BREAST CARE CENTRE

NEWS LETTERS

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No.1

The IBIS team is undergoing great change. Ruth Illingworth is leaving in the New Year to take up a National post relating to the Breast Cancer Prevention Study and working with ICRF. Her post will be replaced but we shall go through a period of reduced staff, so please bear with us. We wish Ruth well in her new career. Cathy Prosser, who worked with Ruth, has left for a change in career direction and now works for NHS Direct. In her place we welcome Sally Pearce.

We have changed our website address to be in line with hospital addresses and also to make it easier for users of the Internet. The new address is www.frenchaybreast.co.uk. the old address remains linked to the new one so both will access our website.

Frenchay Breast Care Centre Newsletter No. 5 July 2000

letter from the editor

Welcome to the 5^th edition of our Newsletter. As many of you are aware we issue the Newsletter every 6 months. It attempts to keep you up to date of any changes or future changes with in our service. However I am very interested to gain your views of what you wish to be included in the Newsletter. If you have any ideas please could you leave a note with the receptionist?

Many thanks

Jane Barker Co-ordinator

leavers and starters

Lesley Jones, Breast Care Nurse is leaving to take up a new post with the Trust in June 2000. This will be both promotion and a specialty change for Lesley. We shall miss her but wish her well for the future. We are currently in the process of appointing a new Breast Care Nurse; the person may well not be in post until the end of June. During this time Jane Barker, Breast Care Nurse will also cover Lesley’s post. Lesley’s telephone number will be transferred to Jane so support for existing women will be maintained.

Mr. Gill is rotating into a new post with the general surgery department. In his place will be Mr. Ian Finlay.

IBIS (International Breast Cancer Intervention Study)

The Southwest centre for this study is run from the breast care Centre. We are trying to find out if it will be possible to prevent breast cancer and inviting women who may have an increased risk due to a family history to take part. There are 800 women taking part in the Southwest. They are asked to take a tablet daily and visit us every 6 months.

If you or anyone else would like to know more about this research please contact Ruth or Cathy on 01179753809

charter mark award

It is almost 3 years since we were awarded the charter mark. The award is valid for 3 years, following this one reapplies. We will commence the reapplication In July/August. The application will contain all aspects of patient centered improvements we have made over the last 3years.

The charter mark is rewarded for providing high standards of care to the general public if you wish to support our application please ask the receptionist for details.

consumer audit

As mentioned in our previous newsletter we have now completed our survey. The results were quite positive. There are areas in which we can improve the service, which are noted as a result of the survey. We have met as a team to discuss the questionnaire, and these results and action plans are available in the blue information folder in the waiting area. If you wish for a personal copy of the results please ask at the reception.

ultra sound/ mammotome

B.U.S.T – our main charity, once again through public donations are enabling us to purchase 2 ultra sound machines and a hand held mammotome biopsy system. The ultra sound will replace our 2 rather out dated versions. The new machines are more high powered which enable a more detailed view of the breast.

The mammotome which removes small benign lesions or tissue for diagnostic purposes under local anaesthetic and with minimal scarring has been updated, the new system is smaller and less frightening and has been designed for better manipulation and handling by the consultant. Our Thanks are extended to everyone who has donated money through this charity.

patient resource room

As a team we believe it is important that patient/family are able to have access to as much information as they feel they need. The internet has many web sites, which contain details of both benign and malignant conditions including treatments. (The information pack for women with breast cancer provides a list of internet sites). As a result of this need to be able to access information, we are in the process of converting the treatment room into a patient resource room. With in this room will be internet access, leaflets, and a small library of books which will relate to benign and malignant conditions of the breast. There will also be relaxation tapes and books relating to coping emotionally with the impact of a cancer diagnosis.

For women who wish for teaching on self-examination there will be silicone forms and instructions for practice. We will also be developing an information base for the computer, which will be a self-service system user. To ensure we have the optimum information for you we have, through questionnaires as previous visitors to the Breast Care Centre their views on what would be best to include within the room. This room will be open during weekdays only – 9-5pm Monday to Thursday, 9-4pm on Fridays. The room will no be manned, as we do not have the staff or volunteers (yet) to be present. We shall be asking people to sign in out of the room through the receptionist, as security of the room is essential.

