Discovering Your Cancer Risk
- National TV Correspondent Alison Hall, who works for Inside Edition, is grateful for actress Olivia Munn for having “played a role in saving my life”—as she led her to undergo a Breast Cancer Risk Assessment, ultimately leading to her stage zero breast cancer diagnosis.
- Hall chosen to undergo a double mastectomy to have her cancer removed and a significantly decreased risk of breast cancer. She has since returned to work and is working to encourage other women not to neglect their breast health.
- The Breast Cancer Risk Assessment Munn credits to saving her life is a “statistical model that allows healthcare professionals to calculate the probability of a woman developing breast cancer throughout their lifetime,” Dr. Ruth Oratz, breast medical oncologist at NYU Langone, tells SurvivorNet. It assesses a woman’s age, family history with breast cancer when she first had a menstrual period, and her reproductive history to determine her risk of breast cancer.
- Genetic testing for breast cancer is done to determine if a person has a specific mutation that puts them at a higher risk of developing cancer.
- Like anything in life, there are limitations to genetic testing for breast cancer, specifically the commercially available tests women can take. And one of those limitations is the lack of genetic counseling available to people who receive positive results on a genetic test.
Hall, who describes herself as a “storyteller, people connector and dog love” on social media, took to recently shared her breast cancer story in an effort to spread awareness for others like herself and encourage other women to stay on top of their breast health.
Read MoreThe Breast Cancer Risk Assessment they both credit for catching their breast cancer is a “statistical model that allows healthcare professionals to calculate the probability of a woman developing breast cancer over the course of their lifetime,” Dr. Ruth Oratz, breast medical oncologist, NYU Langone Health’s Perlmutter Cancer Center; clinical professor of medicine, NYU Grossman School of Medicine tells SurvivorNet.
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She explained in a recent Instagram post, featuring a photo of her inside a doctors office, “Last spring, after @oliviamunn shared her story about her breast cancer journey, the producers at @insideedition assigned me to the story and sent me to a breast cancer doctor here in NYC to undergo testing, on-camera. Inspired by Olivia, I took the Breast Cancer Risk Assessment Test.
“After my risk was revealed to be high, the wonderful doctor at @lenoxhillhospitalnyc encouraged me to start a schedule of yearly mammograms and MRI’s. I was prepared to do this for a long time and had no idea just how quickly this story would change my life.”
She continued, in her January 8th post, “In October, I had my first breast MRI and a few weeks later just before I turned 33, I became one of millions of women to hear the words ‘you have breast cancer.’ Thankfully, it was followed by ‘it’s stage zero,’ it has not spread. I have an early form of malignancy called DCIS. As you can imagine, I have been on a rollercoaster ride of fear, anxiety, dread AND gratitude.
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“My husband reminds me that this is ‘the best, bad news’ we could have gotten. For many reasons including my family history of breast cancer and my own history of breast abnormalities, I’ve decided to not only tackle the current cancer head-on but dramatically reduce my risk of future breast cancer. I’ve chosen to undergo a double mastectomy with reconstruction, next week.”
It’s important to note that stage zero breast cancer or ductal carcinoma in situ, which Hall was diagnosed with, are abnormal cells that line the duct in a breast. A normal breast comprises many ducts carrying milk to the nipple in a lactating woman. This type of breast cancer is not invasive, meaning it has not spread outside the milk duct and can’t invade other parts of the breast.
Some oncologists approach stage zero breast cancer with a watch-and-wait approach, meaning no invasive procedure happens immediately. Other oncologists may opt to perform surgery followed by possible radiation.
SurvivorNet experts say if DCIS is left untreated, it may develop into more advanced breast cancer. However, it’s important to understand that treatment for early-stage breast cancer is one of the great debates—and recently, there was incredible progress in understanding whether women diagnosed with stage zero breast cancer either need treatment right away or can take a watch-and-wait approach.
WATCH: I Have Stage Zero Breast Cancer: What Should I Do?
Hall concluded, “I consider this experience a gift. I *get* to do this for my future self, for my future children. I have some of the best family, friends, dog, therapist, doctors and colleagues in the world who have shown up for me and provided more love than I could imagine.
