultation document, PGD is not without risks and is still very much a new technology in which the long-term effects are unknown. Risks to consider are: - PGD relies on IVF, a burdensome and risky procedure with a low success rate. The likelihood of failure is important when consenting women and helping them reach a decision about PGD. The figures from HFEA in May 2003 state that the average live birth rate for IVF is approximately 17% with fresh eggs and sperm and 12% with frozen embryos. Therefore IVF may not result in a child. This is always an important consideration but especially if the mother had treatment for breast cancer that had led to her becoming infertile. If she has PGD, she knowingly consents to her faulty embryos being allowed to perish. This would need to be very clear to a couple as these might later prove to be her only chance of pregnancy lost. - False or inconclusive test results. The genetic tests used in PGD are not 100% reliable, meaning a theoretical long term risk of inherited breast cancer remains for the person born following PGD. Generally, good practice denotes that counselling support and surveillance are key for those at high risk of breast cancer. It is extremely important that the HFEA makes it clear what support will be offered to those born after PGD and who will be responsible for providing it. There are obvious resource issues considering the potential for lifetime risk. This has to be a major consideration if PGD is offered. - Lack of long-term data on the procedure s success and long-term health of babies born as a result of PGD.
5 Psychological Implications The effect that offering PGD may have on increasing the complex decisions facing people at high risk of inherited breast cancer because of family history needs to be considered, as these people already have many complex decisions to make, for example whether to have a bilateral risk reducing mastectomy or surveillance, and may also have been through the difficulty of multiple bereavements. Given that they may never go on to develop breast cancer, and that their children may not either, the option of PGD may lead to further anxiety and pressure of decision making as well as heighten fears. Other breast cancer genes The guidance refers to BRCA 1 & 2 but it is highly likely that other genes predisposing to breast cancer will be discovered (e.g. TP53) which may have lower prevalence or penetrance. If this is the case, the HFEA will need to consider whether all breast cancer gene carriers will be eligible for PGD or only if the newer genes have a certain level of penetrance. Process Women considering risk reducing surgery for high risk of breast cancer have to go through a rigorous process, including genetic assessment and psychological counselling before being given the operation. If PGD for inherited breast cancer is agreed, it is crucial that the HFEA makes it clear whether similar levels of support will be available to women considering it and who will be responsible for this. Difficulty may arise if a woman with a family history develops breast cancer at young age and then chooses to freeze some embryos because of the risk of chemotherapy induced infertility. Could she then have PGD and will there be enough time to prepare her adequately before starting chemotherapy? Prevention and Treatment The proposal for PGD breast cancer must also be considered in light of preventive measures and treatment options available now and those anticipated in the forthcoming years. Although breast cancer is not preventable, its impact and implications may be improved through early detection, for example, through being picked up by attending routine breast screening (e.g. mammography) and being breast aware. Five-year survival rates from breast cancer in the UK have been steadily improving since the 1970s. Almost two thirds of women now diagnosed with breast cancer are likely to survive for at least 20 years. Women aged between 50 and 69, who are most likely to be diagnosed with the disease, have an even better prognosis, with 72% surviving for 20 years. 9 9 Cancer Research UK, October 2005.
6 New hormonal therapies have had a significant impact on breast cancer survival rates. In recent years, there has been an increase in the number of life-saving treatment advances against breast cancer. Instead of only one or two options, today there is an overwhelming catalogue of treatment choices that fight the complex mix of cells in each individual cancer. For example, recently, Herceptin has been shown to reduce the chance of recurrence in HER2 positive early stage cancer by half and a new class of drugs, the aromatase inhibitors, has been shown to reduce the risk of the disease recurring in post menopausal women. Some experts are starting to suggest that within the next years, breast cancer may become seen as a long term manageable condition. In a survey carried out in 2003, Breast Cancer Care asked 80 UK cancer experts their views on possible advances in breast cancer. 83% said that they believe breast cancer will be considered a long-term manageable condition in 20 years. 10 There are also strategies to reduce the risk of breast cancer developing in high risk women. For example, Tamoxifen has been shown to reduce the risk of breast cancer in high risk women and trials are now looking at the role of aromatase inhibitors in prevention. Prophylactic surgery has also proven to be highly effective in preventing breast cancer: following prophylactic mastectomy, the risk reduction of breast cancer has been estimated at 90% over 14 years following prophylactic oophorectomy, the risk reduction for breast cancer has been estimated at 50% over 9 years. 11 In addition, there are significant developments in the area of gene profiling which may positively alter outcomes for gene carriers in future generations. CONCLUSION Breast Cancer Care would like to emphasise the importance of consulting with people who are or may be affected by this issue. Whilst PGD has strong scientific and ethical implications, it also has significant psychological and emotional consequences that only people affected by the issue can explain appropriately. In particular, we would like to acknowledge that the fear of passing on breast cancer to their children is a very significant concern voiced to us by breast cancer patients and PGD will inevitably be seen as vital by some hence the views of those with a significant family history should be sought to establish needs and the level of support required. 10 Breast Cancer Care, Breast cancer in the UK What s the prognosis, July L. C.Hartmann, et al. Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer, New England Journal of Medicine, 14 January 1999, Vol. 340(2), pp See also T.R. Rebbek et al., Double Preventive Mastectomy Lowers Risk in Women with BRCA1 or BRCA2 Mutations, Journal of Clinical Oncology, 15 March 2004.
