American breast cancer specialist Dr. Kevin Hughes has seen more than 50 local women. Dr. Hughes of Massachusetts General Hospital in Boston, Massachusetts heads the Bermuda Cancer Genetic Risk Assessment Programme.

The programme began last year in conjunction with Partners HealthCare of Massachusetts. It looks at women who are at increased risk of developing breast and ovarian cancer.

These cancers can be hereditary. Medical research has isolated genes BRCA1 and BRCA 2 as key in determining the likelihood of a woman getting breast or ovarian cancer. Mutations in these two genes are an indication of increased risk of developing the diseases.

Dr. Kevin Hughes has been studying hereditary cancers in Bermuda since 1998. At the launch of the Bermuda Cancer Genetic Risk assessment Programme last year, 15 women were in the programme. Dr. Hughes said since that time he's seen between 50 and 60 women ranging in age from 21 to 80 years old.

"We continue to follow those at higher risk, and also continue to see new patients. Patients who are not at high risk have been reassured and released from the programme," he said.

The programme is not a clinical study and was formed to help decrease deaths from breast and ovarian cancer. In fact, while largely considered cancers that affect women, Dr. Hughes said there are four Bermudian men in the programme with a possible increased risk of developing cancer in their breast tissue.

"This is clinical care. We are trying to find every high-risk woman on the Island, and then change her management to either not get cancer or to find it at an earlier, more treatable stage," said Dr. Hughes. "Bermuda is one of the few places where this is possible due to size, and its excellent medical care system."

"Our programme is primarily a patient education and evaluation service," Dr. Hughes said at the launch. "When we determine that a patient is at high risk, we will develop a plan of care in collaboration with her local doctor."

He said the collaboration has worked well. He has seen each patient in the programme and given his opinion relative to hereditary risk to the respective doctor. Local doctors continue to be the primary care givers of their patients. There are no fees attached to be included in the programme. Dr. Hughes said local insurance companies pay his travel expenses and Bermuda Cancer and Health Centre (formerly TB Cancer and Health) allow him to operate from their Point Finger Road location. "I do not currently charge a consultation fee, and the insurance companies have agreed to pay for genetic testing when appropriate," he said.

But few of the people in the programme have undergone genetic testing. Dr. Hughes said: "We have identified several for whom genetic testing may be worthwhile, and have done testing on four so far." The testing is done through a simple blood test. The blood is drawn in Bermuda and sent to Myriad Genetics in Utah — the only genetic testing facility in Western Hemisphere.

Preventative measures have included more frequent mammograms, the use of MRI for breast screening, and use of the prescription medications Tamoxifen or Raloxifene to reduce the risk of breast cancer. Oral contraceptives are another preventative tact.

He said there might also be cases where organs have to be removed to prevent cancer mutation. Although breast cancer strikes almost three in every ten Bermudian women, Dr. Hughes said the rates are not much higher than the rest of the world.

"The rate of breast cancer appears consistent with most countries," he said. "Because Bermuda does such a great job of screening, more cancers are found earlier, so it appears to be more common here."