Screening and acting quickly is key when it comes to finding out you have breast cancer, according to a 30-year-old woman who noticed a lump earlier this year when she was breastfeeding her third child.
By the time she arrived at Cleveland Clinic Abu Dhabi, the woman had already undergone a screening mammogram and biopsy. Further investigation with genetic counseling found a mutation in BRCA1, a breast cancer-susceptible gene.
Women who have BRCA1 or BRCA2 mutations can have up to a 72 percent risk of being diagnosed with breast cancer during their lifetime, according to the latest research. Additionally, breast cancers associated with these mutations develop at a younger age and more often in both breasts. Patients also have an increased risk of ovarian, colon and pancreatic cancers.
“When I first found the lump, I thought it was due to breastfeeding,” said the woman, who prefers to remain anonymous in her recovery. “But when it persisted and began to grow, I got worried. It never crossed my mind that I might have cancer, because I’m young and had just had a baby. I was in denial. When doctors at Cleveland Clinic Abu Dhabi informed me about the mutation, I felt naïve, because my mother had the same issue and I completely ignored the risk. I saw her go through all the same stages and pain that I went through. I won’t make the same mistake with my girls.”
Based on the woman’s medical history, the care team at the hospital decided to start her on preoperative chemotherapy first, explained Dr Ellie Choufani, an oncologist who is part of Cleveland Clinic Abu Dhabi’s Breast Health Clinic.
“Her full-body CT scan did not reveal any disseminating cancer, but because her tumor was slightly enlarged with an involvement of the lymph nodes, we decided to go with eight cycles of chemotherapy first,” he says.
In the meantime, the clinic also referred her for genetic counseling to assess all her risk factors and determine the right treatment plan.
Dr Stephen R. Grobmyer, chair of the Oncology Institute at Cleveland Clinic Abu Dhabi, says genetic counseling becomes a particularly useful tool if the patient is young.
“This is an important service that enables us to look for abnormal gene mutations, so that we can offer surgery to address the current cancer and provide proactive management options to the patient,” he explains. “Additionally, now her family can get tested as there is a 50 percent chance that her siblings and children who may not have cancer carry the same mutation. We recommend that her children get tested after they turn 20 years of age.”
The patient underwent a preventative double mastectomy and was counseled about the possibility of removing her ovaries and fallopian tubes in a few years to reduce the risk of ovarian cancer.
“I was in shock and the whole world stopped when they told me about this,” she said. “But I realized that this was the best decision for my health and long life. I got my breast reconstruction at the same time and am currently undergoing radiation therapy. Doctors said that waiting to remove the ovaries would be a good idea as I am under the age of 40, and to prevent other issues, such as bone loss. I trust their judgement and will continue to follow up.”
The age of 40 is an important marker, explains Dr Choufani, as that is when the risk of ovarian cancer increases by 60 percent in patients with these mutations.
The patient credited her doctors and her husband with getting her to the other side of surgery and treatment.
“The doctors at Cleveland Clinic Abu Dhabi have been amazing in helping me get back on track,” she said. “But my husband has been my greatest support. He has comforted me every step of the way, especially during the tough chemotherapy sessions. My entire family has also helped boost my morale and strength.”
Mostly she wants everyone to understand that early intervention can make a big difference.
“Don’t wait! If you find something abnormal, go to your doctor immediately. Health issues can happen at any age. I have two girls and I promise to start taking them for regular checkups.”
• Story provided by Cleveland Clinic Abu Dhabi
Ann Marie McQueen
Ann Marie McQueen is the founding editor-in-chief of Livehealthy and host of The Livehealthy Podcast. She is a veteran Canadian digital journalist who has worked in North America and the Middle East. Her past roles include features editor for The National, trends writer and columnist for the Canadian newspaper chain Sun Media, and correspondent for CBC Radio.