The Family Cancer Clinic at St Mark’s Hospital was founded in 1986 as part of the then new Imperial Cancer Research Fund Colorectal Cancer Unit.
St Mark’s had a long history of managing patients with familial polyposis coli, an inherited condition in which affected individuals develop hundreds or thousands of colonic polyps and then develop colorectal cancer. The St Mark’s Polyposis Registry had been set up in 1924.
There were many other families at St Mark’s with a strong family history of colorectal cancer that did not have Polyposis. These patients were then described as having Hereditary Non Polyposis Colorectal Cancer (HNPCC).
The aim of the new Family Cancer Clinic was to define the inherited causes of colorectal cancer in non-polyposis families and to refine the management of these families so as to prevent familial cases of colorectal cancer.
The clinic was the set up by Dr Joan Slack, a clinical geneticist from the Royal Free Hospital. A method of empiric risk assessment was derived from a previous study by Lovett of the family history of colorectal cancer in patients at St Mark’s. Those patients whose lifetime risk of colorectal cancer was assessed to be 1 in 10 or greater were offered five-yearly colonoscopy from the age of 25 and those with a lesser familial risk annual faecal occult blood testing.
A weekly family cancer clinic was established and a nurse specialist and clinical research fellow appointed. A computer database was established to record the clinical details of individual undergoing colonoscopic surveillance.
The Clinic moved, with the Hospital, from City Road, Islington to Northwick Park in 1995. Dr Huw Thomas was appointed to run the clinic in 1994 when Dr Slack retired.
The clinic has had a successful role in identifying new genetic predispositions to colorectal cancer and initiating clinical genetic testing to define which family members carry a gene predisposing to colorectal cancer.
The Bobby Moore Computer Database records the family history, results of genetic testing and prospective outcome of colonocopic surveillance in our families. This has allowed evidence-based guidelines to be developed on the age at which to start and frequency that colonoscopy should be undertaken in different genetic and familial risk groups.
Research and Developments:
Presymptomatic genetic testing in Lynch syndrome
Chemoprevention studies in Lynch syndrome (CaPP aspirin studies)
Definition of non- Lynch familial colorectal cancer
MYH-associated polyposis- definition
Hereditary Mixed Polyposis Syndrome- identification of gene
Proofreading polymerase associated polyposis- identification of genes
Prospective outcomes of colonoscopic surveillance in different familial risk groups
Contributed to national and European guidelines on the management of familial risk of colorectal cancer.
From October 2021, The Polyposis Registry and Lynch/Family Cancer Service moved to new centralised offices at the Central Middlesex Hospital Site. The combined service is now known as The St Mark’s Centre for Familial Intestinal Cancer.