Members, primarily PALS, listened with rapt attention to a clear, understandable, sometimes humorous, and very engaging and informative talk from Cliona Kirwan about breast cancer, as part of the regular series of events arranged by our Public Affairs sub-committee. And unsurprisingly, after the tea and cake break (kindly provided by Frodsham WI, there was no shortage of questions.
Caroline Bennison, a member of the fund-raising team at The Nightingale Centre, accompanied Cliona with information leaflets and advertising material. If you would like to learn more about the Nightingale Centre or contact Caroline please click here
From a family of doctors, her grandmother qualified in 1930, Cliona inevitably followed her older brother and sister into medicine. Following MBBS qualification in London and, inter alia, a spell in South Africa working in trauma, she obtained her PhD in Manchester where she is still based.
Both a senior lecturer in surgical oncology with a particular interest in the relationship between blood clotting and cancer and consultant breast surgeon at the University Hospital of South Manchester, Cliona divides her work between clinical work and academia. In addition to doing diagnostic and follow-up clinics, Cliona performs re-constructive surgery alongside lumpectomy or mastectomy.
Also a Fellow of the Royal College of Surgeons, Cliona’s talk focussed on the Nightingale Centre in Wythenshawe hospital. Based in a state of the art building opened in 2007, it coordinates the NHS breast screening programme for Greater Manchester. With diagnostic and treatment services, consultants and dedicated breast care nurses, it is home to the Prevent Breast Cancer Charity. About 50,000 patients are screened by mammogram each year, and where further investigations are necessary, see a consultant. The centre houses many of the Prevent Breast Cancer Charity researchers looking at ways to predict and prevent breast cancer. In addition to her other roles (as clinician and researcher) Cliona advises on prioritising areas of clinical research and identifying and applying for research grants.
Cliona told members that breast cancer is the most common cancer in the UK with 150 people diagnosed each day (1.6 million world-wide), that one in 9 women and 1 in 1000 men will get breast cancer and that these figures are rising, probably due to increasing obesity.
But after telling members about different types of cancer (including ductal carcinoma in situ which is a pre-cancer which has not escaped from the milk ducts) and what individuals can do to prevent breast cancer, by being breast aware: by self- examination (looking for changes from individual normal – lumps on the breast or in the armpit, thickening, dimples, irritation, swelling, discharges and pain), regular screening (every 3 years), and, reducing life-style risks, Cliona moved onto the positives – the greatly improved treatments (both reductions in the toxicity of treatments as well as improvements in surgical techniques leading to much improved outcomes in survival rates and cosmetic satisfaction. It was emphasised that those over 70 years of age, 73 in some areas, are also eligible for screening by directly contacting the local centre. Early diagnosis, whatever age, leads to improved prognosis.
Cliona finished her presentation by talking about the 4 pillars of high-quality research funded by Prevent Breast Cancer: gene research (how differences and mutations in genes may increase the chance of breast cancer eg the BRCA1 & BRCA2 genes), early detection and screening (identifying new screening methods for early accurate diagnosis), preventative drugs (to reduce the risk of breast cancer, such as first, Tamoxifen (an anti-oestrogen) and more recently Herceptin (for those with the BRCA gene) as well as diet and lifestyle (identifying lifestyle factors that contribute to risk). And too aid all of the many research projects there is are 10,000 families in the family history library.
Cliona maintains her interest in an apparently symbiotic relationship between blood clotting and cancer. Research focuses on the observation that there is an increased risk of DVT (deep vein thrombosis, thromboembolism) in people with cancer and that those patients with DVT appear to have a worse prognosis, with more aggressive cancer than those without. In breast cancer, increased clotting has been seen in the breast tissue surrounding carcinoma in situ and it may be that clotting helps cancer escape from the ducts and progress to invasive cancer. Use of anti-clotting drugs, such as Rivaroxiban, may target clotting system cancer facilitated cancers. The PROCAS (predicting risk of cancer at screening) studies are examining breast density, which can increase risk of breast cancer up to 6 times, with a view to assigning a risk score at initial mammogram. These form a small part of the total number of studies being carried out.