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Breast Cancer Risk Factor Recognition Could Mean Better Prevention

N-W-SUR52549-GemCity_PnkPgs_ImageDAYTON, Ohio (October 9, 2015) – At 33 years old, Jackie Spraley decided she no longer wanted to fear whether breast cancer would knock on her door one day.

It was 2013 and her aunt had been diagnosed with breast cancer – it was her third maternal aunt to be diagnosed with either breast or ovarian cancer. Spraley had become increasingly concerned about what it meant for her and decided to meet with a genetic counselor. Genetic testing revealed that she was positive for the BRCA1 and BRCA2 mutations, a gene defect that prohibits her body from making a protein that prevents cells from becoming abnormal.

Testing positive for BRCA1 and BRCA2 meant her odds of developing breast cancer were more than six times that of the average American woman.

“The facts were overwhelming,” said Spraley, who lives in Englewood with her husband and six-year-old daughter. “I knew my family history and I knew I had both of the genes, greatly increasing my chances of the cancers. I chose the surgeries. I did not want to wait for what I felt was almost inevitable.”

The surgeries Spraley chose were a double nipple sparing mastectomies as well as the removal of her ovaries. Both are extensive surgeries that unfold tremendous change in a woman’s body. Yet, for Spraley, the short-term physical pain and emotional rollercoaster far outweighed the concern of developing ovarian and breast cancer later in life.

“It’s a huge decision to willingly put your healthy body through major surgeries,” Spraley said. “It was not easy to know I would need six to eight weeks to recover let alone the changes I was getting ready to put my body through. But, at the same time, I personally did not see any other choice to my situation. It was one of the scariest and most challenging times of my life to make this decision.”

More women today are being faced with a similar situation as research unveils details as to what can put them at high-risk for breast cancer. Spraley is just one among many across the country who have discovered that their risk is linked to their genetics. But a woman’s genes is just one uncontrollable factor that puts her at a higher risk. Others might include a woman’s age, ethnicity, race, family history and own health.

Understanding what places a woman at a higher risk for breast cancer is an important key in helping to prevent the disease from surfacing. While the reality of being high-risk may at first be daunting, in the end, it can bring much hope to the woman who realizes she has options that can help her take control of her future health.

Higher risk, increased prevention

Thomas Heck, MD, with Gem City Surgeons, was Spraley’s surgeon. Patients like Spraley are referred to Dr. Heck when they have risk factors for breast cancer. Dr. Heck has women fill out a detailed questionnaire that is then analyzed by a geneticist to determine her level of risk.

“The way I like to explain it to my patients is that women fall into three different categories: average risk, medium risk and high risk,” Dr. Heck said. 

The average American woman has a 13 percent chance of developing breast cancer in her lifetime. Lifestyle factors, such as obesity, can raise that percentage, while other choices such as being physically active may reduce a woman’s risk. Women who possess other risk factors or proven genetic mutations fall into the other two categories.

“Women who have tested positive for the BRCA1 and BRCA2 gene mutation are considered the highest risk because they have an 80 percent risk of developing breast cancer and a 50 percent risk of getting ovarian cancer,” Dr. Heck said. “I make it a point to sit down for a long time with these women and walk them through their options.”

The best available option to drastically drop a woman’s risk is to undergo a double mastectomy and the removal of her ovaries. A woman who chooses these surgeries will watch her risk of developing breast and ovarian cancer drop to single digits. 

Women who do not have the gene mutation, but have other factors that increase their risk for breast cancer have options too. Chemoprevention medication is a type of prevention that has proven to reduce a woman’s risk for developing breast cancer by 50 percent. Chemoprevention is an oral medication that is taken for up to five years, but has proven to be effective in a woman’s body for years that follow. Women who take this medication are also monitored every six months with a physical exam and either a MRI or mammogram.

“The goal is to carefully watch these women so that if something does show up, we will find it at an earlier stage,” Dr. Heck said. “In my experience, women who choose chemoprevention have very good results. In our practice, we have seen the statistics borne out.”

Knowledge is power

Prevention methods and tools for breast cancer continue to strengthen; however, they can only benefit the women who know they need it. That’s why Dr. Heck said it is imperative that women become educated on the risk factors and knowing what to do once they suspect they are at high-risk. 

“We know there are women walking around out there who are high risk who have not been discovered,” Dr. Heck says. “Our goal is to discover them and let them know what we can help them do about it.”

There are numerous risk factors for breast cancer including those that a woman can control, such as lifestyle, and others that are out of her hands, such as her heredity. The American Cancer Society (ACS) lists these risk factors for breast cancer as a starting point for women:

A woman’s age – A woman’s risk for developing breast cancer increases as she ages. About one in eight invasive breast cancers are found in women younger than 45, while about two in three invasive breast cancers are found in women 55 years of age and older, the ACS said.

“It is not uncommon when older women come in and say, ‘I am 70 years old. I didn’t think I could get it.’” Dr. Heck said. “There are women who believe that once they hit a certain phase of life that it shouldn’t play into their risk, but that is not true.”

A woman’s genes – According to the ACS, up to 10 percent of breast cancer cases are hereditary or result directly from gene defects, also known as mutations, which are inherited from a parent. The most common cause of hereditary breast cancer is an inherited mutation in the BRCA1 and BRCA2 genes. In normal cells, these genes help prevent cancer by making proteins that keep the cells from growing abnormally. Breast cancers linked to these mutations occur more often in younger women and more often affect both breasts than cancers not linked to these mutations. Women with inherited mutations also have an increased risk for developing other cancers, particularly ovarian cancer.

A woman’s family tree – A woman’s risk for breast cancer doubles if she has one first-degree relative such as a mom, sister or daughter who has been diagnosed with the disease. Having two first-degree relatives increases her risk by three-fold, the ACS said. 

A woman’s race and ethnicity – Caucasian women are slightly more likely to develop breast cancer than are African-American women, however, African-American women are more likely to die from the disease, the ACS said. In the United States, BRCA mutations are more common in Jewish people of Eastern European origin than other racial and ethnic groups.

A woman’s breast tissue – It may be discovered through a mammogram that a woman has dense breast tissue, which means they have more glandular and fibrous tissue and less fatty tissue. Women with dense breast tissue have a risk of breast cancer that is up to two times that of a woman with average breast density. Women are now informed if dense breast tissue is discovered in a mammogram and encouraged to follow up with her physician.

“I don’t expect a woman to know everything that is out there, but at least know enough to question her primary care doctor,” Dr. Heck said. “I think there are a lot of women out there who just don’t raise the question or provide that one bit of information that would help tip off a physician that she needs further evaluation.”

A family pattern of breast and ovarian cancer was enough to cause concern for Spraley and prompt her to seek further counsel. The fact that she possessed the gene mutation was hard, but the ability to take control of her future was empowering. 

“I absolutely feel blessed and fortunate to live in this present time with genetic testing and options,” Spraley said. “I am so hopeful that by the time my daughter is 33, she will never have to worry or make such a decision.”

Read on learn more about breast cancer.

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