“I believe in the power of storytelling.Olivia Munn sharing her story saved lives. It certainly had a part in saving mine. I’m sharing my story with the same hope. Take the Breast Cancer Risk Assessment test (with your doctor or online) and use the information to advocate for yourself. Early detection and prevention is the goal. What I know for sure — I’m going to be okay, and for that, I’m very, very grateful.”
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Hall, who chose to undergo a double mastectomy and a two-part breast reconstruction, has since returned to work and using her experience to raise breast cancer awareness.
She wrote alongside another Instagram post, “Ever since I shared my story publicly, I haven’t felt alone for a single second so it feels right to continue to take you along for the ride.
“I’m so grateful for the continued opportunity to shed light on my mastectomy experience and highlight the importance of early detection.”
Expert Resources On Early Detection & Cancer Screenings
- How to Avoid False Positive Cancer Results in Women With Dense Breasts: Ultrasounds Used in Addition To Mammograms
- 6 Common Excuses for Skipping a Mammogram That You Need to Stop Using!
- The Mammogram Debate: Should Women Start Breast Cancer Screening at 30?
- Breast Cancer: Introduction to Prevention & Screening
- Mammograms Are Still the Best Tool for Detecting Breast Cancer — A Warning About Thermography
- Breast Cancer Risk For Post Menopausal Women — Taking Hormones Can Increase Your Risk
- A New Recommendation Adds To The List Of Drugs That Can Lower Breast Cancer Risk For Women With High Risk Of Developing The Disease
Despite her recent cancer journey, Hall has maintained optimism and is channelling life’s difficulties into becoming more resilient and a role model to others.
She wrote alongside footage of her showing what “cancer can look like” to encourage anyone going through a cancer journey to know that life can still continue on as normal because life doesn’t stop after a diagnosis.
“I spent the last few months navigating doctor’s appointments privately while working the on-air TV job that I absolutely love. Sometimes I would laugh or catch myself off guard by noticing the juxtaposition of being in a painful examination room to an hour later standing under lights with a camera in my face,” she explained in another post.
“I was so grateful to work during that time, it distracted me and supported me but it occurred to me that we all do this – no matter what you’re dealing with, you just keep showing up. It’s allowed me to look at the world and the people in it with a lot more empathy and grace. I hope I can share that with you.”
We’re glad to see Hall has since had a successful mammogram and is continuing to excude confidence despite having lost her natural breasts.
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Olivia’s Breast Cancer Diagnosis & Journey
Munn’s breast cancer diagnosis emerged despite receiving a “normal” mammogram and testing negative for the BRCA-gene mutation, which increases your risk for breast and ovarian cancer.
At the suggestion of her OBGYN, the “X-Men” actress underwent a Breast Cancer Risk Assessment, which helps determine a woman’s probability of getting breast cancer. Her results called for additional screening, which revealed she had an aggressive form of cancer in both of her breasts.
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“I wouldn’t have found my cancer for another year – at my next scheduled mammogram – except that my OBGYN…decided to calculate my Breast Cancer Risk Assessment Score. The fact that she did save my life,” Munn said in an Instagram post.
The Breast Cancer Risk Assessment she credits for catching her breast cancer is a “statistical model that allows healthcare professionals to calculate the probability of a woman developing breast cancer over the course of their lifetime,” Dr. Ruth Oratz, breast medical oncologist, NYU Langone Health’s Perlmutter Cancer Center; clinical professor of medicine, NYU Grossman School of Medicine tells SurvivorNet.
Munn underwent genetic testing to better understand her cancer risk. Genetic tests can be as simple as a simple saliva swab or blood sample. The results help your care team determine if you have a specific mutation that puts you at higher risk for cancer. The results help doctors tailor your treatment and are helpful for breast cancer patients.
“I tested negative for all (different cancer genes), including BRCA,” Munn said.
The BRCA1 and BRCA2 gene mutations are among the most important genes to look for in breast cancer. Together, they are responsible for about half of all hereditary breast cancers. These genes prevent cells from dividing haphazardly and uncontrollably in a person without mutations. Mutations prevent these genes from doing their job and can allow unchecked growth of breast, ovarian, and other tissues.
Two months after undergoing genetic testing, Munn was diagnosed with Luminal B breast cancer in both of her breasts.
