We were barely three days into October, National Breast Cancer Awareness Month, when a friend sent me this private message on Facebook:
Hi. Can you put a heart on your FB wall, without comment, only a heart, and then send this message to your women contacts? This is for women to remember it’s the week of breast cancer prevention!
Without missing a beat, I drafted this response:
Sorry, I won’t do this. I am reminded about breast cancer prevention every single day – 365 days a year – each time I look in the mirror after a shower. The best things women can do to prevent breast cancer are to do regular monthly self-exams and, if they're 40+, have an annual mammogram. Those who have a family history of breast, ovarian, prostate, and/or pancreatic cancer should consider consulting with a genetic counselor to explore options for counseling and possible genetic testing. These things – not hearts on people's FB walls – will help prevent breast cancer.
The woman who sent it to me had good intentions and likely did so because she thinks of me as a breast cancer survivor. In fact, I am a “previvor,” a term that describes individuals who have a predisposition to cancer because of a genetic mutation, a strong family history, or other factors, but who remain disease free.
Only after my mom died from extremely virulent metastatic breast cancer in 2010 – without knowing she carried a genetic predisposition to the disease – did a blood test reveal that I, too, carry the same inherited mutation on the BRCA2 gene, predisposing me to cancer, too.
I am a previvor precisely because I took drastic preventive measures: In 2011, I had a prophylactic double mastectomy and microsurgical breast reconstruction using my own abdominal tissue. The surgery required 12 hours, five nights in the hospital, and a 12-week recovery. (Six months earlier, I’d had a complete hysterectomy because BRCA mutations also increase women’s lifetime risk for ovarian and other cancers.)
I share these details not for pity or sympathy, but because they help illustrate why breast cancer awareness is so critically important in the North American Jewish community.
Let’s start with some basics:
- Everyone – men and women – is born with BRCA genes. Healthy BRCA genes function as tumor suppressors, helping the body fight off rapid and unregulated cell growth.
- Women who inherit a mutated BRCA gene have a significantly increased risk of developing breast and/or ovarian cancer within their lifetime – often at an earlier age than those in the general population.
- Men born with a mutated BRCA gene are at increased risk of developing breast and prostate cancer.
- BRCA mutations also increase carriers’ risk of melanoma, Fallopian tube and primary peritoneal cancer, and pancreatic cancer.
- Mutated BRCA genes can be passed along from either parent, and in each pregnancy in which one parent is a carrier, there is a 50% chance this will occur. (Unlike some genetic diseases, such as Tay-Sachs, in which individuals must inherit two “recessive” genes – one from each parent, both of whom are carriers – to develop a disease, BRCA gene mutations are “dominant.” Inheriting just one BRCA gene mutation puts individuals at increased risk of developing cancer at some point during their lifetime.)
Here’s the important part: At a rate of one in 500-800, BRCA mutations in the general population are exceedingly rare. Within the Ashkenazi Jewish population, however, which includes most of North America’s Jews, one in every 40 people (2.5% of the population) carries a BRCA mutation – and most carriers are unaware of their BRCA status.
It’s vital, then, to know the possible signs of hereditary cancers, which can be caused by mutations in these and other genes (CDH1, CHEK2, PALB2, TP53, and more):
- A family member with: ovarian or Fallopian tube cancer at any age, breast cancer before age 50, breast cancer in both breasts at any age, both breast and ovarian cancer, triple negative breast cancer, or male breast cancer
- More than one relative on the same side of the family with any of these cancers: breast cancer, ovarian or Fallopian tube cancer, prostate cancer, or pancreatic cancer
If you suspect the possible presence of a hereditary genetic mutation in your family, consider genetic counseling and testing, which should be done in consultation with a certified genetic counselor, a specialist trained to assess personal cancer risks and help determine appropriate risk management strategies. The National Society of Genetic Counselors can help you find genetic professionals in your area.
In the meantime, although neither mammograms nor monthly self-exams can prevent breast cancer, they do promote early detection, when the chance for remission and/or cure are greatest. In fact, strictly speaking, even prophylactic mastectomy doesn't prevent breast cancer, but it does drastically reduce the possibility of the disease in those who are at greatest risk.
That said, these are the best options available to women today, so please use them – and encourage those you love to use them, too.
For more information about all facets of hereditary cancer, visit FORCE: Facing Our Risk of Cancer Empowered, a non-profit organization dedicated to improving the lives of individuals and families affected by hereditary breast, ovarian, and related cancers.