It is important to say at this point a n overwhelming thank you to all people especially the friends and family of Christine Kehoe & Lyn Jones, who have donated the Breast Care Centre fund, as your money has totally equipped and decorated the room. Without you all this would not have been possible.

BUST

The Breast Ultrasound Scanner Trust continues to raise funds for equipment for the Breast Care Centre.

Since its inception in 1991, over £330,000 has been raised through BUST to to provide equipment for the Breast Care Centre.

B.U.S.T is raising money for new, more sensitive scanners to detect small cancers which are not seem on mammograms.

BUST ran a barn dance in March which was a great success. It raised £348. Judy Nutting from Thornbury Library, together with hr husband, ran the London Marathon for BUST this year. The ladies of Chipping Sodbury Golf Club raised £1,000 for BUST. Malcolm Brown, the deputy headmaster of St. George Community College and Frank Thompson, a property renovator have been climbing three mountains in Switzerland, finishing with the North face of the Matterhorn, for BUST this Easter. Two young men Stephen Powell and Gary Smith raised £503 for BUST and we thank them most sincerely, we are most grateful to them.

However we still need you help! Please consider giving a donation to BUST or organising a fund raising event. We would still like more friend of BUST who will receive a twice yearly newsletter and will be kept updated of all our activities. If you are interested in joining please contact: Connie Hembrough, 62 Firework Close, Kingswood, Bristol BS15 4LO. tel: 9672580. Forms for joining are at reception.

Current Clinical Trials

As Part of a National or International Study

ATAC Trial

This trial compares Tamoxifen with Arimidex taken for 5 years after an operation for breast cancer. The trial is closed now to new patients, but we continue the work of collecting information from the 86 women from Frenchay who are on the trial each time we see them.

ATTOM Trial

This trial is for women who have had 5 years of Tamoxifen after their operation. They then either take Tamoxifen or not for the next 5 years to answer the question of whether there is any benefit of taking it beyond 5 years. About 20 women have already joined this trial from Frenchay.

EXEMESTANE Trial

This is a trial for women who have been on Tamoxifen for 2 to 3 years and then either changing them to a newer drug called Exemestane or continuing with Tamoxifen for the next 3 to 2 years. We have just joined this trial and will be asking women who would be eligible about it in the next month.

MARIBS Trial

This is a trial for women at high risk of breast cancer through their family history i.e. 4 or more close relatives with breast cancer. They will have MRI scans as well as mammograms in the hope that this might detect cancer earlier. There are 15 women in the study from Frenchay so far and we hope to start doing scans this summer.

IBIS Trial

There are 800 women in this trial being looked after by the Frenchay Centre. ?(See separate article)

Our Own Studies

We are doing a randomized study to see if a type of temporary stitch in the skin of the armpit during breast surgery stops the build up of fluid there.

A study continues into using the mammotome. This is a machine, of which there are very few in the country, which uses a needle to biopsy and mostly remove small lumps in the breast. This is done under local anaesthetic in the clinic and doesn’t leave a scar.

Several studies are continuing into how measuring different types of chemicals and receptors in breast cancer cells can predict how the cancer will respond to different types of treatment.

Another study aims to see if the use of a tablet will get rid of swelling of the breast in men, which sometimes occurs, so that they don’t need an operation.

Other studies are being done to discover the best way of speedily responding to letters of referral from General Practitioners.

Welcome to the 4th edition of the Breast Care Centre Newsletter

EXTENSION OF THE CENTRE

There are now more doctors working in the clinics. This has resulted in an insufficient number of consulting rooms so we have been fortunate in being able to extend the Breast Care Centre.

By re-locating the secretarial and research staff to behind the reception desk this has given us 2 extra consulting rooms. These have been furnished by your charitable donation of which, we are extremely grateful.

Previous consumer audits and regular comments in the suggestion box showed our waiting room busy, cramped and stuffy during large clinics. Therefore the reception has moved into the corridor, the waiting area now has extra seating and feels more light and open during busy clinics. Unfortunately this will not completely enable free seats for everyone due to the family and friend that attend for support with each patient so this varies from clinic to clinic.

The new offices are larger which was a great need due to the increasing administration team and the increase in the amount of research projects we are involved with.

