Cancer Conversations with CMCA

In this episode, special guest Mrs Gina Barnett, who has experienced breast cancer (and is Managing Director of SWAGGA PCN in Liverpool) joins Dr Hong Tseung  (GP Clinical Lead at the Cheshire & Merseyside Cancer Alliance) and Miss Sonia Bathla (Consultant Oncoplastic Breast Surgeon at the Burney Breast Unit, Mersey and West Lancashire Teaching Hospitals NHS Trust) to discuss the after-effects of breast cancer treatment and life beyond cancer. Gina shares her breast cancer journey and reflects on how it has shaped her life. The episode explores the “void” that can follow treatment, and the anxiety it may create, as well as the psychosocial challenges, surgical and menopausal side effects, and recurrence concerns that can affect patients. It also discusses symptom management and support available in primary and secondary care, including Cancer Care Reviews and Holistic Needs Assessments. Practical resources are included to support clinical practice and deepen listeners’ understanding. Here are the links to the resources mentioned in the episode:1. Cheshire & Merseyside Cancer Alliance: Holistic Needs Assessment (5 minute video) Holistic Needs Assessment (HNA) :: Cheshire & Merseyside Cancer Alliance 2. Cheshire & Merseyside Cancer Alliance: PrOCEDE: Personalised Care Resources What is personalised care? :: Cheshire & Merseyside Cancer Alliance 3. Cheshire & Merseyside Cancer Alliance: End of Treatment Summary E-Learning (free) and Guidance Document End of Treatment Summary e-Learning :: Cheshire & Merseyside Cancer Academy 4. Macmillan Cancer Support: Cancer Care Review Guidance https://www.macmillan.org.uk/healthcare-professionals/cancer-pathways/prevention-and-diagnosis/cancer-care-review   5. “The reason I stopped being a breast surgeon” – Liz O’Riordan (a patient’s experience of life after breast cancer, 23 min video) https://www.youtube.com/watch?v=EpJKX6tmCTo&t=5s   6. Breast Cancer Now: Moving Forward: for people living with and beyond breast cancer  (downloadable booklet for patients) https://breastcancernow.org/download-and-order-publications/moving-forward-for-people-living-with-and-beyond-breast-cancer-bcc197 We are always trying to improve the educational resources we offer, and your feedback is vital in helping us shape our future planning. We would appreciate if you could spare a few minutes to complete this anonymous survey.The Primary Care Cancer Team, Cheshire and Merseyside Cancer AllianceCancer Conversations with CMCA: Feedback Survey – Fill in form

In this episode, Dr Hong Tseung (GP Clinical Lead at the Cheshire & Merseyside Cancer Alliance) and Professor Carlo Palmieri (Professor of Translational Oncology at the University of Liverpool and Consultant Medical Oncologist with a specialist interest in breast cancer at The Clatterbridge Cancer Centre) discuss breast cancer recurrence. They explore the risks, assessment, management and referral of metastatic breast disease across primary and secondary care, as well as the support available for affected patients. Practical resources are included to support clinical practice and deepen listeners’ understanding.Here are the links to the resources mentioned in the episode:1. ABCD (After Breast Cancer Diagnosis) Infographic: Red Flag Symptoms of Secondary Breast Cancerhttps://www.abcdiagnosis.co.uk/resources/infographics/   2. Cheshire & Merseyside Cancer Alliance: Safety Netting https://cmcanceralliance.nhs.uk/resources/introduction/primary-care-resources/referral-quality/safety-netting 3. Breast Cancer Now: Secondary Breast Cancer (useful patient information website) https://breastcancernow.org/about-breast-cancer/secondary-breast-cancer  4. Predict breast cancer online tool https://breast.predict.cam/   5. Pocket Medic: Secondary Breast Cancer (short videos) https://pocketmedic.org/secondary-breast-cancer/   6. Breast Cancer Now: Moving Forward: for people living with and beyond breast cancer  (downloadable booklet for patients) https://breastcancernow.org/download-and-order-publications/moving-forward-for-people-living-with-and-beyond-breast-cancer-bcc197   7. Macmillan Cancer Support: Cancer Care Review Guidance https://www.macmillan.org.uk/healthcare-professionals/cancer-pathways/prevention-and-diagnosis/cancer-care-review   8. Macmillan Cancer Support Line (for patients)0808 808 00 00 We are always trying to improve the educational resources we offer, and your feedback is vital in helping us shape our future planning. We would appreciate if you could spare a few minutes to complete this anonymous survey.The Primary Care Cancer Team, Cheshire and Merseyside Cancer AllianceCancer Conversations with CMCA: Feedback Survey – Fill in form

