Managing risk through testing, genetic counseling
Charlene Cunningham isn't giving breast cancer a chance.
Two of Charlene's great-aunts died of breast cancer, her grandmother died of ovarian cancer, two aunts are breast and ovarian cancer survivors, and a second-cousin has been diagnosed and treated for breast cancer more than once.
"Cancer has been lurking over my shoulder my entire life," says Charlene, 40.
Charlene and her sisters and cousins were tested for breast cancer risk, and 16 of the 20, including Charlene and three sisters, tested positive for the breast cancer susceptibility gene, BRCA.
About 5 to 10 percent of breast cancer is hereditary, often caused by a mutation in the BRCA1 or BRCA2 gene. Risk increases in families with cases of breast cancer and cases of both breast and ovarian cancer.
The Banner MD Anderson Clinical Cancer Genetic Program in Gilbert coordinates genetic testing and health surveillance for patients with hereditary cancer syndromes. The Breast Cancer Program offers services in screening, treatment, support and recovery.
Counseling before and after genetic testing is vital, says Mary Cianfrocca, DO, FACP. Cianfrocca is Director of Banner MD Anderson's Breast Cancer Program and is Medical Director of the Clinical Cancer Genetics Program.
Genetic counseling reviews a woman's personal and family history to determine the appropriate type of testing and, secondly, discusses the implications of potential test results, so the woman can decide whether to be tested, Cianfrocca says. "That is the first decision that women need to make when they have a family history," Cianfrocca says.
Even if a patient's test results are negative, counseling afterward is important to determine whether additional testing is needed. Patients who test positive for a mutation will sit down with a medical oncologist for counseling about available treatments.
"If you have the information, you can decide how you want to manage your risk," Cianfrocca says. "The right decision for your neighbor might not be the right decision for you."
In addition to surveillance and medications, treatment options for patients with a genetic mutation includes prophylactic, or preventive, surgery. A prophylactic mastectomy lowers breast cancer risk by as much as 90 percent. The prophylactic salpingo-oophorectomy, which removes fallopian tubes and ovaries, lowers breast cancer risk by 50 percent.
Breast reconstructive surgery options include "direct to implant," with full reconstructive surgery immediately folowing the mastectomy. Also, "expanders" can be inserted in a surgery following the mastectomy. The expanders slowly fill over time, and implants are inserted in a final surgery.
Charlene and her sisters chose to have surgeries to reduce their risk. One sister will travel from out of state for a mastectomy at Banner MD Anderson in September.
Charlene had a salpingo-oophorectomy in 2012. She went to Banner MD Anderson in April for a double mastectomy and initial reconstructive surgery.
"I have two more follow-up appointments, final reconstructive surgery at the end of August and, then, done," Charlene says.
Charlene is a high school teacher and part-time community college instructor raising 10-year-old twin sons and a daughter, 14, on her own. "I have to be there for those babies of mine," she says.
She adds, for a cancer patient, Banner MD Anderson is the place to be.
"I have loved everything about it," she says. "I have a team of doctors. They meet to discuss this comprehensive care. You can do all the blood work here, the surgery prep, everything. I'm so lucky I have this place."