CONSUMER AUDIT

Once a year we ask people who attend our centre to complete a questionnaire. The aim of the questionnaire is to find out in greater depth your expectations and experiences when attending the Breast Care Centre. From these results we then attempt to improve our service

Therefore please. if you are asked to complete a questionnaire please do so!

Previous changes have included improving waiting times for mammograms in the one stop clinic, changes in the waiting room, changes in the consultation.

We intend to have the questionnaires at the reception desk sometime in September.

THE NEWSLETTER We believe it is very important the Newsletter is of interest to you. If you have any suggestions of the contents of the newsletter —please place them into the suggestion box.

SUGGESTION BOX The most common comment placed regularly within the suggestion box is the music played with in the Centre (see book of comments). Can we bring to your attention that we will never to achieve satisfaction for all. If soft soothing music is playing comments say it is too "depressing’; if the radio is played invariably we are told it is the wrong channel (too fast, loud, too much chatting) although it does appear that most people do want music. Therefore we can only vary the tapes and channels acknowledging that every ones tastes are different (including our own) and we will never win!!

CLINICAL TRIALS

BREAST CYSTS — Introduced into the Centre is a national study on breast cysts This seems to be very common problem among women. The study is to establish if the wearing of a bra, which does cause restriction of the breast tissue is the cause of the development of cysts Over 60 women are participating in the study, which is being sponsored by channel 4.

ATAC— (Arimidex v Tamoxifen alone or in combination). This trial is for post operative, postmenopausal women. This is to help us to answer whether abolishing oestrogen with Arimidex is better than Tamoxifen either alone or in a combination. ATOM — A trial for women who have been on Tamoxifen for 5years, to either stop or continue for a further 5years

We are also starting a study evaluating the benefit of MIRI breast imaging in women with a 50% chance of carrying a dominant family gene

WEBSITE

The Breast Care Centre website address is www.users.globalnet.co.uk~mshere/ It contains information about our clinics, our , patient information.

Numbers in excess of 700 have accessed our website.

BUST

BUST The Breast Ultrasound Scanner Trust — Continues to raise funds for equipment for the Breast Care Centre. B UST recipe books costing £2 are on sale in the Centre 4 people ran in the London Marathon for BUST Denise Maggs and Linda Robinson - £ 1773 Colin Axford

Bridget Haydon raised £627

They all have family connections with breast cancer. we are very grateful to them for their great efforts in training, running and raising the money for B UST and we thank them warmly.

Friends of BUST ran a wine and cheese evening in April to thank a few of the people who have raised money for BUST. During the evening Mr. Cawthorn gave a talk on new developments in the fields of breast cancer detection and treatment and explained the workings of the new machines which B UST have helped to fund Although BUST have funded the machine we still have to raise money for a room to house it and its associated equipment so we need all the help we can get.

We would still like more fiends of BUST who will receive a bulletin twice a year and be kept informed of our activities and progress. If you are interested in joining please contact: Mrs. Connie Hembrough 62 Firework Close, Kingswood, Bristol. B515 4L0. Tel 0117 9672580. Forms for joining are at reception.

PLEASE support BUST in continuing to raise money to help find ways of prevention, early detection and better treatment for patients with breast cancer at Frenchay Hospital.

DAY IN THE LIFE OF-

A BREAST CARE NURSE

My days vary —4 sessions are being in the clinics. The main aim on these days is to support women and their carers when they receive a diagnosis of breast cancer. I help them to make decisions regarding their treatment, to explain what will happen and provide written information. This support continues for several months after treatment. A clinic that I run with my colleague Lesley is monitoring and therapy for lymphoedema (swollen arm that can occur following surgery).

At the start of my day I take all calls from the answerphone. I will then visit any women who are on the wards before and after surgery. I may also be asked to visit women on plastic surgery wards who have undergone reconstructive surgery. When I am not in the clinic I use the remaining time in one to one sessions either in my room or at the patients home. This gives time for women and/ or their families to talk through the impact of their diagnosis and surgery or treatment. Telephone calls obviously come throughout the day these include inquiries regarding outpatient appointments (in the letter sent for a first appointment, is my contact number if they wish to talk over what tests they have or they are worried). Women who have attended with benign conditions, GPs, district nurses, families and any one who requires any further help, information or advice.

