Gene Test, Preventive Surgery Save Women's Lives
Preventive Surgery Cuts Death Risk for Women With BRCA Cancer Genes
There's no surefire way to screen women for ovarian cancer. That means that by the time the cancer is found, it's often too late for a cure, says Virginia Kaklamani, MD, DSc, director of translational breast cancer research at the Lurie Comprehensive Cancer Center at Northwestern University.
"Any woman who is positive for BRCA1 or BRCA2 should consider RRSO," Kaklamani says. "Usually it's done at age 40 or when a woman is finished having children, as the risk of ovarian cancer increases at age 40 but not before that. But since there is no good screening for ovarian cancer, the only way to prevent it is to have the surgery."
What It's Like to Get a Positive BRCA Test Result
The BRCA mutations can be carried by either men or women. This means that a woman could be carrying the gene if a female relative on either her mother's or father's side of the family had breast cancer at an early age.
While the test itself is simple, explaining a positive result is complicated. Not every doctor is up to the task.
"It is really important to go to someone who knows what they are talking about," Rebbeck says. "These tests can be ordered by any clinician, but some do not have full knowledge of how these tests may work or what a woman's options may be. You really need to talk to someone who knows this business."
Grossman's experience is a case in point.
"The genetic counselor I went to gave me good information, but I think I was her first patient to test BRCA positive," Grossman says. "She didn't even have tissues with her. She didn't know what to do when I cried. And cussed."
What's it like to find out you're carrying the BRCA mutation?
"I was offended. I thought, 'How could I lose my mother to cancer, how could I have these other medical challenges in my life, and then turn out to be BRCA positive as well?'"
Fortunately, Grossman's cousin -- a breast cancer survivor -- gave her the support she needed. Soon she was ready for the next step: considering preventive surgery.
As she'd already had all the children she wanted, it was not hard for Grossman to accept her doctors' adamant advice to have her ovaries and fallopian tubes removed. Deciding whether to keep her breasts was another matter.
Kaklamani notes that a woman in Grossman's situation has options. There are medications that reduce a woman's risk of breast cancer. And frequent screening -- alternating mammograms and MRI tests every six months -- is likely to catch cancers while they still can be cured.
But Kaklamani also notes that women with the BRCA gene are at high risk of aggressive, fast-growing breast cancer.
"If it were me, as I am an oncologist and have seen what advanced breast cancer looks like, I would elect for the procedure," she says. "But it is hard to tell women to undergo bilateral mastectomy when there are screening modalities that can find breast cancer when it can be cured. Most women will opt not to."
Grossman says that none of the doctors and very few of the family members she's consulted have urged her to keep her breasts. She intends to have the mastectomy.
"The real honest answer is that I don't like my breasts enough to be constantly monitoring for cancer," she says. "I have two small children. I lead a very busy life. I do not want to have chemo. And I do not value my breasts above all those other things."