It’s in Your Genes

New break­through in ge­net­ics now helps fam­i­lies with a his­tory of can­cer pre­dict and pre­vent the world’s most dreaded dis­ease

India Today - - SPORT - By Da­mayanti Datta

Dr Nir­mala Vaze’s fam­ily tree is not just a patch­work of long­for­got­ten names and dates. There’s a se­cret that flows through its branches: Can­cer. It shows up like clock­work with ev­ery new gen­er­a­tion. Breast, ovar­ian, uter­ine, blood, throat, prostate— you name it and it’s here. It has rav­aged 15 lives in the last three gen­er­a­tions, the 67- year- old Nag­pur gy­nae­col­o­gist be­ing one of three in her gen­er­a­tion of 10 to have de­fied death, if not can­cer. It has also spilled on to gen­er­a­tion next, with the age of onset fall­ing from 40s to 20s: Vaze’s ar­chi­tect daugh­ter, Sam­pada Peshwe, 39, was di­ag­nosed with breast can­cer at just 26. If this is a fam­ily saga of heart­break, it’s also one of hope. The war on can­cer has turned a new cor­ner. And rad­i­cal new ge­netic man­age­ment of the dis­ease, even be­fore can­cer strikes, is catch­ing on. The Tata Me­mo­rial Cen­tre ( TMC) in Mum­bai, where Peshwe was a pa­tient, has put 35 mem­bers of Vaze’s fam­ily through ge­netic tests: To pre­dict their can­cer risk and pre­vent it on time.

Vaze and her rel­a­tives were not sur­prised when Hol­ly­wood star An­gelina Jolie vaulted into global head­lines in May with her dou­ble mas­tec­tomy. Jolie may have stunned the world, but it’s a story qui­etly be­ing re­peated all over the coun­try, and the world. Hered­i­tary can­cers are in the news. Breath­tak­ing changes in ge­netic re­search have given doc­tors new tools and tests to sort out the ab­nor­mal genes that lead to can­cer. Go­ing by statis­tics, just 10 per cent of all can­cers are in­her­ited. But by ab­so­lute

num­bers, it’s no less than 50,000 lives each year in In­dia, says Dr Ra­jiv Sarin, who set up one of In­dia’s first can­cer ge­net­ics units at TMC with sup­port from the In­dian Coun­cil of Med­i­cal Re­search. As the ge­og­ra­phy of in­ves­ti­ga­tion shifts from or­gans, tis­sues and cells to the DNA, it be­comes in­creas­ingly pos­si­ble for fam­i­lies with a his­tory of can­cer to buy their way out of des­tiny.

“In fact, An­gelina Jolie has put us in a fix,” says Dr Harit Chaturvedi, di­rec­tor of sur­gi­cal on­col­ogy at Max Health­care in Delhi. “We are now flooded with pa­tients ask­ing for the same type of treat­ments she went through.” Preven­tive surg­eries, where the sur­geon re­moves tis­sue that does not yet con­tain can­cer cells but may be­come can­cer­ous, have been steadily ris­ing in In­dia in the last three years. Dr Chaturvedi has been do­ing at least one such surgery ev­ery two months. But his cham­ber is fill­ing up with anx­ious men and women keen to fol­low in Jolie’s foot­steps. “Surgery is not the only preven­tive op­tion,” he says. Can­cer ge­net­ics has opened up a whole new world: Ge­netic coun­selling, test­ing, screen­ing, chemo­pre­ven­tion, surgery and, of course, ag­gres­sive life­style mod­i­fi­ca­tions. “What started with breast can­cer has spread to ovar­ian, thy­roid, uter­ine, colon and some rare gas­tric and kid­ney can­cers. We can help more pa­tients now,” he says.

Ruchi V., 25, of Chen­nai is one such pa­tient. Her mother has just been di­ag­nosed with can­cer, the dreaded word that unites her blood fam­ily. The dis­ease has snuffed out five pre­cious lives in the last three gen­er­a­tions. Ruchi had al­ways con­sid­ered the deaths and the dis­eases un­re­lated. It is only now that she has started giv­ing more than a fleet­ing thought to the idea that so many can­cers in one fam­ily might not be nor­mal. At a dif­fer­ent time, she would have waited silently, in fear and faith, for the dis­ease to strike. To­day, thanks to the new treat­ment op­tions, she can walk up to an on­col­o­gist and ask: “Can you tell me what I can do to save my­self from can­cer?”