As the senior nurse within the department I also have a varying degree of paper work to attend to which includes managing the budget, dealing with inquires and complaints, co-ordinating the smooth running of the centre and writing the Newsletter

Each day differs and there are both highs and lows with patients and colleagues. There is nothing more pleasing than seeing a familiar face from the past.

THE INTERNATIONAL BREAST CANCER INTER VENTION STUDY (IBIS)

The South West Centre for this study is run from the Breast Care Centre. We are trying to find out if it will be possible to prevent breast cancer and are recruiting women who may be at increased risk, to take part. There are nearly 750 women taking part from all over the south west and they are asked to come to see us every 6 months for 5 years. We have been asked to continue looking for more volunteers until December 2000. The Imperial Cancer Research Fund and the Cancer Research Campaign are funding this project and there are over5,500 women involved world wide so far.

If you or anyone else would like to know more about this research please contact Ruth Illingworth, 01179753809 and she will do her best to help.

Breast Care Centre

Newsletter

Volume 1, Issue 1 July 1998

WELCOME to the first edition of our Newsletter. The aim of the Newsletter is to keep patients, relatives and visitors to the Breast Care Centre up to date with our practices. We intend to publish four times a year on a seasonal basis (January, April, July and October). If you wish to be sent any editions please forward a stamped addressed envelope to the Breast Care Centre.

As this is the first edition we briefly explain the role of each person in the Centre. In future editions we intend to write in more detail "a day in the life of" which we hope will be of interest to you.

MEMBERS OF STAFF

We have two breast consultants, two plastic surgeons. two consultant oncologists. one staff grade surgeon (senior doctor), two clinical assistants, one consultant pathologist, One consultant radiologist as permanent members of the medical staff. Other doctors support the team. A breast care nurse works in each consultant’s team. A further breast care nurse from the Oncology Centre attends one clinic on a weekly basis with one of the consultant oncologists. There are four researchers working on specific projects.

The clerical staff of five are headed by an administrator. There is also an Associate General Manager for this service.

NUMBERS OF CLINICS PER WEEK

3 one stop diagnostic clinics

4 follow up clinics

I family history clinic

I Lvmphoedema clinic

3 IBIS (Tamoxifen Research Clinic)

I bra advisory fitting service

I reflexology session

Weekly breast reconstruction Clinics

REFERRALS TO The BREAST CARE CENTRE

In 1997/8 3581 patients were referred with a potential problem within the breast. 3256 of the patients were diagnosed with a benign (non cancerous) condition. Each week we receive between 75-100 referrals for both consultants. The GP surgery will either phone or fax with the appointment request In 1997 87% of the urgent referrals were seen within 5 working days The clerical staff work promptly to inform the patient of their appointment.

THE CHARTER MARK AWARD BOARD

We are extremely pleased that we have been awarded a Chartermark from the Government. This acknowledges the standard of care provided by the Centre. We obviously acknowledge that standards should be as high as possible and we constantly make changes to improve the service. If you have any suggestions or comments please place these in our suggestion box.

BRA FITTING AND ADVISORY SERVICE

This service has recently been taken over by the breast care nurses. The main contact person is Lesley Jones. If you wish for a replacement breast form (prosthesis) then please contact Lesley at the Centre. Weekly clinics take place on a Wednesday morning. If you have any tips on bra advice for women who have had a mastectomy please let us know.

SOUTH WEST CENTRE - INTERNATIONAL BREAST CANCER INTERVENTION STUDY

We are trying to find out if we can prevent cancer and are seeking healthy women volunteers who may have an increased risk to take part to see if Tamoxifen can help prevent this disease. We need 750 women by December 1999 and we will see them every 6 months for 5 years. We are funded by the Imperial Cancer Research Fund and Cancer Research Campaign and have 19 clinics around the

U. K

INTRODUCTION TO MEMBERS OF THE TEAM

Mr. Simon Cawthorn and Mr. Tony Dixon are the breast surgeons. Each has a medical team who work within the centre.