7 Breast Cancer Care s response also makes it clear that the current and foreseeable medical advances would call for a regular review of PGD should it be agreed, as advances in prevention may somewhat negate the need for PGD. Breast Cancer Care will follow-up the developments arising from this consultation very closely and will provide any relevant information and evidence that may have implications for the issues at stake. January 2006
BRCA genes and inherited breast and ovarian cancer. Information for patients
BRCA genes and inherited breast and ovarian cancer Information for patients This booklet has been written for people who have a personal or family history of breast and/or ovarian cancer that could be
More informationThis information explains the advice about familial breast cancer (breast cancer in the family) that is set out in NICE guideline CG164.
Familial breast cancer (breast cancer in the family) Information for the public Published: 1 June 2013 nice.org.uk About this information NICE guidelines provide advice on the care and support that should
More informationBRCA1 & BRCA2 GeneHealth UK
BRCA1 & BRCA2 GeneHealth UK BRCA1 & BRCA2 What is hereditary breast cancer? Cancer is unfortunately very common, with 1 in 2 people developing cancer at some point in their lifetime. Breast cancer occurs
More informationHALTON CLINICAL COMMISSIONING GROUP NHS FUNDED TREATMENT FOR SUBFERTILITY. CONTENTS Page
HALTON CLINICAL COMMISSIONING GROUP NHS FUNDED TREATMENT FOR SUBFERTILITY CONTENTS Page 1. INTRODUCTION 2 2. GENERAL PRINCIPLES 2 3. DEFINITION OF SUBFERTILITY AND TIMING OF ACCESS TO TREATMENT 3 4. DEFINITION
More informationNHS FUNDED TREATMENT FOR SUBFERTILITY. ELIGIBILITY CRITERIA POLICY GUIDANCE/OPTIONS FOR CCGs
NHS FUNDED TREATMENT FOR SUBFERTILITY ELIGIBILITY CRITERIA POLICY GUIDANCE/OPTIONS FOR CCGs CONTENTS Page 1. INTRODUCTION 2 2. GENERAL PRINCIPLES 2 3. DEFINITION OF SUBFERTILITY AND TIMING OF ACCESS TO
More informationSt Helens CCG NHS Funded Treatment for Subfertility Policy 2015/16
St Helens CCG NHS Funded Treatment for Subfertility Policy 2015/16 1 Standard Operating Procedure St Helens CCG NHS Funded Treatment for Sub Fertility Policy Version 1 Implementation Date May 2015 Review
More informationFertility treatment in trends and figures
Fertility treatment in 2010 trends and figures Contents Page No: Foreword by the Chair of the HFEA 3 Summary 4 Section 1: Overview How many fertility clinics were there in the UK in 2010? 6 How many women
More informationINTRODUCTION TABLE OF CONTENTS. If you want to become a parent after cancer, we would like to give you the information you need to make that happen.
TABLE OF CONTENTS INTRODUCTION INTRODUCTION 1 MEN Fertility Risks 2 Fertility Preservation Options 3 Possible Fertility Outcomes 4 Parenthood After Cancer Options 5 Important Tips for Men 6 WOMEN Fertility
More informationBlackpool CCG. Policies for the Commissioning of Healthcare. Assisted Conception
1 Introduction Blackpool CCG Policies for the Commissioning of Healthcare Assisted Conception 1.1 This policy describes circumstances in which NHS Blackpool Clinical Commissioning Group (CCG) will fund
More informationGeneHealth BRCA 1&2_ qxp_Layout 1 21/02/ :44 Page 3 BRCA1 & BRCA2 GeneHealth UK
GeneHealth BRCA 1&2_8.2.17.qxp_Layout 1 21/02/2017 16:44 Page 3 BRCA1 & BRCA2 GeneHealth UK GeneHealth BRCA 1&2_8.2.17.qxp_Layout 1 21/02/2017 16:44 Page 4 BRCA1 & BRCA2 What is hereditary breast cancer?
