Breast cancer survivor encourages at-risk women to take action early

Double mastectomy patient vows to get her children tested early and often

ABU DHABI, Oct 21: Earlier this year, a 30-year-old mother who had just given birth to her third child,was faced with several tough decisions. She was informed that a lump she had noticed while breastfeeding was not a blocked milk duct but cancerous.

When she arrived at Cleveland Clinic Abu Dhabi, part of the Mubadala network of healthcare providers, she had already undergone a screening mammogram and biopsy to confirm this. However, further investigation with genetic counseling found a mutation in BRCA1, a breast cancer-susceptible gene.

Women who have BRCA1 or BRCA2 mutations can have up to a 72 percent risk of being diagnosed with breast cancer during their lifetime, according to the latest research. Additionally, breast cancers associated with these mutations develop at a younger age and more often in both breasts, and patients also have an increased risk of ovarian, colon and pancreatic cancers.

“When I first found the lump, I thought it was caused due to breastfeeding. But when it persisted and began to grow, I got worried. It never crossed my mind that I might have cancer because I’m young and had just had a baby. I was in denial,” says the patient.“When doctors at Cleveland Clinic Abu Dhabi informed me about the mutation, I felt naïve because my mother had the same issue and I completely ignored the risk. I saw her go through all the same stages and pain that I went through. I won’t make the same mistake with my girls.”

Dr. Ellie Choufani, an oncologist who is part of Cleveland Clinic Abu Dhabi’s Breast Health Clinic, says that based on her medical history when she presented at the hospital, the care team decided to start her on preoperative chemotherapy first: “Her full body CT scan did not reveal any disseminating cancer but because her tumor was slightly enlarged with an involvement of the lymph nodes, we decided to go with eight cycles of chemotherapy first,” he says.

In the meantime, the clinic also referred her for genetic counseling to assess all her risk factors and determine the right treatment plan.

Dr. Stephen R. Grobmyer, Chair of the Oncology Institute at Cleveland Clinic Abu Dhabi, says genetic counseling becomes particularly useful if the patient is young: “This is an important service that enables us to look for abnormal gene mutations, so that we can offer surgery to address the current cancer and provide proactive management options to the patient. Additionally, now her family can get tested as there is a 50 percent chance that her siblings and children who may not have cancer carry the same mutation.We recommend that her children get tested after they turn 20 years of age.

For the patient, this meant a preventative double mastectomy and encouraging her family members to act. She was also counseled about the possibility of removing her ovaries and fallopian tubes in a few years to reduce the risk of ovarian cancer.

“I was in shock and the whole world stopped when they told me about this. But I realized that this was the best decision for my health and long life. I got my breast reconstruction at the same time and am currently undergoing radiation therapy,” she says. “Doctors said that waiting to remove the ovaries would be a good idea as I am under the age of 40, and to prevent other issues, such as bone loss. I trust their judgement and will continue to follow up.”

Dr. Choufani adds: “This would be a prophylactic approach because the risk of ovarian cancer increases by 60 percent in patients with these mutations at the age of 40.”

The patient says her tough journey was made only possible by the constant support of her husband and care team at the hospital: “The doctors at Cleveland Clinic Abu Dhabi have been amazing to help me get back on track. But my husband has been my greatest support.

He has comforted me every step of the way, especially during the tough chemotherapy sessions. My entire family has also helped boost my morale and strength.”

She says that she wants people to understand that early intervention can make a big difference.