Lesley Jones and Jane Barker are the two breast care nurses based at the Breast Care Centre at Frenchay hospital. Lesley is funded by the charity Macmillan cancer Relief and therefore carries this title and works with those patients referred to Mr. Dixon. Jane works along side Mr. Cawthorn. They are concerned with the care of women who have or fear they have breast cancer. They are able to offer longterm emotional support and practical advice to people with breast cancer and their families. As breast care nurses they are a resource to women on referral to the breast care centre to provide information regarding diagnosis to help them make decisions about their treatment and in coming to terms with breast cancer.

An important part of our role is sharing our experiences and knowledge with other healthcare professionals, helping to raise the standards of breast care generally. They are also concerned with health promotion and are involved in promoting breast awareness and the early detection of Breast cancer.

Lesley and Jane also run a clinic for the monitoring and treatment of Lymphoedema (swelling of arm) and Lesley runs the bra fitting and advisory service.

Mrs. Ruth lllingworth and Mrs. Frances Holliday are the two research nurses at the Southwest Centre for the International breast Cancer Study (IBIS) based at the Breast Care Centre. They are funded by ICRE and CRC. IBIS is a research study trying to see if Tamoxifen will prevent breast cancer in some women who may be at increased risk. Women who join are asked to come to the clinic every 6 months for five years for screening and monitoring. There are three clinics per week for IBIS. We would be happy to talk to anyone who is concerned about their family history of breast cancer that may increase their risk of developing this disease. We also see women at the BRI in Bristol and RUH in Bath.

Diana 1-larcourt is the research Psychologist in the Breast Care Centre. As part of the psychology team associated with the Breast Care Centre, she researches the psychological aspects of referral, diagnosis and treatment, including the role of the breast care nurse and the impact of speeding up the diagnostic process in the one stop clinic. Diana also runs focus groups in which women discuss their experiences of the Breast Care Centre and the care they received. She is currently examining how women make decision about their treatment, in particularly mastectomy and reconstructive surgery.

The Associate General Manager is Mrs. Lesley Fudge. She provides Managerial advice and support for all members of the multidisciplinary team. Her main responsibilities include contract and finance management, marketing of the service to both purchasers and prospective purchasers ensuring GPs from a wide catchment area are kept abreast of service developments for their patients. and working with the multidisciplinary team to continually critique and improve service delivery. The clerical and administrative staff are here to help both GPs surgeries and patients with any queries relating to appointments. We have a fax in the office to facilitate the making of urgent out patient appointments. We try to help GPs and patients as quickly and efficiently as possible and if we cannot help at the time of a call, we will endeavour to seek out the information required and get back to the caller with it as soon as possible.

We also have two volunteers:

One of whom, Irwin. assists with the smooth running of the one stop clinic, he escorts women to the x-ray department and delivers samples to the pathology department.

Linda is the volunteer reflexologist. She offers three free sessions to the patients who have undergone surgery to assist them with relaxation.

Both our volunteers offer an invaluable service and their work is appreciated by staff and patients alike.

We are also about to appoint a 3^rd volunteer

Involving patient within the Centre

As a team are we extremely interested in gaining views of the people who use our service. We believe that changes. as far as possible, should be based on what patients themselves say. Therefore on a regular basis we intend to distribute questionnaires and also ask women and partners to attend group discussions. From this we hope to make improvements within the Breast Care Centre.

The results of the previous questionnaires are available in the patient information rack within the waiting area. Please put any comments/suggestions about this newsletter in the suggestion box

Breast Care Centre

Newsletter

Volume 1 Issue 2

Welcome to the 2nd edition of The Breast Care centre Newsletter. Our first edition proved to be of some success. Approximately 400 copies were taken by visitors to the Breast Care Centre (patients, relatives, friends and colleagues). If you have any preference of what the Newsletter should contain please place your comments in the suggestion box in the waiting room, or write to Jane Barker at the Breast Care centre. Please remember that the Newsletter is produced quarterly so the next edition is due in January1999. We will then review the success of the Newsletter and either continue quarterly, or on a 6 monthly basis.

Psychology Research in the Breast Care Centre

Over the past 5 years we have been carrying out a series of research projects, investigating the psychological and emotional aspects of attendance, diagnosis and treatment at the Breast Care Centre. This research is carried out in collaboration with the Psychology Department at the University of the West of England and has been funded by the NHS Research and Development 5chemes.