TRACK­ING THE DEADLY GENE

It’s a typ­i­cal ques­tion Dr Amit Verma, who runs the Fa­mil­ial Can­cer Clinic at Max Health­care, tries to an­swer. On any given day, his clinic fills up with men and women ask­ing anx­ious ques­tions: “My mother had can­cer. Will I get it, too?”, “Will I pass it on to my chil­dren?” Like a su­per sleuth, the can­cer ge­neti­cist asks plenty of ques­tions, fills his note­books with sketches of fam­ily trees— cir­cles for fe­male, squares for male— sifts for clues in gene pools, sim­u­lates ge­netic mod­els on his com­puter, does the al­go­rithm to fig­ure out

per­cent­age risk of can­cer in one’s genes and sug­gests the best bat­tle plans to ward off can­cer. And of­ten his di­ag­no­sis is the dis­cov­ery of a life­time, the life­time of his pa­tients, for bet­ter or for worse. “Can­cer is a dis­ease of old age, but most fam­ily can­cers strike at an un­usu­ally young age, even in teens and of­ten be­fore age 40,” he says. “And all those who carry mu­tated genes have a 60- 100 per cent life­time risk of can­cer.”

At the root of it is God’s own jig­saw puz­zle: The hu­man genome, or the en­tire set of in­her­i­ta­ble traits in our cells that make us who we are. With sci­en­tists map­ping more genes in the hu­man body, can­cer ge­net­ics is now one of the fastest ex­pand­ing med­i­cal spe­cial­i­ties. And it is al­ter­ing clin­i­cal prac­tice, with on­col­o­gists and ge­neti­cists tar­get­ing genes that are ‘ faulty’ ( see box). Hered­i­tary can­cers arise from al­tered genes pass­ing down gen­er­a­tions. “The prob­a­bil­ity of an in­her­ited can­cer goes up if you have a num­ber of close rel­a­tives with can­cer,” says Dr Sarin. There are other point­ers, too: Can­cer at a young age and if the types of can­cers in a fam­ily are sim­i­lar. “For in­stance, all breast can­cers are linked to ovar­ian or prostate can­cers,” he says.

ABOMB WAIT­ING TO EX­PLODE Age is a time bomb for in­her­ited can­cer. Vaze was 41 and a mother of two when she found a lump on her breast. She was not aware that some can­cers could run in fam­i­lies, al­though her el­der sis­ter had been di­ag­nosed with breast can­cer. “Are you go­ing to die like aunty?” her chil­dren asked. “I am sure I will come out of it,” she told them. That was the pat­tern, even when she got can­cer in her other breast 17 years later. “None of us sat and cried.” But it broke her heart when her daugh­ter was di­ag­nosed with breast can­cer at 26, just a month af­ter her wed­ding. “What have I passed on to you,” she had said. “Your can­cer, yes, but also your fight­ing spirit,” her daugh­ter replied.

Shachi Marathe, 30, lost her mother to ovar­ian can­cer by the time her breast can­cer was spot­ted. The Mum­bai girl was just 22. Her child­hood sweet

heart was by her side through the rounds of surgery, chemo and ra­di­a­tion. “We got mar­ried three years ago,” she says. With a very strong fam­ily his­tory of can­cers on her mother’s side, doc­tors at TMC of­fered ge­netic coun­selling and test­ing for her blood fam­ily. This would al­low ge­neti­cists to study how the mu­tated gene be­haves in her fam­ily and help those at high risk avoid can­cer. And if a fam­ily mem­ber did get can­cer, they would know ex­actly which genes to look for. “Un­for­tu­nately, many in my fam­ily did not agree to such tests,” says Marathe. “They pre­fer to deal with can­cer only af­ter they get it.”

That’s ex­actly what doc­tors are warn­ing against. “Can­cer does not hap­pen overnight. It’s a process that takes time and then man­i­fests one day,” says Dr Verma. One’s stress level, physique, weight, diet— all th­ese come into the pic­ture. “I have seen pa­tients with strong

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