In this episode, Dr Jennifer McBride (GP with a specialist interest in Sexual Medicine and Reproductive Health and Sefton GP Clinical Lead for Gynaecology at the Cheshire & Merseyside Cancer Alliance) joins Miss Sonia Bathla (Consultant Oncoplastic Breast Surgeon at the Burney Breast Unit, Mersey and West Lancashire Teaching Hospitals NHS Trust) to discuss how patients with menopausal symptoms commonly present in primary care, which symptoms matter most to them, and what clinical assessment is required. They clarify the relationship between HRT and breast cancer risk, including management options and when referral is appropriate. They also explore the challenges of managing treatment-related menopausal symptoms in women with breast cancer, including patient concerns, available treatment options, and contraceptive choices, including hormonal methods. Practical resources are included to support clinical practice and deepen listeners’ understanding. Here are the links to the resources mentioned in the episode:1. British Menopause Society. Fast Facts: HRT and Breast Cancer Risk (Sep 2025) https://thebms.org.uk/wp-content/uploads/2025/09/12-NEW-BMS-ToolsforClinicians-Fast-Facts-HRT-and-Beast-Cancer-Risk-SEPT2025-B.pdf   2. British Menopause Society Short videos on : HRT & Risk Of Breast Cancer, HRT & breast cancer: overall risks and benefits,  Post Cancer Treatments https://thebms.org.uk/publications/bms-tv/  3. Update on Menopause Hormone Therapy: Current Indications and Unanswered Questions. Mukherjee A, Davis SR. Clinical Endocrinology 2025.  https://onlinelibrary.wiley.com/doi/10.1111/cen.15211?msockid=09b63fd088756a85080429af893b6bd7   4. British Menopause Society. Consensus statement: The benefits and risks of HRT before and after a breast cancer diagnosis. Updated September 2025.  https://thebms.org.uk/publications/consensus-statements/risks-and-benefits-of-hrt-before-and-after-a-breast-cancer-diagnosis/ 5. NICE CG164, Familial Breast Cancer: classification, care and managing breast cancer and related risks in people with a family history of breast cancer: Section 1.7.10 Hormone Replacement Therapy) https://www.nice.org.uk/guidance/cg164/chapter/Recommendations   6. British Menopause Society. Consensus statement: Management of oestrogen deficiency symptoms and arthralgia in women treated for early breast cancer. Updated September 2025.  https://thebms.org.uk/wp-content/uploads/2025/09/03-BMS-ConsensusStatement-Management-of-symptoms-after-breast-cancer-SEPT2025-C.pdf   7. NICE NG23: Discussion aid - HRT and likelihood of some medical conditions (includes breast cancer) https://www.nice.org.uk/guidance/ng23/resources/incidence-of-medical-conditions-with-and-without-hrt-a-discussion-aid-pdf-13553199901   8. NICE NG101 – Early and locally advanced breast cancer: diagnosis and management, Section 1.14.20 – 25 Menopausal Symptoms. https://www.nice.org.uk/guidance/ng101/chapter/Recommendations#management-of-treatment-side-effects-and-menopausal-symptoms   9. British Menopause Society. BMS Tool for Clinicians: Prescribable alternatives to HRT: updated March 2026 https://thebms.org.uk/wp-content/uploads/2026/03/02-NEW-BMS-Prescribable-alternatives-to-HRT-MARCH2026-A.pdf  10. NICE: Clinical Knowledge Series: Menopause: Prescribing Information: Fezolinetant (May 2026) https://cks.nice.org.uk/topics/menopause/prescribing-information/fezolinetant/   11. Contraception and Breast Cancer, FSRH Guidance: The College of Sexual & Reproductive Healthcare, 2023 https://www.cosrh.org/Public/Public/Standards-and-Guidance/Contraception-and-Breast-Cancer.aspxWe are always trying to improve the educational resources we offer, and your feedback is vital in helping us shape our future planning. We would appreciate if you could spare a few minutes to complete this anonymous survey.The Primary Care Cancer Team, Cheshire and Merseyside Cancer AllianceCancer Conversations with CMCA: Feedback Survey – Fill in form

