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When I was 12, my vivacious, beautiful 33-year-old mother disappeared for a month. Only weeks later did I learn that she had breast cancer. My aunt developed breast cancer at 36, and my mother, after beating breast cancer in her 30s, was diagnosed with ovarian cancer at 46.
I knew our family had a “gene.” At the time, the BRCA gene had not yet been identified, but I didn’t need science to tell me we had it, only common sense.
With my family history, I knew breast cancer would become a significant part of my world. Breast cancer inspired my zealous commitment to a career in medicine and more specifically, to becoming a breast cancer radiologist. Today, I am the director of breast imaging and intervention at George Washington University.
As part of my job, I am charged with picking ultrasound equipment. I would ask the vendors to bring it in and try it out on myself. On one night in 1996, I found my own breast cancer at just 37 years old. I have the BRCA gene mutation and so do my daughters. Here are the things I've told them and what I want other women to know.
1. You can get the BRCA gene mutations from your mother or father.
The BRCA gene is an autosomal gene, which means you can get the gene from your mother or your father. In fact my mother undoubtedly inherited the gene mutation from her father. Her mother lived well into her 90s without ever having cancer.
Don’t be misguided in thinking that if breast cancer runs in your father’s family, you are protected. You are not. In fact, if either one of your parents has a breast cancer gene mutation, you have a one in two chance of inheriting it.
2. All populations do not have the BRCA gene mutation equally.
All populations DO NOT have the same prevalence of breast cancer gene mutations. In the general population, one in 400 women carry the gene mutation. In some populations, the gene mutation is much more common — like Ashkenazi Jews, where one out of 40 women carry a BRCA gene mutation. Some think that all women in populations with higher incidence should be tested for the gene.
3. Men can get breast cancer, too.
One percent of breast cancer in the U.S. occurs in men. Men with the BRCA 2 gene mutation get breast cancer as frequently as women in the U.S. and therefore some men with this particular mutation should consider getting screened.
4. For women with BRCA mutations, screening for breast cancer involves more than mammography.
In women with the BRCA gene mutation, mammography alone is not enough. While most women should begin breast cancer screening at 40 with annual mammograms, women with the BRCA gene mutations should begin at age 25 with MRIs — since an MRI can detect early, smaller cancers than mammography alone, especially in women with the BRCA mutation.
The role of mammography in BRCA mutation carriers is somewhat controversial. However, as it stands now, women with BRCA 2 mutations should get annual mammograms. Women with BRCA 1 should discuss screening strategies with a radiologist or oncologist who is expert in breast cancer.
5. Women can have children after preventative mastectomies.
Breasts are needed to make milk, not children. Many young women undergo prophylactic mastectomies and can safely and happily have children following this surgery. They just can't nurse.
6. If you come from a family that has members with breast cancer, consider seeing a genetic counselor.
Genetic counselors are experts in gene mutations. They are there to help and they are extraordinary. They help work out a path forward with you in considering whether you should be tested for the gene.
Testing for the BRCA gene mutation, or other genes does not always require a blood test. Often, a saliva sample works equally well. A a number of commercially available saliva or low-cost tests can test for the gene. These tests are accurate, but I would recommend you seek the advice of a genetic counselor since they can be critical in understanding the overall situation for you.
7. Remember that no one has a perfect set of genes.
If you do find out you have a genetic mutation that increases your risk of breast cancer, remember: No one is born with a perfect set of genes. We just know what the mutations are. Women with the BRCA gene mutation can —and often do — live long, happy and healthy lives.
Pink Power on TODAY is sponsored by the Genius 3D Mammography Exam. Dr. Rachel F. Brem is the director of breast imaging at George Washington University, and the founder of The Brem Foundation, an nonprofit organization devoted to helping women find breast cancer early.