Put to the Test: The Breast Cancer Gene

A woman with breast cancer undergoes genetic testing to find out whether she carries a breast cancer gene

By Peggy Orenstein

The BRCA tests were among the first gene tests to hit the marketplace, and since they involve half the population and are harbingers of so much to come, they’re important and bear watching. That doesn’t make them any easier to deal with. "There are people who come in for their first genetic counseling session, then we never see them again," said Richard King, director of the division of genetics and molecular medicine program at the University of Minnesota, in Minneapolis. "The risks are scary to face. But I’ve also seen the benefits of testing, even with Huntington’s disease. Families can get things organized and understand things better, be more prepared.

"Would I be tested in that position?" he paused. "I don’t know. I can’t give a direct answer without thinking about it. Just like everyone else."

A Schism in Our DNA

My mother mentioned something in passing: My Great Aunt Goldie had died of a "stomach ailment."

"You mean she had ovarian cancer?" I asked.

She hesitated. "It’s possible," she said. "Though who knows? Back then, it could’ve been appendicitis."

Oh, she continued, and Great Aunt Jane? On Grandpa’s side? She had breast cancer in her 70s. And Anice, my first cousin once removed? The one who’d lived on a ranch in Montana? Breast cancer killed her in her early 40s. Then there was Great Aunt Minnie; she died of breast cancer too. "But she was phobic," my mom assured me, as if mental illness changed the physical one. Minnie wore only white and lived in an all-white house in Los Angeles with all-white furniture, including her grand piano. When she got sick, she refused to go to a hospital for treatment — she was afraid there’d be germs there. It seemed to me that Minnie had a lot more to worry about than breast cancer.

I, on the other hand, was getting increasingly nervous — maybe cancer really did lurk in my family’s gene pool. I still hoped to have children; what might I be passing on to them? A year after finishing my breast cancer treatment, I finally mentioned it to my GP. "Everyone has some family history of cancer," he said, shrugging. But he suggested I make an appointment with a genetic counselor, saying, "I think it will ease your mind."

I eyed the other patients at the Comprehensive Cancer Center at the University of California San Francisco. Were they getting treatment, or were they also waiting for someone to read their genetic tea leaves? An elderly couple shuffled in with his-and-hers walkers, the legs of which had been made scuff-proof by attaching Day-Glo tennis balls. In another context I might have pitied them their frailty, but nowI found myself envious. At least they’d made it this far.

Calculating My Breast Cancer Risk

My counselor was a young, sweet-faced woman named Lisa, who would assess my risk of a mutation from what was already known; then the decision of whether to get tested would be mine. She took my family history, tapping her pencil on her desk a few times before explaining that a Jewish family with just one case of early onset breast cancer, combined with one case of ovarian cancer at any age, was statistically likely to have a mutation. Then she pulled out a pie chart. "See this section?" she asked, pointing to a large white slice. "This is sporadic breast cancer. It’s random. It represents about 70 percent of all breast cancers. These women have no previous family history of disease."

I nodded. That, I had assumed, was me. "Now see this section?" she continued, pointing to a smaller, striped area. "These are people with familial cancer, but without any known cancer-gene involvement; they may have other behavioral or inherited factors at work, such as body size or a naturally higher level of estrogen. This represents about 20 percent of cases.’‘

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