In this episode, Dr Hong Tseung (GP Clinical Lead at the Cheshire & Merseyside Cancer Alliance) and Miss Sonia Bathla (Consultant Oncoplastic Breast Surgeon at the Burney Breast Unit, Mersey and West Lancashire Teaching Hospitals NHS Trust) discuss the assessment of breast pain and when it may indicate breast cancer. They also explore other common causes of breast pain, including breast infection, and consider when referral to breast services is appropriate. The episode also covers the assessment and management of gynaecomastia and suspected male breast cancer. Practical resources are included to support clinical practice and deepen listeners’ understanding. Here are the links to the resources mentioned in the episode:Breast Pain: 1. Cheshire & Merseyside Cancer Alliance: Information for Primary Care on Referral of Breast Symptoms https://cmcanceralliance.nhs.uk/application/files/2517/8230/0417/Female_Breast_Symptomatic_cancer_not_suspected_Referral_Form_vF2.0.pdf  2. Cheshire & Merseyside Cancer Alliance: Referral Form for Adult Female Patients Requiring Symptomatic Breast Clinic. https://cmcanceralliance.nhs.uk/application/files/7817/8230/0216/USC_Female_Breast_Referral_Form_vF2.0.pdf 3. Breast Pain – Cyclical, NICE CKS (April 2026). https://cks.nice.org.uk/topics/breast-pain-cyclical/  4. Scenario: Management “how should I manage cyclical breast pain?”, NICE CKS.  https://cks.nice.org.uk/topics/breast-pain-cyclical/management/management/  5. GatewayC: Cancer Keys: Is breast pain a symptom of breast cancer? https://www.gatewayc.org.uk/cancer-keys/is-breast-pain-a-symptom-of-breast-cancer/  6. Mastitis and breast abscess: NICE CKS, 2025 https://cks.nice.org.uk/topics/mastitis-breast-abscess/  7. Rajiv V Dave et al, British Journal of General Practice 2022: No association between breast pain and breast cancer: a prospective cohort study of 10,830 symptomatic women presenting to a breast cancer diagnostic clinic.   BJGP 2022, 72(717) e234-243, https://doi.org/10.3399/BJGP.2021.0475 Gynaecomastia: 1. Cheshire & Merseyside Cancer Alliance: Gynaecomastia https://cmcanceralliance.nhs.uk/application/files/3517/8230/0834/Gynaecomastia.pdf 2. BMJ Best Practice: Gynaecomastia April 2025 https://bestpractice.bmj.com/topics/en-gb/869  3. Association of Breast Surgeons Guidance on Investigation & Management of Gynaecomastia in Primary & Secondary Care, version 3, 2021 https://associationofbreastsurgery.org.uk/media/b2ljdqhr/abs-summary-statement-gynaecomastia-v3.pdf 4. CMCA Urgent Suspected Cancer and Symptomatic Referral form for Adult Male Patients with Suspected Breast Cancer Referral form.  https://cmcanceralliance.nhs.uk/application/files/7817/8230/0216/USC_Female_Breast_Referral_Form_vF2.0.pdf 5. Red Whale Article: Gynaecomastia (needs a login account)https://www.redwhale.co.uk/content/gynaecomastia  We are always trying to improve the educational resources we offer, and your feedback is vital in helping us shape our future planning. We would appreciate if you could spare a few minutes to complete this anonymous survey.The Primary Care Cancer Team, Cheshire and Merseyside Cancer AllianceCancer Conversations with CMCA: Feedback Survey – Fill in form

