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October 1, 2006

Burden of Truth

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When Positive News Isn't

Normal BRCA 1 and 2 genes suppress tumors, but inherited mutations in these genes leave women vulnerable to breast and ovarian cancer. Having the mutation doesn't guarantee cancer, but it does raise your risk. The average risk of breast cancer by age 70 is estimated to be 65 percent for women with the BRCA1 mutation and 45 percent with BRCA2, according to Debbie Saslow, Ph.D., director of breast and gynecologic cancer at the American Cancer Society. Women without the mutation have about a 13 percent lifetime risk. The mutation bumps ovarian cancer risk from 1.7 percent up to a 16 to 60 percent risk, according to the National Cancer Institute. Many women who test positive for the mutation opt for preventive removal of the breasts and/or ovaries (in one study of 208 women with a BRCA mutation, slightly more than half chose these surgeries). There are currently no absolute guidelines on what to do next if you test positive and reject the surgery option.

Since your cancer risk is determined by other issues in addition to heredity--including age, diet and exercise habits, and exposure to possible carcinogens--the health changes to be made and the frequency and type of screening needed are different for everyone. Currently, digital mammograms are proving to be significantly more accurate for pre-menopausal women and those with denser breast tissue. For high risk women, following mammography with ultrasound helps identify up to a third more cancers--many at a far earlier stage. Magnetic-resonance imaging (MRI) is emerging as a promising additional tool. Regular exercise may also reduce risk. And while studies of diet and cancer have had conflicting results, most physicians recommend that you avoid excessive alcohol and reduce the amount of animal fat, including full-fat dairy products, that you eat. Also, eat more fruits and vegetables.

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