The first project involved developing a way in which the Breast Care Nurses provide support at the time of diagnosis, by ensuring that patients’ concerns are addressed during the consultation. We found that the approach we devised was welcomed by both patients and medical staff, and it is now part of the standard care provided in the Centre.

Our largest project so far was a 3-year study of the ‘one-stop’ clinic - examining the psychological effects of speeding up the diagnostic process and providing results in a single clinic visit. This project highlighted the extent to which attending the clinic and awaiting results is often a very stressful experience for all concerned. It was evident that people referred to the clinic want to know the outcome of their tests with as little delay as possible. Ours was the first large-scale study to consider these clinics from the patients’ point of view and there has been considerable interest in our findings.

We also looked at the impact, both upon patients and their carers, of leaving hospital sooner than was previously possible following breast surgery. A series of focus groups which we conducted earlier this year gave us useful feedback on the service provided through the Breast Care Centre and re-enforced some of our earlier findings.

Our current project is investigating women’s experiences of mastectomy and how they decide whether or not to have reconstructive surgery. This research is taking place with the support of the plastic surgeons, Mr Reid and Mr Kenealy, and also at the Royal Hampshire County Hospital in Winchester. The aim of this study is to identify ways in which appropriate support can be given to women facing this choice, to help each woman make the decision that is best for her.

The results of the research - both past, present and future - increases our awareness of the emotional and psychological aspects of breast problems and enables us to monitor the provision of care from a patients’ perspective.

We would like to thank everybody who has helped us with any of this research, by filling in questionnaires or agreeing to be interviewed. We are very grateful and appreciate the contributions you have made.

Diana Harcourt

Research Pschologist /

FUNDRAISING

You may well have noticed through posters, folders and leaflets within the Centre, that we have a team of fundraisers. We regularly receive donations and we are touched by peoples’ generosity. We acknowledge any amount to be of great value. Some ideas for fundraising can be quite exciting from abseiling to musical events.

BUST

The Frenchay Bust Ultrasound Scanner Trust was set up in 199 1 by a group of patients who had been treated for breast cancer at Frenchay Hospital. The purpose was to raise money to buy a portable ultrasound scanner for use in the breast clinics. This was achieved and the charity just grew and grew.

BUST has now funded six ultrasound scanners in the clinic, the latest two of which are higher definition scanners particularly useful in screening younger women. BUST also provided a breast coil for the MRU scanner to give regular check ups to women who have undergone breast surgery and radiotherapy.

BUST went on to raise money for x-ray viewing equipment for Dr Slack the consultant Radiologist, and her colleagues to enable the careful scrutiny of the thousands of mammograms performed at Frenchay each year. BUST are currently raising funds for an x-ray guided biopsy system which uses low dose digital x-rays and can take multiple biopsies and can even remove small lumps under local anaesthetic.

PLEASE support BUST in continuing to raise money to help to find ways of prevention early detection and better treatment for patients with breast cancer at Frenchay Hospital.

Breast Care Centre

Newsletter

Volume 1, Issue 3 February 1999

Welcome to the 3rd edition of The Breast Care Centre Newsletter. Once again this has proved to be successful by the number of copies taken from the reception desk. We will be continuing the Newsletter every 6 months and continually reviewing its success. Good news Mr. Sahu is returning to work in March

DAY IN THE LIFE OF.. .A RECEPTIONIST

There are 4 receptionists in the team that man the reception desk of the Breast Care Centre. The receptionist desk is in operation 5 days a week and is manned by the receptionist staff on a rotational basis.

We are there to greet people on arrival, checking there details are correct, and seating them. ready for consultation with a doctor.

On departure we ask patients to visit the reception desk where a further appointment can be made if required. As well as manning the desk we make new appointments for people referred by their GP, sending the appointment with a map and a brief questionnaire for medical data purposes. Although we do not have clinic every day of the week there is always someone on reception to take calls, change appointments or to help with general inquires.

WEB SITE

The Breast Care Centre now has its own web site for those of you who are connected to the internet.

www.users.globalnet.co.uk/~mshere/

It contains information about how our clinics work and what you might expect, also the staff, patient leaflets, contact numbers, protocols for treating breast cancer etc. It is intended for people attending the clinics, and doctors referring patient to the clinic. There are also links to other sites giving information about breast cancer, but please remember what you see on the internet are only opinions and not necessarily the best treatment or what we would recommend.

