When my mother was diagnosed with breast cancer last year, I had a lot of questions swimming inside my head. Of course I was concerned for my mother, but I couldn’t help but think of myself now that both my grandmother and mother had been diagnosed with breast cancer. What did this mean for me? Did this increase my chances of developing breast cancer?
Fear entered my heart, and some friends intensified the feeling when they asked if I had considered genetic testing to determine if I carried the breast cancer gene. You see, Angelina Jolie had recently revealed she was tested and carried the gene, and had decided to have prophylactic surgery to lower her risk. Women across America were wondering if they should have genetic testing, and I was one of them.
I always like to look at the facts first before making a decision, so I decided to talk with my doctor and do some research before jumping to any conclusions about genetic testing for breast cancer. I discovered that breast cancer is linked to the BRCA1 and BRCA2 genes. So, what are the BRCA1 and BRCA2 genes?
BRCA1 and BRCA2 are human genes that produce tumor suppressor proteins. These proteins help repair damaged DNA and, therefore, play a role in ensuring the stability of the cell’s genetic material. When either of these genes is mutated, or altered, such that its protein product is not made or does not function correctly, DNA damage may not be repaired properly. As a result, cells are more likely to develop additional genetic alterations that can lead to cancer. (National Cancer Institute).
A woman’s lifetime risk of developing breast cancer is greatly increased if she inherits a mutation in the BRCA1 or BRCA2 gene. The average woman has about a 12% chance of developing breast cancer, but that risk is increased to a 45-65% chance if she inherits the BRCA1 or BRCA2 gene mutations. Sounds scary doesn’t it? Yes, but it’s important to keep in mind that only 5-10% of breast cancers are linked to these gene mutations. That means that 90-95% of breast cancers developed are not related to the BRCA1/BRCA2 gene mutations. We must also note that genetic testing for breast cancer is relatively new, and there are no long term studies to compare the risk between women with and without the gene mutations. So although your risk is increased if you carry the gene mutations, it doesn’t mean that you will definitely develop breast cancer in your lifetime.
After looking at the facts and talking with my doctor, I still was unsure if I wanted to be genetically tested. I mean, I already knew I was at greater risk of developing breast cancer than others without a history of it in their family. But since my mother and grandmother developed breast cancers after the age of 50, my chances of carrying a gene mutation was lessened. Hmmm….what to do… It took some thought and prayer, but I finally came to a decision. There were 5 questions I asked myself to help me make my decision, and I’m happy to share them with you today.
Am I psychologically prepared for the consequences of a positive result?
People who test positive for a breast cancer gene mutation must face the fact that they are more likely to develop the cancer. How will you deal with the stress of a positive result? Will it provide you with relief now that there is no uncertainty if you carry the gene mutation? Will you become angry or deeply depressed? Will you live in a world of worry anticipating a breast cancer diagnosis? You must decide if the genetic knowledge will benefit or harm your emotional health.
What medical decisions am I prepared to make if I receive a positive result?
If you receive a positive result, your treatment options are to take preventive medication or have a preventive prophylactic mastectomy. Are you prepared to make the decision? Not all of us are as bold as Angelina Jolie and can make the decision to have our breasts removed without evidence of cancer, but some of us are. Not everyone wants to take medication and deal with side effects if there is no certain diagnosis. You have to weigh the risks and decide if you will be willing to take medical action upon receiving a positive result. If not, genetic testing may not be for you.
How will my relationships change due to a positive result?
Have you considered how your family will receive the news? Genetic testing can reveal information about additional family members, so it’s important to consider their reaction to the news as well. It can be difficult to tell children and/or siblings of your positive result since it increases their chances of carrying the gene mutation. How will your husband react to your decision to proceed with a prophylactic mastectomy? Perhaps you’ve changed your mind about childbearing now that you’ve tested positive. How do you share that with your husband? Family members may get angry, upset and/or depressed from the news, so be sure to consider how your genetic testing result will affect your family.
Do I have the finances to cover the medical costs involved?
Insurance may or may not cover the cost of the test, which could cost anywhere from several hundred to several thousand dollars. If you test positive and decide to go forward with preventive treatment and/or surgery, there is no guarantee insurances will cover for those costs either. It is important to speak with your health insurance provider in advance to make sure you have the finances needed for testing and/or treatment.
Will my lifestyle change if I receive a negative result?
We all know how to reduce our risk of any cancer, right? We should maintain a healthy weight, eat right, exercise, limit alcohol use and eliminate smoking. For breast cancer prevention we should also perform monthly breast exams, receive a yearly breast exam from a doctor and begin yearly mammograms at the age of 40. But what if you don’t have the breast cancer gene mutation? Will you stick to the plan, or have a false sense of security? You may have the tendency to stop doing these cancer prevention tasks if you believe you are at a lower risk of developing the cancer. You need to be prepared to stay proactive concerning your breast health even if you receive a negative result, and not forgo the necessary screenings since you still have a 12% chance of developing breast cancer.
So, what was my decision?
After considering my options and contemplating the questions above, I have decided against genetic testing. I will stay on top of my breast health with monthly exams, yearly doctor visits and mammogram screenings. I don’t need a positive test result to enhance my screening options and live a healthier lifestyle to prevent cancer from developing in my body. You see, I try to see the glass half full instead of half empty. So instead of thinking I have at least a 13% chance of getting breast cancer, I’m thinking I have up to 87% chance of NOT getting breast cancer. If I do have the gene mutation, I still have a 35-55% chance of NOT developing breast cancer. I plan to enjoy my life and not live in fear of the future. The Bible says in I John 4:18 that “perfect love drives out fear” (NIV). I am relying on God’s love to give me peace and contentment, so I can do the work he’s called me to do and be productive in this life. As a Christian, I’ve decided to put my trust in God and believe that no matter what lies ahead, he will be with me every step of the way.
Note: The opinions in this post are entirely my own, based on my own beliefs and the conclusion I made after researching genetic testing and speaking with my doctor. I am not saying that genetic testing is wrong, only that it was wrong for me. You should make your decision about genetic testing based on your own beliefs and knowledge. Do you want to know more about the BRCA1 and BRCA2 cancer risk and genetic testing? I used facts from The National Cancer Institute for this post. You can find much more useful information on their website.