More informationA Stepwise Approach to Embryo Selection and Implantation Success
Precise Genetic Carrier Screening An Overview A Stepwise Approach to Embryo Selection and Implantation Success Put today s most advanced genetic screening technology to work for you and your family s future.
More informationASSISTED CONCEPTION NHS FUNDED TREATMENT FOR SUBFERTILITY ELIGIBILITY CRITERIA & POLICY GUIDANCE
ASSISTED CONCEPTION NHS FUNDED TREATMENT FOR SUBFERTILITY ELIGIBILITY CRITERIA & POLICY GUIDANCE Version 1.0 Page 1 of 11 MARCH 2014 POLICY DOCUMENT VERSION CONTROL CERTIFICATE TITLE Title: Assisted Conception
More informationPolicy statement. Commissioning of Fertility treatments
Policy statement Commissioning of Fertility treatments NB: The policy relating to commissioning of fertility treatments is unchanged from the version approved by the CCG in March 2017. The clinical thresholds
More informationCancer & Fertility: Patient Education Booklet. information suppor t hope
Cancer & Fertility: Patient Education Booklet information suppor t hope 1 table of contents introduction 1 men Fertility Risks 2 Fertility Preservation Options 3 Possible Fertility Outcomes 4 Parenthood
More informationFertility care for women diagnosed with cancer
Saint Mary s Hospital Department of Reproductive Medicine Information for Patients Fertility care for women diagnosed with cancer Contents Page Overview... 2 Our service... 2 Effects of cancer treatment
More informationSo how much of breast and ovarian cancer is hereditary? A). 5 to 10 percent. B). 20 to 30 percent. C). 50 percent. Or D). 65 to 70 percent.
Welcome. My name is Amanda Brandt. I am one of the Cancer Genetic Counselors at the University of Texas MD Anderson Cancer Center. Today, we are going to be discussing how to identify patients at high
More informationSHIP8 Clinical Commissioning Groups Priorities Committee (Southampton, Hampshire, Isle of Wight and Portsmouth CCGs)
SHIP8 Clinical Commissioning Groups Priorities Committee (Southampton, Hampshire, Isle of Wight and Portsmouth CCGs) Policy Recommendation 002: Assisted Conception Services Date of Issue: September 2014
More informationCoversheet for Network Site Specific Group Agreed Documentation
Coversheet for Network Site Specific Group Agreed Documentation This sheet is to accompany all documentation agreed by Pan Birmingham Cancer Network Site Specific Groups. This will assist the Network Governance
More informationPolicy updated: November 2018 (approved by Haringey and Islington s Executive Management Team on 5 December 2018)
Islington CCG Fertility Policy First approved: 29 January 2015 Policy updated: November 2018 (approved by Haringey and Islington s Executive Management Team on 5 December 2018) Introduction Islington CCG
More informationGenetic screening. Martin Delatycki
7 Genetic screening Martin Delatycki Case study 1 Vanessa and John are planning a family. They see their general practitioner and ask whether they should have any tests prior to falling pregnant to maximise
More informationThis fact sheet describes the condition Fragile X and includes a discussion of the symptoms, causes and available testing.
