Pre­emp­tive strike

Af­ter a woman is found to have breast can­cer, her daugh­ter dis­cov­ers her own op­tions.

The Star Malaysia - Star2 - - HEALTH - by MelISSA HeAly

BON­NIE Jaffe has spent much of the last year liv­ing her own pos­si­ble fu­ture, and plot­ting ways to al­ter it. Last Oc­to­ber, her 67-year-old mother, Mar­i­lyn Jaffe, was di­ag­nosed with in­va­sive breast can­cer – the dis­ease that had killed her own mother.

Bon­nie, who does busi­ness plan­ning and anal­y­sis for a Cal­i­for­nia-based com­pany, swung into ac­tion to co­or­di­nate her mother’s care.

But at the Uni­ver­sity of Cal­i­for­nia, Los An­ge­les’ (UCLA), Jon­s­son Com­pre­hen­sive Can­cer Cen­tre, she found that physi­cians had more on their agenda than bat­tling the clear and present dan­ger to her mother.

They were fo­cused on as­sess­ing and chang­ing her fu­ture can­cer risks as well.

Mar­i­lyn tested pos­i­tive for a mu­ta­tion in the BRCA2 gene that in­creases her risk of de­vel­op­ing breast can­cer.

Physi­cians en­cour­aged Bon­nie to get tested to see whether she had in­her­ited the mu­ta­tion from her mother.

In June, at age 44, she learned the an­swer was yes.

Now, Bon­nie lives with the knowl­edge that she is five times like­lier than the av­er­age woman to de­velop in­va­sive breast can­cer, and as many as 10 times more likely to get ovar­ian can­cer – a can­cer that is es­pe­cially deadly be­cause it is so rarely caught early.

But in see­ing her mother through her breast can­cer treat­ment – which in­cluded a dou­ble mas­tec­tomy, breast re­con­struc­tion and a reg­i­men of drugs called aro­matase in­hibitors to pre­vent re­cur­rence – Jaffe was given an early glimpse of some of her own op­tions.

That ex­pe­ri­ence forced her to con­sider tak­ing a dra­matic pre­ven­tive step – hav­ing her breasts sur­gi­cally re­moved.

Pre­ven­tive op­tions

Since 2002, the pro­por­tion of women like Bon­nie, who have cho­sen a strat­egy of pre­emp­tion to pro­tect them­selves from their high ge­netic risk of can­cer has grown from vir­tu­ally zero to, at least, one in 10.

By hav­ing her breasts re­moved, a woman aims to deny breast can­cer a place to take root.

By hav­ing her ovaries, fal­lop­ian tubes and, of­ten, her uterus re­moved, a woman looks to erase ovar­ian can­cer’s sanc­tu­ary. And be­cause she has re­moved a key source of oe­stro­gen, to re­duce her risk for breast can­cer as well.

The ap­proach seems sen­si­ble enough. But women choos­ing this route have done so amid un­cer­tainty about its ul­ti­mate abil­ity to save lives.

A study pub­lished last month in the Jour­nal Of The Amer­i­can Med­i­cal As­so­ci­a­tion (JAMA) fi­nally of­fered strong ev­i­dence that such rad­i­cal steps do, on av­er­age, pro­long the lives of women with high­risk ver­sions of the BRCA1 and BRCA2 genes.

The JAMA study fol­lowed 2,482 car­ri­ers of BRCA1 and BRCA2 mu­ta­tions for about four years af­ter they de­cided to have pro­phy­lac­tic surgery, or not.

Re­searchers found that the women who had mas­tec­tomies had lower rates of sub­se­quent breast can­cer than those who de­clined the surgery.

In ad­di­tion, women who had their ovaries re­moved were less likely to de­velop breast or ovar­ian can­cer, or to die of any cause, than women whose ovaries re­mained in­tact.

For now, Bon­nie has de­cided to pro­ceed with surgery to re­move her ovaries, fal­lop­ian tubes and uterus, but to keep her breasts.

Hav­ing chil­dren was not a pri­or­ity for her, and at 44, her chance to do so has largely passed.

Even so, she says, “there is some­thing very fi­nal and de­fin­i­tive about hav­ing surgery” to re­move one’s ovaries.

At the same time, Bon­nie says she would like to avoid the long and dif­fi­cult con­va­les- cence her mother has en­dured fol­low­ing her dou­ble mas­tec­tomy.

While the prospect of breast re­con­struc­tion might lessen the blow, Bon­nie has seen first­hand how ex­haust­ing that sec­ond round of surgery can be.

She rea­sons that with the re­moval of her ovaries and uterus, she should avert the worst-case sce­nario – the devel­op­ment of ovar­ian can­cer – and drive down her breast can­cer risk in the process.

Mean­while, she and her doc­tors will step up their vig­i­lance for any sign of breast can­cer with bet­ter and more fre­quent self-ex­ams, yearly mag­netic res­o­nance imag­ing of her breasts and yearly mam­mo­grams.

If breast can­cer does ap­pear, saysBon­nie, her breasts may still have to go.

But be­cause it will have been caught early, she hopes it would be less likely to threaten her life, and she will have spaced her surg­eries fur­ther apart.

Bon­nie says many friends have asked her why she would want to know whether she had a high-risk ver­sion of the BRCA2 gene.

It is a view she says she would un­der­stand if there were noth­ing she could or would do to im­prove her odds.

But while none of her op­tions is per­fect, the an­a­lyst in her sees trade-offs to con­sider, risks to be shaved and steps to be taken.

“There is a good rea­son to find out,” Bon­nie says, “be­cause you may save your own life.” – Los An­ge­les Times/McClatchy-Tribune In­for­ma­tion Ser­vices

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