FAMILY HISTORY CLINIC

We run a weekly Family History Clinic to closely women who are at high risk of developing breast cancer because several of their close relatives have developed the disease. To put it into context, only about 5% of all breast cancers are though to be due to an inherited breast cancer gene, the other 95% are sporadic — we do not know their cause.

We therefore assess the individual risk by a postal questionnaire, which is sent after GP referral, before offering screening. screening low risk women is not with out risks, the extra dose radiation and the risk of unnecessary operations for benign conditions. The criteria that we use, which are national guidelines, are as follows:Under 50 and:

(A first degree relative is a, Sister or Daughter, a second degree is an Aunt or Grandmother)

We generally start screening at the age of 35 or 5 years before the age of the youngest effected relative. The screening involves annual clinical examination and ultrasound with 18 monthly mammograms. Our screening stops at age 50 because there is a NHS screening programme for all women from this age.

We have recently purchased a computer programme, which works out the risk that a women is carrying an abnormal gene from the family history, which is very useful especially for very complicated family histories. This was partly paid for by a specific donation from one of our patients.

B.U.S.T

B.U.S.T. (The Breast Ultrasound scanner Trust) continues to raise funds for equipment for the Breast Care Centre here at Frenchay Hospital.

B.U.S.T recipe books costing £2 are on sale in the Centre. These contain 100 recipes donated by both staff and patients and are of very good value.

Denise Maggs, who is in the IBIS study (The International Breast Cancer Study) here is going to run the London Marathon for BUST on the 1 April. This is a magnificent effort and we would be very grateful if you would please support her (sponsorship forms are on the BUST notice board in the corridor).

We have now started friends of BUST which is for people who are interested in our activities and progress. If you are interested in joining the Friends of BUST, please contact:

Connie Hembrough, 62 Firework Close, Kingswood, Bristol. BS15 4LU. tel. 0117 9672580. The joining forms are on our notice board.

We have raised a lot of money so far and provided much needed equipment for the Centre, including 6 ultrasound scanners. Our next project is to fund the purchase of an x-ray guided biopsy system, which will use low dose digital x-rays and can take multiple biopsies and can even remove small lumps under local anaesthetic.

PLEASE support BUST in continuing to raise money to help find ways of prevention early detection and better treatment for patients with breast cancer at Frenchay Hospital

USEFUL TELEPHONE NUMBERS

Sue Moulder — head of Administration —011797012 12 Ext. 3491

Reception —01179753752 Fax —01179753767

Jane Barker—0117 918 6501

LesleyJones—0117 918 6502

edited by Jane Barker & Wendy Scadding

MR A R DIXON

We are sorry to have to announce that our Consultant

Surgeon, Mr. Dixon, will be leaving the Breast Care

Centre at the end of February to specialise in cob-rectal

surgery. We wish him every success for the future.

All patients under Mr. Dixon care will _be transferred to Mr. Cawthorn’s team for further follow up.

SOUTH WEST CENTRE - INTERNATIONAL BREAST CANCER INTERVENSION STUDY

We are trying to find out if we can prevent cancer and are seeking healthy women volunteers who may beat an increased risk to take part to see if Tamoxifen can help prevent this disease. We need 750 women by December 1999 and we will see them every 6 months for 5 years. We are funded by the Imperial Cancer Research Fund and Cancer Research Campaign and have 19 clinics around the U.K

CLINICAL TRIALS IN THE BREAST CARE CENTRE

IBIS (Tamoxifen prevention trial) — continue recruitment for a further year. The trial is for high risk women with a family history and is a randomisation of Tamoxifen v Placebo for 5 years.

ATAC — (Arimidex v Tamoxifen alone or in combination). This trial is for post operative, postmenopausal women. This is to help us to answer whether abolishing oestrogen with Arimidex is better than Tamoxifen either alone or in a combination.

ATOM — A trial for women who have been on Tamoxifen for 5 years to either stop or continue for a further 5 years

We are also starting a study evaluating the benefit of MM breast imaging in women with a 50% chance of carrying a dominant family gene

Shortly starting is a trial of a new oestrogen receptor Faslodex compared with Tamoxifen. This new drug may be better than Tamoxifen in certain groups of patients.