by Melissa Brunner
I admit, when I first heard about actress Angelina Jolie undergoing a double mastectomy to reduce her breast cancer risk, I thought the decision was a bit drastic. Sure, I'd heard of the BRCA gene mutations and how it increasted cancer risk, but I never really understood just how much it increases the risk and how effective removing the breasts really is in bringing the risk back down. That is, until I visited this week with Ginger Reaves, APRN, who does genetic counseling at the Cotton-O'Neil Cancer Center for our weekly medical segment.
Reaves gave me a pamphlet from Myriad Genetic Laboratories which spells out the risks the general population has of developing certain cancers versus the risk for people with the BRCA gene mutation. Most people have an 8 percent risk of developing breast cancer - it's up to 87 percent for the BRCA folks. And that's not all - ovarian cancer is up to 44 percent versus less than one percent; male breast cancer up to 8 percent versus .05; pancreatic cancer up to 7 percent versus less than one percent; and prostate cancer up to 20 percent versus 13 percent. Yes, men can be carriers, too.
Obviously, the risk increase of breast and ovarian cancer in women is the most startling. It also would stand to reason that, if you no longer have your breasts or ovaries, you wouldn't get the cancer. But I wanted to know from Reaves if that really was all you could do to protect yourself. The answer is that it's not - but, just as logic would tell you, it is the most effective. It's not foolproof - Reaves explained some residual breast tissue would remain. But it does reduce the risk by 90 percent or more. Likewise, removing the ovaries and uterus can lower the ovarian cancer risk for BRCA carriers up to 96 percent. Other options are the drug Tamoxifen, which lowers breast cancer risk 53 percent, or oral contraceptives, which lower ovarian cancer risk up to 60 percent.
If neither of those is feasible, Reaves says women can opt to simply increase screening. Instead of annual mammograms, they might be checked every six months with the addition of MRI screening. Instead of a basic annual pelvic exam, a doctor might add ultrasound screening of the ovaries and uterus to the routine. This approach won't prevent the cancer, but Reaves says it will catch it early, which ups the odds for successful treatment. Women with the gene who are young and still wanting to start (or complete) their families might find this a very viable approach, Reaves said.
The ovarian cancer risk is especially concerning because the disease is often called a silent killer. By the time a woman notices symptoms, it's often at an advanced stage, difficult to treat. Unlike breast cancer, this is no self-exam.
So, with all the Angelina Jolie talk, should we all run out and get tested for BRCA? Not so fast, Reaves said. First, only eight to ten percent of breast cancers are BRCA related. While having the gene does significantly increase your risk, the reality is that only a small percentage actually carries it. Screening involves a blood test or cheek swab. While that sounds simple enough, the test costs several thousand dollars. If you don't meet high-risk criteria to be a carrier, insurance will not cover the cost. Even then, it might be questioned. If you're concerned, talk to your doctor.
Reaves says Jolie's decision to publicly share her decision will raise awareness, which is a good thing. Women who are at highest risk need to be aware so they can weigh their options and arrive at decisions that are best for their individual situations. Knowledge is power and, after visiting with Reaves, I understand the thought process a whole lot better.
Myriad Genetics offers additional information at www.BRACnow.com