Angelina Jolie has given St. Vincent Healthcare a gift that money could not buy.
The Oscar-winning actress’s stunning revelation that she had a prophylactic double mastectomy due to a genetic cancer risk has thrust to center stage the issue of specific genes being linked to the development of both breast and ovarian cancers.
Jolie’s announcement comes as St. Vincent Healthcare this month launches the Risk Assessment Prevention Program at the Yellowstone Breast Center. The program, a year in the making, is reportedly the first of its kind in the region. The goal of the program is to identify women who are at high risk of breast and ovarian cancer because of their family history of cancer or personal medical history and who can benefit from an individualized preventive health care plan.
Jolie revealed in May in an op-ed piece in the New York Times that she carries the “faulty” BRCA1 gene and opted to have her breasts removed as a preventive measure. She said her decision was informed by her mother’s long fight against cancer and she had an 87 percent risk of breast cancer, along with a 50 percent risk of ovarian cancer.
BRCA1 stands for breast cancer susceptibility gene 1. Everyone has the BRCA1 and BRCA2 genes, which were discovered in the mid-1990s. They normally help protect the body against the development of cancer. Individuals with mutations in either of these genes have increased cancer risk, most notably for breast and ovarian cancer.
Women with a faulty BRCA1 gene have an average of a 65 percent lifetime risk for breast cancer, along with heightened risk of the cancer at an early age.
There are a lot of women who have never heard of BRCA 1, said Dr. Kathleen Ryan, a radiologist at St. Vincent Healthcare. Jolie went public with her decision to make women aware that there are certain conditions that predispose you to having breast and ovarian cancer. She went public as a way of informing people and educating people.
“It was perfect timing on her part,” Ryan said. “That’s basically what we’re trying to do. We’re trying to educate women that you could be at risk.”
Most women are not at risk, Ryan said, but they would like to find the women who are and counsel them before they are diagnosed with cancer.
“It’s not important for a lot of people but for the people who have the genetic predisposition, it is very important,” Ryan said.
About one in 500 to one in 1,000 individuals will carry a mutation or a gene change in one or another of these genes. Certain populations are more likely to carry the genetic mutation. Ashkenazi Jews of Eastern European ancestry have about a one in 40 chance of having the mutated BRCA gene, considerably higher than the general population.
Most breast cancers, Ryan said, are “bad luck.”
About 39,620 women will die this year from breast cancer, according to the American Cancer Society. Breast cancer is the most common cancer among women in the United States, other than skin cancer. It is the second leading cause of cancer deaths in women, after lung cancer.
Other health care facilities will do genetic testing once you’re diagnosed with cancer. That’s very common – locally and everywhere, Ryan said. But it’s not done as a screening, which is where St. Vincent Healthcare wants to make inroads.
“We have a strong program to identify those women at increased risk for having a genetic predisposition of BRCA1 or BRCA2 genes that play a role in cancer genetics,” said Karen Stears, a genetic counselor at the Yellowstone Breast Center.
The screening program begins when a woman comes in for her annual mammogram. She will be asked a series of detailed questions about her family’s history of cancer and her personal medical history. Each patient’s risk will be determined using a statistical program.
“We have 10,000 to 12,000 women come through here every year for a screening mammogram,” Ryan said. “This gives us the opportunity to grab 10,000 to 12,000 women every year and ask them these questions.”
Health care providers will look at a patient’s short-term and lifetime risk for breast cancer as well as her risk for having inherited a genetic predisposition to cancer. Based on the results, an individualized preventive health care plan will be developed. To reduce the risk of cancer after a positive result, a woman might increase the frequency of her breast exams, use oral contraceptives, or take a medication to reduce the risk of cancer or undergo preventive surgery.
Preventive surgery doesn’t eliminate all cancer risk, but it reduces breast cancer risk by about 90 percent. Removing healthy fallopian tubes and ovaries reduces breast cancer risk by 50 percent in premenopausal women, and it reduces ovarian cancer risk by more than 90 percent in both pre- and postmenopausal women.
“This is powerful work,” Stears said. “We can detect breast cancers earlier, delay the cancer, or prevent it entirely.”
The test, which costs $4,700, can either be done with a blood test or buccal wash, a noninvasive, mouthwash method to collect buccal cells to get a DNA test. In many instances the cost is covered, either in part or in full, by insurance carriers. Medicare and Medicaid will also cover the cost if the person has already been diagnosed with cancer, not if you simply want to be tested based on family history of breast and/or ovarian cancer, Stears said.
The chance of breast and ovarian cancers being linked to the mutated genes are highest among the following families: those with a family history of breast or ovarian cancer, early onset of breast cancer in one or more female relatives before age 50, breast and ovarian cancer in a single relative, family members developing cancer in both breasts and a male relative with breast cancer.
“I never thought I’d be in the same club as Angelina Jolie,” Teresa Wicks of Billings said, pumping her fists in the air.
Wicks, 57, was diagnosed with breast cancer in 2009 and subsequently was offered the BRCA1 test because of her family history. Her mother died at age 52 of endometrial and lung cancer. Her maternal grandmother died of gynecological cancer. Four maternal aunts died of breast and gynecological cancer. Both a first and second cousin also died of breast cancer.
When she was first diagnosed, Wicks, an assistant professor at Montana State University-Bozeman, had a lumpectomy.
“I was not ready to face a full mastectomy even though I knew I wanted to do that in the long run,” Wicks said. She knew she was at increased risk for an aggressive reoccurrence.
Wicks went on to have a double mastectomy, reconstructive surgery and an oophorectomy, which is removal of the ovaries.
“I just decided to do everything I can because I have a lot left to do in my life and I’m not ready to go yet.” Wicks said.
Wicks, who talked candidly about her diagnosis and aftermath, said that she did not want to be the focus of the story. The story, she said, is about what women and their families need to know. She applauded the launch of St. Vincent’s Risk Assessment and Prevention Program.
“It’s important for patients to have someone who’s asking the questions,” Wicks said. “That’s the best hour I’ve ever spent. This is knowledge and knowledge is power.”