With elevated risks, these survivors and ‘previvors’ aren’t taking any chances
When doctors told Mariana Torrado she had breast cancer, she didn’t believe them at first.
“I thought, ‘no way, I’m only 30 years old,’” says Mariana, a project accountant for a real estate development company in Houston.
Know your risks
“Genetic counseling helps people assess their genetic risk for certain cancers, most commonly breast and ovarian,” says Banu Arun, M.D., a professor of Breast Medical Oncology and co-director of the Clinical Cancer Genetics Program.
Counselors help those who either have cancer themselves or a high incidence of cancer in their families get tested, understand the results and make decisions about what to do next.
Arun says some patients discover through counseling that they’d prefer not to know if they carry a BRCA mutation. Ultimately, the decision is the patient’s.
“But knowing you’re at increased risk because of family history is empowering,” Arun says. “Through various options, you can reduce your chance of getting cancer by up to 95%.”
Some women considered to be at high risk will undergo alternating mammograms and MRIs every six months (as opposed to standard yearly mammograms). Others will take anti-cancer drugs or adopt healthier lifestyles. Yet others will choose to have their ovaries, Fallopian tubes and/or breasts removed — an option known as preventive or prophylactic surgery.
Actress Angelina Jolie spotlighted this most aggressive route for managing cancer risk when, in 2013, she underwent a preventive double mastectomy. Jolie decided to have the procedure after she tested positive for a BRCA1 mutation. Her mother died of ovarian cancer, and Jolie learned she herself had up to an 87% chance of getting the disease. Some breast cancer experts noted that the “Angelina Jolie effect” — the dramatic surge in testing for breast cancer genes that followed her story — was a good thing. It raised awareness of a problem and gave women the power to take charge of their health and their future.
A powerful weapon
Only 5 to 10% of all cancers are caused by inheriting a mutated gene. The vast majority of cancers occur because people get older, smoke, become obese, abuse alcohol or have a disposing condition such as hepatitis C.
Red flags that may help identify families with an increased risk of inherited cancers include relatives who are diagnosed with cancer before the age of 50, a family history of male breast cancer, two or more cancers in the same person or cancers spanning multiple generations.
“Mutations in the BRCA1 and BRCA2 genes, known as the breast and ovarian cancer susceptibility genes, account for only about 5 to 10% of breast cancers and 10 to 11% of ovarian cancers,” says Karen Lu, M.D., chair of Gynecologic Oncology and Reproductive Medicine, and co-director of the Clinical Cancer Genetics Program.
Still, for the small proportion of patients at risk of inheriting cancer, genetic testing can be a powerful weapon.
Paola is screened every six months and identifies with the term “previvor.” The label has been adopted by many BRCA mutation carriers who have taken preventive measures — surgeries, drugs or vigilant screenings — to dramatically reduce their risks of developing cancer. Paola is considering her options, and says she’ll likely choose to undergo a preventive double mastectomy.
To guard against fertility problems, she’s banked seven frozen eggs with help from MD Anderson.
To reduce the risk of her breast cancer recurring after treatment, Mariana underwent a double mastectomy in January. She says she’ll likely have her ovaries surgically removed by age 40 in a procedure known as a preventive oophorectomy.
Until then, she’ll be screened every six months for ovarian cancer.
“I know my MD Anderson doctors will be following me closely,” she says.
Mariana Torrado identifies with the term “survivor.” She plans to marry and have children when she beats cancer.