Facing the risk of cancer, empowered.

Imagine being diagnosed with cancer quite unexpectedly. Then imagine telling your siblings, only to discover, following their being tested, that two of them were also unknowingly suffering from the disease. That’s what happened to 64 year old Gibraltarian Tizzy Hoare and her elder sisters Rosie, 67, and Jenny, 70. To add to the heartbreak, Rosie’s 40 year old daughter Louise, the vibrant and energetic mother of two young boys, was also diagnosed with cancer. Eldest sister Paddy tested BRCA positive but is cancer free, and brother Chris has not been affected by the genetic curse. It is indeed faulty genes which are at the root of their problems, and mutated genes can be passed on to both daughters and sons.

The family lost their mother when Tizzy, the youngest in the family, was just 6 years old. Her mother Mercy Hoare, succumbed to breast cancer in 1960 at the age of 48. Her aunt died of ovarian cancer. Their mother was a carrier of the BRCA hereditary gene mutation, with a 50/50 chance of it being passed on. The gene mutations greatly raise the risk of ovarian and breast cancer, with a marginally increased risk for prostate cancer. Tizzy has the much rarer fallopian tube cancer, whilst her sisters have been treated for ovarian cancer and her niece Louise for breast cancer. They have all undergone gruelling operations, chemotherapy and suffered resulting hair loss.

Over the past three years the family has laughed and cried together. They are all strong and bright women with an indefatigable sense of humour and are determined that some good should come out of their predicament. They strongly believe that genetic testing is the way forward for both men and women with a pronounced family history of cancer.

Actress Angelina Jolie has done much to create public awareness surrounding the inherited BRCA1 mutation gene. She lost her mother, grandmother and aunt to cancer and elected to have preventative surgery; a mastectomy followed by the removal of her fallopian tubes and ovaries. The likelihood of her now developing cancer has been greatly reduced, although she stressed in the diary she made public at the time that “the most important factor is knowing what your options are, in order to make a decision that is right for you”.

Tizzy totally agrees and is keen to stress that it is vital to know if you carry the gene mutation. Fallopian tube and ovarian cancer often present very generalised symptoms, so a diagnosis is frequently made when the cancer is advanced. It is thanks to Tizzy’s diagnosis that her sisters and niece were tested, and discovered that not only had they inherited the gene mutation, but that it had already caused them to develop cancer. Luckily her sisters’ and niece’s cancer was discovered early. Yet in spite of everything, she remains positive and proactive. As a keen supporter and fund raiser for Cancer Relief, Tizzy is determined to create awareness about the importance of being tested for the BRCA gene mutation. She is also very grateful and relieved that the Gibraltar Government established a Chemotherapy Suite at St Bernard’s Hospital, obviating the need to travel abroad for treatment.

So what is the position in Gibraltar? Christina Macano, Consultant Surgeon for the Gibraltar Health Authority, has introduced genetic testing for breast cancer patients here. Eligibility for testing is strictly based on GHA guidelines, which in turn is based on guidance from The Royal Marsden in London.

Eligible patients include:

  • Patients who have developed breast cancer under the age of 45.
  • Patients who have had two breast cancers under the age of 60.
  • Or patients who have a letter confirming the BRCA gene mutation in the family and who have been advised to be tested.

Christina emphasises that requesting genetic testing is a major decision which firstly requires a counselling and consent session. If eligible patients decide to proceed, then she would make arrangements for a blood test to be carried out locally, which would then be sent to the U.K. for analysis. In the event of a positive result, the Consultant Surgeon would arrange for the patient to be put in touch with a geneticist. The GHA is currently in talks with The Royal Marsden with the aim of running genetic clinics locally with a visiting Consultant Geneticist.

Christina says that although she is not a gynaecologist, she has had a few referred ovarian cancer patients whom she has counselled and had tested for the BRCA gene mutation.

In January, the GHA will be launching breast cancer family history clinics for family members of cancer patients, to determine if they need genetic testing. GPs will be able to refer to the Surgical Outpatient Department (SOPD) as from January 2019. At present, this work is being wonderfully carried out under the care of the Consultant Radiologist.

As Tizzy Hoare says, had she herself been tested before, her cancer would have been diagnosed at an earlier stage. That is why she and the family are promoting awareness of the genetic link, and the importance of being tested for it.

For more information or to donate, visit cancerrelief.gi. Susan has asked that her fee for this article be donated to Cancer Relief Gibraltar.