11111 Fact Sheet 54 FRAGILE X SYNDROME This fact sheet describes the condition Fragile X and includes a discussion of the symptoms, causes and available testing. In summary Fragile X is a condition caused
More informationNICE fertility guidelines. Hemlata Thackare MPhil MSc MRCOG Deputy Medical Director London Women s Clinic
NICE fertility guidelines Hemlata Thackare MPhil MSc MRCOG Deputy Medical Director London Women s Clinic About the LWC 4 centres around the UK London Cardiff Swansea Darlington The largest sperm bank in
More informationInformation leaflet for women with an increased lifetime risk of breast and ovarian cancer. Hereditary Breast and Ovarian Cancer (HBOC)
Information leaflet for women with an increased lifetime risk of breast and ovarian cancer Hereditary Breast and Ovarian Cancer (HBOC) What is Hereditary Breast and Ovarian Cancer (HBOC)? Hereditary Breast
More informationApproximately 5% to 10% of breast cancer (BC) is hereditary in nature. Since. By Dawna Gilchrist, MD, FRCPC, FCCMG
By Dawna Gilchrist, MD, FRCPC, FCCMG Approximately 5% to 10% of breast cancer (BC) is hereditary in nature. Since the discovery of the genes BRCA 1 and 2 in the early 1990s, genetic counselling and testing
More informationWelcome! Here s our agenda for today:
Welcome! Here s our agenda for today: What is ovarian cancer? What causes it? When does genetic testing come in? When are families at risk for ovarian cancer? What are the treatments? 3 things to remember
More informationPlanning for Parenthood After a Cancer Diagnosis
Cancer and Fertility Planning for Parenthood After a Cancer Diagnosis If you or someone you love is facing cancer, preserving fertility may be the last thing on your mind. But if you re a woman of childbearing
More informationHereditary Breast and Ovarian Cancer (HBOC) Information for individuals and families
Hereditary Breast and Ovarian Cancer (HBOC) Information for individuals and families What is Hereditary Breast and Ovarian Cancer (HBOC)? Hereditary Breast and Ovarian Cancer is a genetic condition which
More informationCOMMISSIONING POLICY FOR IN VITRO FERTILISATION (IVF)/ INTRACYTOPLASMIC SPERM INJECTION (ICSI) WITHIN TERTIARY INFERTILITY SERVICES V2.
COMMISSIONING POLICY FOR IN VITRO FERTILISATION (IVF)/ INTRACYTOPLASMIC SPERM INJECTION (ICSI) WITHIN TERTIARY INFERTILITY SERVICES V2.3 2017 Agreed at Cannock Chase CCG Signature: Designation: Chair of
More informationDirector of Commissioning, Telford and Wrekin CCG and Shropshire CCG. Version No. Approval Date August 2015 Review Date August 2017
Commissioning Policy for In Vitro Fertilisation (IVF)/ Intracytoplasmic Sperm Injection (ICSI) within tertiary Infertility Services, in Shropshire and Telford and Wrekin Owner(s) Version No. Director of
More informationA beginner s guide to BRCA1 and BRCA2
i A beginner s guide to BRCA1 and BRCA2 A beginner s guide to BRCA1 and BRCA2 Contents Introduction 1 What does it mean to have a BRCA gene mutation? 1 Background information about the BRCA1 and BRCA2
More informationFertility Policy. December Introduction
Fertility Policy December 2015 Introduction Camden Clinical Commissioning Group (CCG) is responsible for commissioning a range of health services including hospital, mental health and community services
More informationRecommended Interim Policy Statement 150: Assisted Conception Services
Southampton City Clinical Commissioning Group (CCG) took on commissioning responsibility for Assisted Conception Services from 1 April 2013 for its population and agreed to adopt the interim policy recommendations
More informationAccess to IVF. Help us decide Discussion paper. South Central Specialised Commissioning Group C - 1
Access to IVF Help us decide Discussion paper South Central Specialised Commissioning Group 1 C - 1 Access to IVF treatment Contents 1. Background 3 2. Developing a single policy for NHS South Central..4
More informationCOMMISSIONING POLICY. Tertiary treatment for assisted conception services
Final Version COMMISSIONING POLICY Tertiary treatment for assisted conception services Designated providers for patients registered with a Worcestershire GP BMI The Priory Hospital, Birmingham - 1 - Commissioning
More informationFAQ-Protocol 3. BRCA mutation carrier guidelines Frequently asked questions
ULast updated: 09/02/2015 Protocol 3 BRCA mutation carrier guidelines Frequently asked questions UQ: How accurate are the remaining lifetime and 5 year breast cancer risks in the table? These figures are
More informationReproductive Technology, Genetic Testing, and Gene Therapy
Michael Cummings Chapter 16 Reproductive Technology, Genetic Testing, and Gene Therapy David Reisman University of South Carolina 16.1 Infertility Is a Common Problem In the US, about 13% of all couples
More informationOvarian Cancer Causes, Risk Factors, and Prevention
Ovarian Cancer Causes, Risk Factors, and Prevention Risk Factors A risk factor is anything that affects your chance of getting a disease such as cancer. Learn more about the risk factors for ovarian cancer.