In this episode, Dr Hong Tseung (GP Clinical Lead at the Cheshire & Merseyside Cancer Alliance) and Ms Tanya Davis (Senior Genetic Counsellor and Breast Care Lead at the Liverpool Centre for Genomic Medicine) discuss family history risk assessment for breast cancer. They talk about how assessments are carried out in primary and secondary care, when genomic testing may be appropriate, and how to make appropriate referrals to the Family History Clinic or Genomics services. They also outline the differences between “Mainstream” and “Diagnostic” genetic testing. Practical resources are included to support listeners’ clinical practice and deepen their understanding. Here are the links to the resources mentioned in the episode:1. Primary Care & Genomics Resources, Cancer Academy, Cheshire & Merseyside Cancer Alliance https://cmcanceralliance.nhs.uk/resources/genomics/breast-genomics (free access but requires registration – also free) 2. Cheshire & Merseyside Cancer Alliance: Referral from Primary Care to the Family History Clinic in Secondary Care https://cmcanceralliance.nhs.uk/application/files/9717/8230/0680/Female_Breast_Family_History_Referral_vF2.0.pdf 3. NICE Clinical Guideline (CG164) on Familial Breast Cancer https://www.nice.org.uk/guidance/cg164   4. RCGP E-Learning Genomics Toolkit https://elearning.rcgp.org.uk/mod/book/view.php?id=12892 5. Royal Marsden Beginner’s Guide to BRCA1 and BRCA2 (patient friendly resource) https://patientinfolibrary.royalmarsden.nhs.uk/brca1brac2   6. Preventative and Prophylactic Surgery https://www.bmj.com/content/376/bmj.o258  7. CanRisk https://www.canrisk.org/  8. GatewayC E-Learning Course– The Role of Genomics in Primary Care https://www.gatewayc.org.uk/courses/the-role-of-genomics-in-primary-care/   9. GeNotes: a reliable place to check pathways and assessing which patients need onward referral. The section for Primary Care has a number of scenarios about cancer. https://www.genomicseducation.hee.nhs.uk/genotes/primary-care/   10. NHS National Genomic Test Directory Version 8.1, 2025:  (Part XI – Inherited Cancer: R208 Inherited Breast Cancer and Ovarian Cancer: pages 186-188 https://www.england.nhs.uk/wp-content/uploads/2018/08/rare-and-inherited-disease-eligibility-criteria-V8.1.pdf We are always trying to improve the educational resources we offer, and your feedback is vital in helping us shape our future planning. We would appreciate if you could spare a few minutes to complete this anonymous survey.The Primary Care Cancer Team, Cheshire and Merseyside Cancer AllianceCancer Conversations with CMCA: Feedback Survey – Fill in form

In this episode, Dr Hong Tseung (GP Clinical Lead at the Cheshire & Merseyside Cancer Alliance) and Miss Sonia Bathla (Consultant Oncoplastic Breast Surgeon at the Burney Breast Unit, Mersey and West Lancashire Teaching Hospitals NHS Trust) explore the NHS Breast Screening Programme, including current national screening criteria and the implications for patients outside these criteria, such as transgender people and women over 70. They also discuss breast cancer prevention, focusing on lifestyle changes that can make a meaningful difference. Practical resources are included to support listeners’ clinical practice and deepen their understanding. Here are the links to the resources mentioned in the episode:1. Local NHS Breast Screening Contact Details (UK) https://www.nhs.uk/service-search/other-health-services/breast-screening-services/   2. NHSE Guidance on Breast Screening: reducing Health Inequalities https://www.gov.uk/government/publications/breast-screening-identifying-and-reducing-inequalities/breast-screening-reducing-inequalities  3. Cheshire & Merseyside Cancer Alliance (CMCA) PRACTICE Dashboard Can be accessed via the CMCA Cancer Academy (free registration) which then directs to free registration with the PRACTICE Dashboard to gain access to its data: https://cmcanceralliance.nhs.uk/resources/introduction/primary-care-resources/cheshire-merseyside-practice-dashboardCMCA PRACTICE Dashboard Access.pdf4. NHS Exercise Guidelines https://www.nhs.uk/live-well/exercise/  5. Parkrun https://www.parkrun.org.uk/  6. Exercise and Cancer – CRUK https://www.cancerresearchuk.org/about-cancer/coping/physically/exercise-guidelines We are always trying to improve the educational resources we offer, and your feedback is vital in helping us shape our future planning. We would appreciate if you could spare a few minutes to complete this anonymous survey.The Primary Care Cancer Team, Cheshire and Merseyside Cancer AllianceCancer Conversations with CMCA: Feedback Survey – Fill in form