A LEADING Irish oncologist has claimed funding restrictions mean fewer than one-in-three people in need of genetic testing for cancer can take advantage of the service each year.
Dr David Gallagher, of St James’s Hospital, who has trained in both medical oncology and genetics, said inadequate funding has resulted in “very stringent" criteria for testing.
Around 2,000 tests are carried out in Ireland each year but Gallagher believes this could be more than trebled.
“If you were to do all breast, ovarian, colorectal and a number of rarer cancers in the country, you would probably be talking about 6-7,000 incident cases of cancer per year in Ireland that need genetic testing,” said Gallagher. “That is a significant increase on what we are currently doing and that is what we will have to do if we want to continue delivering good quality care in Ireland.”
Genetic testing is carried out in three Dublin hospitals: Our Lady’s Children’s, St James’s and the Mater Private.
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“We have a very limited testing budget in all three centres and therefore we have to be very stringent about who we test,” he said.
“In the UK they now offer testing to unaffected women, whereas we can’t do that. How we figure out if a gene is in a family is by testing someone with cancer which, if you can, is a better way to do it. A lot of the time we don’t have someone with cancer as they are deceased.”
Earlier this year Angelina Jolie, a Hollywood actress and director, had her ovaries and fallopian tubes removed to avoid the risk of ovarian cancer. Two years earlier she had a double mastectomy. She wrote in the New York Times that she underwent surgery after blood tests showed what could have been early signs of the disease.
Jolie, who is married to Brad Pitt, carries a mutation in the BRCA1 gene that increases her risk for breast and ovarian cancer. Her mother died of ovarian cancer when she was 56.
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Currently in Ireland if a woman or a man wants to find out if they carry a gene that will predispose them to a particular cancer they have to pay for testing. Gallagher says this can cost in the region of €1,200-1,400, depending on the gene involved. While this is not covered by health insurers, Gallagher and colleagues have presented to the various insurance companies in a bid to get them to change this policy.
Gallagher continued: “That’s another battle I have been fighting. In countries private insurers cover the cost of this testing because it is prevention. I have presented to [health insurers] Laya and VHI and their medical boards accept it is a good idea. It makes sense financially as it is a lot cheaper to prevent cancer than to treat it. Medically it is the right thing to do for their clients so I think they will eventually fund it.”
Gallagher was appointed the HSE clinical lead for cancer genetics in May. He said his first task was to make a submission to the new strategy for cancer services calling for increased funding for genetic testing.
“I think this is recognised as a weak point of the Irish cancer service. It has improved a lot and this is an area that is topical right now because it is moving forward so quickly elsewhere. Our deficit in this area is going to become more and more obvious as time goes on. Hopefully cancer genetics will be a bigger part of the new cancer strategy and receive adequate funding going forward.”