More informationMainstreaming Cancer Genetics (MCG) Information Pack
Mainstreaming Cancer Genetics (MCG) Key Points Information Pack Genetic information is important for people with cancer and their relatives. New gene testing methods can be harnessed so that more genes
More informationI have ovarian cancer
I have ovarian cancer Everything you need to know about BRCA1/2 gene mutations (NHS England only) 1 An introduction to BRCA1/2 gene mutations BRCA1 and BRCA2 are genes that repair damage in cells and prevent
More informationFertility preservation for women wishing to freeze egg/ embryo for fertility preservation
Fertility preservation for women wishing to freeze egg/ embryo for fertility preservation The aim of this leaflet is to help answer some of the questions you may have about fertility preservation. It explains
More informationCOMMISSIONING POLICY FOR IN VITRO FERTILISATION (IVF)/ INTRACYTOPLASMIC SPERM INJECTION (ICSI) WITHIN TERTIARY INFERTILITY SERVICES
COMMISSIONING POLICY FOR IN VITRO FERTILISATION (IVF)/ INTRACYTOPLASMIC SPERM INJECTION (ICSI) WITHIN TERTIARY INFERTILITY SERVICES Version number V2.3 Responsible individual Author(s) Barry Weaver Trish
More informationAdvice about familial aspects of breast cancer and epithelial ovarian cancer
Advice about familial aspects of breast cancer and epithelial ovarian cancer a guide for health professionals FEBRUARY 2006 These guidelines contain three parts: 1. Information for health professionals
More informationGOVERNING BOARD. Assisted Conception (IVF): Review of access criteria. Date of Meeting 21 January 2015 Agenda Item No 13. Title
GOVERNING BOARD Date of Meeting 21 January 2015 Agenda Item No 13 Title Assisted Conception (IVF): Review of access criteria Purpose of Paper The SHIP (Southampton, Hampshire, Isle of Wight and Portsmouth)
More informationCEL 09 (2013) 15 May Dear Colleague
Director General Health and Social Care and Chief Executive NHS Dear Colleague Provision of Infertility Services in Scotland (updated IVF criteria) As you know a National Infertility Group was convened
More informationNational Fertility Preservation Register: datatabase to help cancer patients with fertility issues
National Fertility Preservation Register: datatabase to help cancer patients with fertility issues by: SUE DUNLEVY NATIONAL HEALTH REPORTER From: News Corp Australia 14 days ago April 20, 2014 8:07PM Time
More informationWhat Are Genes And Chromosomes?
Clinical Genetics Predictive testing for a Breast Cancer 2(BRCA2) Gene alteration Information for families where an altered cancer gene has been found and who are considering undergoing predictive testing
More informationApproved January Waltham Forest CCG Fertility policy
Approved January 2015 Waltham Forest CCG Fertility policy Contents 1 Introduction 1 2 Individual Funding Requests 1 2.1 Eligibility criteria 1 2.2 Number of cycles funded 2 2.3 Treatment Pathway 3 Page
More informationSo, Who are the appropriate individuals that should consider genetic counseling and genetic testing?
Hello, I m Banu Arun, Professor of Breast Medical Oncology and Co-Director of Clinical Cancer Genetics at the University of Texas MD Anderson Cancer Center. Today I will be discussing with you Hereditary
More informationCancer Genetics Unit Patient Information
Chemoprevention for women at an increased risk of familial breast cancer Cancer Genetics Unit Patient Information What is chemoprevention? Chemoprevention describes drugs that are used to reduce the risk
More informationNote: This updated policy supersedes all previous fertility policies and reflects changes agreed by BHR CCGs governing bodies in June 2017.
Fertility Policy 10 July 2017 Note: This updated policy supersedes all previous fertility policies and reflects changes agreed by BHR CCGs governing bodies in June 2017. Introduction BHR CCGs are responsible
More informationDoes Cancer Run in Your Family?
