Breast Cancer Awareness Month
October is breast cancer awareness month! It's quite safe to assume that a majority of us are acquainted with someone who has been personally affected by this disease. In fact, breast cancer alone accounts for 12.5% of new annual cancer cases worldwide, making it the most common cancer in the world.
This week, i’m honored to share a very special blog post written by our summer intern, Jessica. Not only is she an incredible writer and future dietitian, but she is also a breast cancer warrior.
This is her story…..
It was just a regular day, like any other day. I was probably preoccupied with thoughts about my future wedding or why I had to have that new trendy outfit I spotted online. Thanksgiving was a couple of weeks away and I was so excited to share the news of my engagement on the holiday celebrated for giving thanks for life’s blessings. I was on break at work with my fiancé when I noticed my cell phone ringing. The caller ID displayed the name of the facility where I recently had a breast biopsy done. I had forgotten all about it because several physicians assured me, I had nothing to worry about.
I left the noisy break room so that I could take the call.
Doctor: “I am calling to go over your biopsy results. It looks like you have some cancer cells here…”
Uhh….come again!?
In that sudden moment my life changed. Forever.
A wave of fear and panic washed over me as I ended the call. I had to signal my husband out of the break room and use voiceless gestures to explain what I was just told. I couldn’t breathe to speak.
Rewind to about a month earlier…
I had recently been seeing a Naturopath for estrogen dominance issues who suggested testing that revealed excessively high levels of 4-OH-E1 estrogen metabolites (for more information on these nasty little metabolites, check out Julie’s blog on “Estrogen: Friend or Foe?”). These byproducts are heavily linked to some cancer-causing activity, and I was FILLED with them! My naturopath strongly recommended I ask my doctor to refer me for regular mammograms. I did just that, but I was told by my doctor that because I was younger than 40 with no history of breast issues, insurance would deny the claims.
Around this time, I had completed a discussion assignment for an online class. The topic was genetic testing. I found this to be strange timing as I had just taken a 23andme DNA test which tests for a few of the most common BRCA1 and BRCA2 gene mutations. I shared the details of my testing experience noting that “I was very relieved to learn that I do not have either BRCA1 or BRCA2 variants”.
A couple weeks later, remembering the above discussion assignment and my Naturopath’s concerns about my 4-OH-E1 levels, I decided to attempt a self-breast exam. My OBGYN had retired and had been a while since my last one. I lifted my right hand to my left breast where I had long since had a gnawing pain that I assumed was an injured muscle. I was a bodybuilder and was no stranger to sore, tight muscles and trigger points. I would describe what I felt as a tiny bead, maybe the size of a pea, so small I was not sure I was actually feeling something. Perhaps a knotted muscle? I figured I would just ask my doctor to check it out at a visit I had coming up.
Family Medicine Doctor- “I am not sure what exactly that is, but I am not concerned that it is cancer. It just doesn’t feel like cancer. I can set you up with an ultrasound if you would like?”
Me: Okay, yes, that would be great.
Radiologist- “The ultrasound images do not concern me. It does not appear to be breast cancer as it is too high up on your chest. We can biopsy it if you would like, since we cannot say for sure what it is? We would have to send you to a breast surgeon first to order the biopsy”
Me: Okay, yes, that would be great.
Breast Surgeon- “This doesn’t feel like cancer to me. We can proceed with the biopsy if you would like to err on the side of caution, but I would not worry about this too much”
Me: Okay, yes, that would be great (did I mention I was persistent?)
A week or so later, I received “that phone call” at work. It PAYS to be persistent!
The double whammy…
A few doctor visits later revealed a BRCA-2 gene mutation diagnosed via genetic testing. Ohhhhh the irony!!!! This testing was recommended because I was only 35 years old at the time. You’re probably wondering why I didn’t have a positive result on the 23ndme test! Well, long story short, I have a mutation in a different BRCA variant which is not tested for on the 23andme.
What exactly does it mean if you have a BRCA-2 gene mutation?
BRCA2 stands for BReast CAncer gene 2. Everyone inherits two copies of each of these genes—one copy from each parent. The BRCA1 and BRCA2 genes are responsible for protecting you from getting certain cancers by producing proteins that help repair damaged DNA, but some mutations in these genes prevent them from working properly. DNA damage is occurring within us all the time due to internal cellular metabolic processes and external environmental factors. Fortunately, organisms such as humans have evolved to efficiently respond to these DNA insults. Unfortunately, folks like me who have mutated BRCA genes cannot. A vast amount of research and studies links some of these mutations to “clinically significant increased risks of various cancers”, most notably breast and ovarian cancer, but heightened risks also include prostate, melanoma, and pancreatic cancers. People who have inherited such mutations also tend to develop cancer at younger ages than people who do not, thus the reason I was urged to do genetic testing.
What are my actual risk percentages as a BRCA2 mutant compared to the general population?
