BRCA genes – options for potential breast cancer prevention

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BRCA genes – options for potential breast cancer prevention

Sharon Gavioli lives in Australia and is a Registered Nurse with over 30 years experience, and an Adult Educator and Counsellor. Not only does she work with people living with cancer, Sharon’s own life has been touched by family members who have had cancer. From experience she is able to appreciate and understand many of the emotional and physical issues and practical options that people with this disease go through. Combining her love of education and ‘informed choice’, Sharon’s understanding of Cancer Care is insightful and inspiring.

With the likelihood of having breast cancer in our lifetime standing at 1 in 8 women, it’s hard to find a woman who does not know another woman who’s been affected by this disease. In my role as a nurse working in cancer care, I have come to understand and appreciate the fact that many women, especially those tested positive for the BRCA genes, live with an underlying anxiety and fear about breast cancer. They feel like they are at the mercy of the statistics/BRCA genes lottery, which highlights the need for women to feel more empowered through understanding ways to reduce their risks of developing cancer that focus on breast cancer prevention.

This fear of breast cancer further intensified in 2013 with Angelina Jolie’s choice to undergo a bilateral preventative mastectomy due to being a carrier of the BRCA 1 gene. In reaction to her choice, many articles and reports flooded the media either praising or criticizing her for ‘going public’. I read very few articles that came with an understanding of the anxiety and fear that the women who tested positive for the BRCA genes live with – or that presented a non-biased position on the many available options for reducing the risks of developing breast cancer.

Maybe presenting some simple facts and current options is what is truly needed to enable women to make a more full, or informed choice – not from fear, but from facts.

Some Simplified BRCA Genes FACTS:

  1. There are 2 BRCA genes: BReast CAncer 1 and BReast CAncer 2
  2. Both women and men carry these human genes
  3. Their role in the body is to produce proteins which repair any damage to cells
  4. When either of these genes are faulty, they are unable to deal with any changes in cells that may result in the development of breast cancer
  5. Only 5% - 10 % of all breast cancers are due to the BRCA 1 or BRCA 2 gene
  6. There is also an increased risk of developing pancreatic, fallopian, peritoneal and prostate cancer if one is a carrier of either gene
  7. Testing positive for either gene does not mean cancer will develop
  8. All women or men deemed at risk need to see a genetic counsellor for assessment
  9. Only those who have been assessed as ‘at risk’ due to having a significant family history, including a relative who has identified as carrying the BRCA genes, can be tested at no personal cost, depending on country of residence

So now we have the facts, let’s look at some options that are used to reduce the risk of breast cancer…

Current Options to reduce the risk of breast cancer:


Option 1: Intensive Breast Cancer Screening

Regular screening that may include mammograms and MRI (Magnetic Resonance Imaging) every 12 months.

Pros:

  • Increased responsibility for health
  • Increased chance of detecting breast cancer early
  • With early detection comes increased likelihood of successful treatment.

Cons:

  • Increased anxiety due to constant testing and waiting for results
  • Does not reduce the likelihood of the breast cancer developing.

Option 2: Preventive Drug Therapy

The use of drugs to reduce the risk of breast cancer development.

Pros:

  • Reduced anxiety around the development of breast cancer
  • Possible reduction or delay in the development of breast cancer

Cons:

  • Side effects of each of the chemoprevention drugs may include hot flushes, vaginal dryness, joint pain, loss of libido, emotional changes, depression and cardiovascular conditions
  • Does not totally reduce the risk of breast cancer developing as women can still develop breast cancer despite these options.

Option 3: Preventative Mastectomy

The surgical removal of the breasts in women who do not have breast cancer.

Pros:

  • Significant reduction in risk of developing breast cancer: actual percentage varies between 90- 95%
  • Reduced anxiety around breast cancer developing

Cons:

  • Does not completely eliminate risk of breast cancer or other cancers developing in high risk women
  • Increased depression and anxiety due to changes in body image
  • Loss of sensation to breasts that may impact sexuality
  • Inability to breastfeed
  • Loss of a sense of femininity

These are the three key options presented to women who have been tested positive for BRCA gene 1 or 2. In light of the research that suggests that we can reduce our cancer risk by a third through embracing healthy lifestyle choices, this would be another positive option for this group of women to consider.