Does Cancer Run in Your Family? A Patient s Guide to Hereditary Breast and Ovarian Cancer Syndrome What is Hereditary Cancer? Most cancers occur in people who do not have a strong family history of that
More informationI have ovarian cancer
I have ovarian cancer Everything you need to know about BRCA1/2 gene mutations (Scotland only) 1 An introduction to BRCA1/2 gene mutations BRCA1 and BRCA2 are genes that repair damage in cells and prevent
More informationWest Hampshire Clinical Commissioning Group Board
West Hampshire Clinical Commissioning Group Board Date of meeting 25 July 2013 Agenda Item 9 Paper No WHCCG13/089 Priorities Committee Statement Assisted Conception/IVF Key issues An Interim Policy Statement
More informationJAWDA Quarterly & Yearly Guidelines for Assisted Reproductive Technology Treatment (ART) Providers January 2019
JAWDA Quarterly & Yearly Guidelines for Assisted Reproductive Technology Treatment (ART) Providers January 2019 Page 1 Table of Contents Executive Summary... 3 About this Guidance... 4 Glossary:... 5 ART
More informationYes infertility policy pdf
1. We would like to understand some of the specifics of your current Treatment Policy Once all tabs are complete, please return to: intern@progress.org.uk Question a. Is the CCGs assisted conception policy,
More informationAssessment and Management of Genetic Predisposition to Breast Cancer. Dr Munaza Ahmed Consultant Clinical Geneticist 2/7/18
Assessment and Management of Genetic Predisposition to Breast Cancer Dr Munaza Ahmed Consultant Clinical Geneticist 2/7/18 Overview The role of the Cancer Genetics team NICE guidelines for Familial Breast
More informationFertility treatment and referral criteria for tertiary level assisted conception
Fertility treatment and referral criteria for tertiary level assisted conception Version Number 2.0 Ratified by HVCCG Exec Team Date Ratified 9 th November 2017 Name of Originator/Author Dr Raj Nagaraj
More informationProstateGene What is hereditary prostate cancer? What are genes?
ProstateGene ProstateGene What is hereditary prostate cancer? Prostate cancer is the most common cancer among men in the UK. Unfortunately, 1 in 8 men will be diagnosed with prostate cancer, with 75% being
More informationHereditary Breast and Ovarian Cancer Rebecca Sutphen, MD, FACMG
Hereditary Breast and Ovarian Cancer 2015 Rebecca Sutphen, MD, FACMG Among a consecutive series of 11,159 women requesting BRCA testing over one year, 3874 responded to a mailed survey. Most respondents
More informationPublic consultation: Seeking your views on IVF
Public consultation: Seeking your views on IVF Introduction We (NHS Bury Clinical Commissioning Group (CCG)) are seeking views from patients registered with a Bury GP practice, Bury health care professionals
More informationpatient education Fact Sheet
patient education Fact Sheet PFS007: BRCA1 and BRCA2 Mutations OCTOBER 2017 BRCA1 and BRCA2 Mutations Cancer is caused by several different factors. A few types of cancer run in families. These types are
More informationEast and North Hertfordshire CCG. Fertility treatment and referral criteria for tertiary level assisted conception
East and North Hertfordshire CCG Fertility treatment and referral criteria for tertiary level assisted conception December 2015 1 1. Introduction This policy sets out the entitlement and service that will
More informationINTRACYTOPLASMIC SPERM INJECTION
1 Background... 2 2 Male Factor Infertility... 2 3 ICSI... 3 4 Surgical sperm aspiration... 4 5 What is the chance of success?... 6 6 What are the risks?... 7 M Rajkhowa, October 2004 Authorised by V Kay
More informationThe BMJ / BMJ Open Press Release
28 November 2016 The BMJ / BMJ Open Press Release Study reveals lack of supporting evidence for claims about fertility treatments Many claims made by UK fertility clinics about the benefits of treatments
More informationFertility treatment in trends and figures
Fertility treatment in 2011 trends and figures Contents Page No: Chair s foreword 3 Summary 4 Background 5 Frequently asked questions 7 Section 1: Overview How many fertility clinics were there in the
More informationGenetic testing for breast cancer susceptibility
Genetic testing for breast cancer susceptibility This leaflet explains more about genetic testing for a breast cancer susceptibility gene panel. If you have any further questions or concerns, please do
More informationSperm Donation - Information for Donors
Sperm Donation - Information for Donors The donation of sperm to help someone to have a child is one of the most generous gifts anyone can give. Many donors feel a sense of pride, knowing the joy they
More informationEgg sharing (Donor) Information for Patients and Partners
Egg sharing (Donor) Information for Patients and Partners Date of Issue: 29/06/2018 Doc 392 Issue 10 1 of 10 Who is this leaflet about and who is it for? This leaflet is produced to inform couples considering
More informationPreimplantation Genetic Testing Where are we going? Genomics Clinical Medicine Symposium Sept 29,2012 Jason Flanagan, MS,CGC
Preimplantation Genetic Testing Where are we going? Genomics Clinical Medicine Symposium Sept 29,2012 Jason Flanagan, MS,CGC Overview Discuss what PGD and PGS are Pt examples What we have learned Where
More informationScreening for Breast Cancer
Understanding Task Force Recommendations Screening for Breast Cancer U.S. Preventive Services Task Force (Task Force) has issued a final recommendation statement on Screening for Breast Cancer. se final
More informationGRANT SUBMISSION Northern Sunrise County. Submitted to: Peter Thomas, CAO
GRANT SUBMISSION Northern Sunrise County Submitted to: Peter Thomas, CAO January 2016 Contents 1. PROJECT OVERVIEW... 1 2. ABOUT THE CAUSE... 1 2.1. What is HBOC syndrome?... 1 2.1. What can be done?...