45%–69% of women who inherit a harmful BRCA2 mutation will develop breast cancer by 70–80 years of age in contrast to about 13% of women in the general population. While my risk is extremely high compared to the general population, 1 in 8 women will be diagnosed with breast cancer and the numbers continue to increase. Therefore, it is critical to get your yearly checkups and request genetic testing if breast/ovarian cancer runs in your family!
11%–17% of women who inherit a harmful BRCA2 mutation will develop ovarian cancer by 70–80 years of age as opposed to only 2% of women in the general population.
5%-10% of women who inherit a harmful BRCA2 mutation will develop pancreatic cancer by 70-80 years of age contrary to the 1% of women in the general population. BRCA1 and BRCA2 are the most common causes of familial pancreatic cancer.
So where does this leave me?
Many women who are diagnosed with BRCA gene mutations opt for prophylactic surgeries. These surgeries include mastectomies (removal of breast tissue) and oophorectomy (removal of ovaries) to drastically reduce their risk of developing cancer in these regions. I chose to do both of these. I felt I had no choice. My breast tumor was estrogen receptor positive which means the tumor is fueled by estrogen. ESTROGEN! The very hormone that can bring so much vitality to women’s lives, is now trying to kill me! Sadly, I was not surprised. I already knew I was a DNA-damaging, estrogen factory, not only evidenced by my considerable excretion of 4-OH-E1 metabolites, but by the ~20 years I had suffered from severe endometriosis and fibroids prior to all of this. A good amount of emerging research is associating these conditions with those pesky estrogen metabolites and other abnormalities in estrogen production and elimination.
Estrogen is also made in small amounts in other areas of the body such as the adrenal glands and fat cells. For this reason, I am also on an aromatase inhibitor for the next decade. This drug blocks the conversion of other hormones into estrogen. Therefore, I literally have zero estrogen and that comes with lifelong consequences as well. But hey! I am coming up on 3 years cancer free, so I am grateful for that!
I would also like to note that my cancer surgeon at Memorial Sloan Kettering Cancer Center who had been a breast cancer surgeon for 40+ years had a difficult time palpating my tumor and told me he would never have found it on examination because it was so small and high up on my chest! This illuminates the importance of knowing your body and seeking definitive answers. Always!
My best chances of survival beyond my treatment…
Because I am susceptible to unrepaired DNA damage, which is how cancer develops, my greatest chances of survival are, you guessed it, avoid DNA damage! Of course, this is easier said than done and I can’t live in a bubble, but I can take charge of my health in several ways:
First, GUT HEALTH! Any imbalance can lead to dysbiosis which is linked to several chronic conditions, including cancer. The intestinal microbiota aids in the breakdown of food products into absorbable nutrients, accelerates the immune system, prevents growth of harmful bacteria, and produces a number of biologically important nutrients essential for health. I have battled gut issues my entire life due to undiagnosed Celiac disease, severe endometriosis, and SIBO(likely a result of the first two!). For many years I suffered from chronic constipation and bowel obstructions. This is harmful since regular elimination prevents toxins from sitting in your intestines and recirculating. Toxins are great at damaging your DNA, so you definitely don’t want them hanging out!
Second, ENVIRONMENT! I no longer bathe in the sun. I have had four close calls with precancerous moles that were said to be “days from turning to full blown melanoma”. I spent endless hours bathing in the sun in my teens and twenties never knowing that all of that sun damage was not going to be repaired well, if at all. I will pay that price for years to come! I try to minimize my toxic exposure by using natural, plant-based formulas for cleaning my home and washing my skin and hair when I can. Whatever your skin comes in contact with, you can absorb! Air purifiers and water filtration systems are also found throughout my home. Regular, moderate exercise and stress reduction fall into this category as well. Chronic stress wreaks havoc on health and fosters inflammation which is heavily linked to chronic disease states including cancer.
I was counseled by a dietitian at Memorial Sloan Kettering after my diagnosis. I was given a couple excellent tips that I will share here:
Soy does not increase estrogen or risk of cancer. While estrogen can fuel certain cancers, such as my breast cancer as I mentioned above, our body’s estrogen is different from the type of estrogen found in soy, which is called phytoestrogen.
The WORST foods you can consume in excess include alcohol, refined sugar, and red or processed meats. I was advised that drinking alcohol should be done in moderation, sugar intake should be minimal, red meat should be consumed no more than once per week, and processed meats apparently should be avoided as much as possible. To my dismay, this includes bacon! How dare them!
I hope sharing my story will inspire everyone who reads this to take charge of their health. You do not need a gene mutation to accumulate DNA damage, and some people will get cancer without any known pathogenic gene mutation. Likewise, not everyone with a gene mutation develops cancer.
It is important to add that breast and ovarian cancer can also be caused by gene mutations other than BRCA1 and BRCA2. If your family has a strong history of breast or ovarian cancer, you and your family members are more likely to have a BRCA1 or BRCA2 mutation. If one of your immediate family members has a known BRCA1 or BRCA2 mutation, it is strongly recommended that the other immediate family members get genetic testing. Knowing can save your life!