Option 4: Embracing Healthy Lifestyle choices

These include:

  1. Maintaining a healthy body weight – being as lean as possible without becoming underweight
  2. Exercise – keeping fit
  3. Healthy Diet – limiting the consumption of unhealthy fats, salty and sugary foods and drinks; eating fruit, vegetables and pulses; eating less red meat and processed meat
  4. Avoiding alcohol – even 1 drink a day increases the risk of breast cancer
  5. Avoiding smoking

Pros:

  • Potentially reduce risk of developing breast cancer
  • Gives the woman a way to be proactive and empowered in her own breast cancer risk reduction

Cons:

  • People find them difficult to maintain regularly
  • Family preferences make it challenging to do things differently
  • May feel like they are missing out in life

The decision to determine what option would best support a woman who has tested positive for BCRA genes is not an easy one. There needs to be a space and the support to consider which outlined option or combination of options feel right for the individual, as no two women’s circumstances are the same. For some living with the constant anxiety and fear that they may develop breast cancer may itself affect their quality of life and physical well-being, which would influence what option would best support them.

It is important to remember that none of these options totally removes the risks of developing breast cancer. For a woman who wants to take a greater responsibility for her own health and wellbeing in the aim to reduce her risk of developing breast cancer, the option of making healthy lifestyle choices is one that can be embraced no matter what other options have been chosen.

This does not mean healthy lifestyle choices should be done out of fear but instead as a loving support for all women, including those who have been tested positive for the BRCA genes. And if anything prevents us from making these choices consistently as part of how we care for ourselves on a daily basis, we can gently reflect on any patterns or beliefs that may get in the way of us tenderly and respectfully making them part of our daily rhythm.


References:

  • [1]

    Barlow-Stewart K, (2012) (edit) Breast and Ovarian Cancer and inherited Predisposition – Cancer Genetics 2, Centre for Genetic Fact Sheet 48

  • [2]

    Cancer Australia (2013) Breast Cancer Statistics. Retrieved December 3, 2013, from http://canceraustralia.gov.au/affected-cancer/cancer-types/breast-cancer/breast-cancer-statistics

  • [3]

    Kasprzak L , Mesurolle B, & Foulkes W (2005) Invasive breast cancer following bilateral subcutaneous mastectomy in a BRCA2 mutation carrier: a case report and review of the literature, World Journal of Surgical Oncology. Retrieved on December 11, 20013 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1201178/

  • [4]

    Mayo Clinic (2013) - BRCA Gene Test for Breast Cancer. Retrieved December 3rd, 2013 from http://www.mayoclinic.com/health/brca-gene-test/MY00322

  • [5]

    National Cancer Institute (2013) – BRCA 1 And BCRA 2 – Cancer Risk and Genetic Testing. Retrieved December 3, 2013 from http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA

  • [6]

    National Cancer Institute (2012) – Hormone Therapy for Breast Cancer. Retrieved December 11, 2013 from http://www.cancer.gov/cancertopics/factsheet/Therapy/hormone-therapy-breast

  • [7]

    National Cancer Institute (2013) – Surgery to Reduce Breast Cancer Risk. Retrieved December 11, 2013 from http://www.cancer.gov/cancertopics/factsheet/Therapy/risk-reducing-surgery

  • [8]

    Preetha A, Ajaikumar B. Kunnumakara, [...], & Bharat B. Aggarwal. (2008) -Cancer is a Preventable Disease that Requires Major Lifestyle Changes. Retrieved January 7, 2014 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515569/

Filed under

LifestyleHealth conditionsCancerBreast cancerWomen's healthGenetics

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    By Sharon Gavioli, Registered Nurse, Adult Educator, Counsellor, Practitioner of Universal Medicine Therapies, EPA Accredited