Wednesday, February 01, 2017
Breast Cancer Avoidance
In 2012 as I was preparing for a consultation with a breast cancer surgeon for a prophylactic bilateral mastectomy (PBM), my ovarian cancer returned. Due to my recurrence the option of preventative surgery was taken off the table.
I remember at the time my mom had done some research on the BRCA migration within the Ashkenazi Jew population, noting that there was a pocket of people in Southern Colorado/Northern New Mexico carrying the mutation. I am linking that article along with a few other articles on this fascinating research.
I recently was told that our grandmother on my paternal side was of Ashkenazi Jewish heritage, which confirms my dearly departed mom's hunch that my gene was inherited on that side of my family. Now to offer respect to people of the Jewish heritage, I am not exactly sure if our ancestry is actually Ashkenazi or Sephardic, as this is a whole new thing for me to absorb, but there are articles reflecting both populations in terms of the BRCA 1/2 mutation migrating to southern Colorado.
Here is an excerpt from the article in the Smithsonian: http://www.smithsonianmag.com/science-nature/the-secret-jews-of-san-luis-valley-11765512/
"When Wright was told that the mutation was characteristic of Jewish people, she recalled a magazine article about the secret Jews of New Mexico. It was well known that during the late Middle Ages the Jews of Spain were forced to convert to Catholicism. According to a considerable body of scholarship, some of the conversos maintained their faith in secret. After Judaism was outlawed in Spain in 1492 and Jews were expelled, some of those who stayed took their beliefs further underground. The exiles went as far as the New World."
My mom used to tell me that grandma had maintained some rituals that were thought to be Jewish, but could not recall what they were exactly. I am desperate to find out. Those rituals were what made my mom curious as to the heritage of my father's mother, whom was otherwise a spanish Catholic.
At the bottom of this post I will share a few
interesting links on the subject.
Now that I have a window of opportunity for surgery once again, I am scheduled for a PBM this February. My wonderful gynonc was very supportive and successfully facilitated the process. With warning that the breast surgeon may want to convince me otherwise, I met with her and defended my position. Understandably breast surgeons are careful to be certain that patients are emotionally ready to undertake such a drastic surgery as opposed to surveillance (annual breast MRI/MAMMOGRAM). I have been under surveillance since 2010 or 2011, not exactly sure, and I am tired of it.
I just don’t want to have to deal with a second cancer and the surveillance is starting to get depressing and burdensome. It is very expensive and the worry is not completely addressed. The breast surgeon did say that if I stayed on surveillance, breast cancer should be caught in an early stage, but early stage is too many stages. I feel good about my decision, and because I did want this in 2012, confidence about this choice is strong. I am grateful beyond measure that insurance will cover the procedure.
Secondly it is important to discuss genetic testing. In 2010 my test was completed by Myriad Genetics, whereby which pre-approval and coverage for such a test was hard to come by. Today things are different and there are a greater number of testing options available. Thanks to a support group via Colorado Ovarian Cancer Alliance I was informed about a new test by Myriad called HRD testing. This test can better predict the ability of parp-inhibitors to effectively treat cancer in women with a BRCA1/2 mutation.
"By predicting response to PARP inhibitors, myChoice HRD can help physicians select the appropriate therapy for their patients. Both a positive and a negative HRD result can help drive treatment decisions. An HRD positive result indicates the patient is more likely to benefit from treatment with PARP inhibitors such as olaparib and rucaparib, while an HRD negative result indicates that the patient is less likely to respond to PARP inhibitors, and can be spared the time and toxicity associated with an ineffective treatment. myChoice HRD seeks to offer physicians the ability to personalize treatment plans for patients." Myriad Genectics
Peace and an Abundance of Blessings