More informationHuman Fertilisation and Embryology Authority. Multiple Births after IVF in the United Kingdom
response to the Human Fertilisation and Embryology Authority public consultation on Multiple Births after IVF in the United Kingdom July 2007 This document represents the British Fertility Society (BFS)
More informationBecause Knowledge is a Powerful Tool. Focused on Patients
Because Knowledge is a Powerful Tool. Focused on Patients As the availability of genetic testing increases, a person may face many questions and choices. A Genetic Counselor provides assistance in understanding
More informationAnnual MRI Breast Screening Criteria Based Access Policy Date Adopted: 21st August 2015 Version:
Annual MRI Breast Screening Criteria Based Access Policy Date Adopted: 21st August 2015 Version: 1516.2 Document Control Title of document Annual MRI Breast Screening Authors job title(s) IFR Manager Document
More informationHBOC Syndrome A review of BRCA 1/2 testing, Cancer Risk Assessment, Counseling and Beyond.
HBOC Syndrome A review of BRCA 1/2 testing, Cancer Risk Assessment, Counseling and Beyond. Conni Murphy, ARNP Cancer Risk Assessment and Genetics Program Jupiter Medical Center Learning Objectives Identify
More informationChapter 17 Oncofertility Consortium Consensus Statement: Guidelines for Ovarian Tissue Cryopreservation
Chapter 17 Oncofertility Consortium Consensus Statement: Guidelines for Ovarian Tissue Cryopreservation Leilah E. Backhus, MD, MS, Laxmi A. Kondapalli, MD, MS, R. Jeffrey Chang, MD, Christos Coutifaris,
More informationCare and support. for younger women with breast cancer. The breast cancer support charity
Care and support for younger women with breast cancer The breast cancer support charity When you re young, breast cancer is often the last thing you expect to have to think about. A diagnosis may feel
More informationBSO, HRT, and ERT. No relevant financial disclosures
BSO, HRT, and ERT Jubilee Brown, MD Professor & Associate Director, Gynecologic Oncology Levine Cancer Institute at the Carolinas HealthCare System Charlotte, North Carolina No relevant financial disclosures
More informationGenetic counseling on VHL. Ignacio Blanco, MD PhD Genetic Counseling and Clinical Genetics Program Germans Trias Hospital Badalona, Spain
Genetic counseling on VHL Ignacio Blanco, MD PhD Genetic Counseling and Clinical Genetics Program Germans Trias Hospital Badalona, Spain Counseling of patients and closely related family members has to
More informationIntroduction 4. Important information about consent to legal parenthood 7. Women s consent to treatment and storage form (IVF and ICSI) (WT form) 9
Introduction 4 Important information about consent to legal parenthood 7 Women s consent to treatment and storage form (IVF and ICSI) (WT form) 9 Men s consent to treatment and storage form (IVF and ICSI)
More informationBreast Cancer Update Michael B. Peyser MS MD FACS Fellow Society of Surgical Oncology Windsong Breast Care
Breast Cancer Update 2017 Michael B. Peyser MS MD FACS Fellow Society of Surgical Oncology Windsong Breast Care Used with permission by Anna Chen MD, Windsong Radiology Group Statistics as of 2013 230,815
More informationThis activity is similar to Unit 1 exam questions. It tests understanding of PGD and some of the ethical issues involved.
Teacher Notes Introduction This activity is similar to Unit exam questions. It tests understanding of PGD and some of the ethical issues involved. The question is adapted from the Science for Public Understanding
More informationWHAT YOU NEED TO KNOW ABOUT DONATING SPERM, EGGS OR EMBRYOS
14 February 2006 WHAT YOU NEED TO KNOW ABOUT DONATING SPERM, EGGS OR EMBRYOS Introduction The donation of sperm, eggs or embryos to help a couple have a child is one of the most generous gifts anyone can
More informationBreast Cancer Prevention Studies. Key Points. Breast cancer prevention studies are clinical trials (research studies conducted with
CANCER FACTS N a t i o n a l C a n c e r I n s t i t u t e N a t i o n a l I n s t i t u t e s o f H e a l t h D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s Breast Cancer Prevention
More informationMy Personalized Breast Cancer Worksheet
My Personalized Breast Cancer Worksheet KNOW For Early-Stage Breast Cancer. No Questions. Only Results. No two tumors are alike. What are the characteristics of your breast cancer and how will that effect
More informationFertility treatment and referral criteria for tertiary level assisted conception
Fertility treatment and referral criteria for tertiary level assisted conception Version Number Name of Originator/Author Cross Reference V2 East of England Consortium Commissioning Policy for Fertility
More informationClinical guideline Published: 25 June 2013 nice.org.uk/guidance/cg164
Familial breast cancer: classification, care and managing breast cancer and related risks in people with a family history of breast cancer Clinical guideline Published: 25 June 2013 nice.org.uk/guidance/cg164
More informationClinical options for mutations of BRCA 1/2 genes. Ioannis Th. Natsiopoulos Breast surgeon
Clinical options for mutations of BRCA 1/2 genes Ioannis Th. Natsiopoulos Breast surgeon The detection of a BRCA mutation is not diagnosis of a disease; it is genetic information and risk assessment Indications
More informationFACT SHEET 49. What is meant by a family history of bowel cancer? What is bowel cancer? What causes bowel cancer?
Important points The most important factors that can influence an individual s chance of developing bowel cancer are getting older and having a family history of bowel cancer A family history of bowel
More informationpatient education Fact Sheet PFS007: BRCA1 and BRCA2 Mutations MARCH 2015
patient education Fact Sheet PFS007: BRCA1 and BRCA2 Mutations MARCH 2015 BRCA1 and BRCA2 Mutations Cancer is a complex disease thought to be caused by several different factors. A few types of cancer
More informationPrecision Medicine and Genetic Counseling : Is Yes always the correct answer?
Precision Medicine and Genetic Counseling : Is Yes always the correct answer? Beverly M. Yashar, MS, PhD, CGC Director, Graduate Program in Genetic Counseling Professor, Department of Human Genetics. (yashar@umich.edu)
More informationSo, now, that we have reviewed some basics of cancer genetics I will provide an overview of some common syndromes.
Hello. My name is Maureen Mork and I m a Certified Genetic Counselor in the Clinical Cancer Genetics Program at The University of Texas MD Anderson Cancer Center. I ll be lecturing today on the Cancer
More informationClinical Policy Committee
Northern, Eastern and Western Devon Clinical Commissioning Group South Devon and Torbay Clinical Commissioning Group Clinical Policy Committee Commissioning policy: Assisted Conception Fertility treatments
More informationGeneHealth BreastGene_New qxp_Layout 1 21/02/ :42 Page 3 BreastGene GeneHealth UK
GeneHealth BreastGene_New 8.2.17.qxp_Layout 1 21/02/2017 16:42 Page 3 BreastGene GeneHealth UK BreastGene What is hereditary breast cancer? Breast cancer is the most common cancer in the UK. Unfortunately
More informationClinical Policy Committee
Clinical Policy Committee Commissioning policy: Assisted Conception Fertility assessment and investigations are commissioned where: A woman is of reproductive age and has not conceived after one (1) year
More informationHenda s Law. Supplemental screening for women with dense breast tissue and increased risk
. Henda s Law Supplemental screening for women with dense breast tissue and increased risk The 2011 Texas Legislature passed House Bill 2102 which is effective 1st September 2011. The law is informally
More informationWHAT IS A PATIENT CARE ADVOCATE?
WHAT IS A PATIENT CARE ADVOCATE? Fertility treatments can be overwhelming. As a member, you have unlimited access to a dedicated Patient Care Advocate (PCA), who acts as your expert resource for discussing
More informationProstateGene GeneHealth UK
ProstateGene GeneHealth UK ProstateGene What is hereditary Prostate cancer? Prostate cancer is the most common cancer among men in the UK. Unfortunately, 1 in 8 men will be diagnosed with prostate cancer,
More informationStrategy Strategic delivery: Setting standards Increasing and informing choice. Details: Output: Demonstrating efficiency economy and value
Strategy 2017-20 Strategic delivery: Setting standards Increasing and informing choice Demonstrating efficiency economy and value Details: Meeting Authority Agenda item 7 Paper number HFEA (11/05/2016)
More informationManagement of BRCA mutation carriers
Management of BRCA mutation carriers Clinical Case Presentation Shani Paluch-Shimon, MBBS, MSc Head, Breast Cancer Service for Young Women Oncology Institute Sheba Medical Center, Israel esmo.org DISCLOSURES
More information