Learning More About Breast Risk Assessment & Genetic Testing
The Breast Cancer Risk Assessment Munn credits for catching her breast cancer is a “statistical model that allows healthcare professionals to calculate the probability of a woman developing breast cancer over the course of their lifetime,” Dr. Ruth Oratz, breast medical oncologist, NYU Langone Health’s Perlmutter Cancer Center; clinical professor of medicine, NYU Grossman School of Medicine explained to SurvivorNet.
Genetic Testing for Breast Cancer: What is This Type of Test? And What Do My Results Mean?
As for genetic testing, it can be as simple as a simple saliva swab or blood sample. The results help your care team determine if you have a specific mutation that puts you at higher risk for cancer. Additionally, genetic testing aids doctors in tailoring your specific treatment, therefore very helpful for breast cancer patients.
BRCA Gene Mutations
When Olivia Munn said she “tested negative for all [different cancer genes], including BRCA,” she was referring to the BRCA1 and BRCA2 gene mutations, which are among the most important genes to look for in breast cancer.
How Testing For BRCA In Breast Cancer Works
Together, they are responsible for about half of all hereditary breast cancers. These genes prevent cells from dividing haphazardly and uncontrollably in a person without mutations. Mutations prevent these genes from doing their job and can allow unchecked growth of breast, ovarian, and other tissues.
Dr. Oratz says if the Breast Cancer Risk Assessment finds that a woman is at higher risk of getting breast cancer, she should expect further testing and screening. However, if a woman is positive for the BRCA gene mutation, a Breast Cancer Risk Assessment “is not really accurate.”
“Having information empowers patients,” Dr. Oratz added. “It is very important for people to be aware of the health risks, their family history, and their own personal medical conditions. All of these things can affect the risk of developing cancer.”
According to the National Cancer Institute, about “13% of women” in the general population will develop breast cancer sometime during their lives. By contrast, 55% to 72% of women who inherit a harmful BRCA1 or BRACA2 variant will develop breast cancer by 70 to 80 years of age.
Between 5% and 10% of breast cancer cases are thought to be hereditary. And about 10% of patients who undergo genetic testing will test positive for the BRCA1 or BRCA2 gene, Dr. Julie Rani Nangia, an assistant professor at Baylor College of Medicine, previously told SurvivorNet.
“The genetic BRCA1 and (BRCA)2 mutations, if a woman has one of these mutations … it puts her at basically the highest quantifiable risk for getting breast cancer,” Dr. Elisa Port, a surgical oncologist at Mount Sinai, also told SurvivorNet in an earlier interview.
“We typically say between the 60 (percent) and 80 percent range. Having a BRCA1 and (BRCA)2 mutation also means that that person is at higher risk of getting breast cancer at an earlier age, and also maybe at risk for other cancers like ovarian cancer, like pancreatic cancer for men, prostate cancer and male breast cancer may be a concern.”
Since the discovery of the BRCA mutations in the 1990s, doctors have gone on to identify many other gene mutations that put people at a higher risk of developing breast cancer.
“There’s actually eight to 10 genes that also can put someone at a higher risk for breast cancer,” Dr. Port says, adding that usually that risk isn’t as high as the BRCA mutations. These additional gene mutations include PALB2, ATM, TP53, CHEK2, PTEN, CDH1 and STK11.
Should I Get Genetic Testing to Assess My Risk for Breast Cancer?
“We call them more moderate penetrance genes and those genes, the risk of breast cancer associated with them can be anywhere from say 20 percent to 50 percent. … so still very high, but lower than the BRCA genes that were the ones we originally described.”
The PALB2 gene is a “moderate penetrance gene, and the risk of getting breast cancer with PALB2 can be a pretty broad range,” Dr. Port says. “And unlike the BRCA genes where we don’t really use the family history of who got breast cancer to affect the risk estimates, with PALB2, you really can dial up risk or dial down risk depending on how many relatives and the age of the relatives in the family got breast cancer.”
Limitations of Genetic Testing
Like anything in life, there are limitations to genetic testing for breast cancer, specifically the commercially available tests women can take. One of the most common types of commercially available tests is from 23andMe, a genomics and biotechnology company, as well as tellmeGen and MyHeritage genetic tests.
“There’s only a cadre of them that are approved and accurate and there can be both false positives and false negatives, so it really depends,” Dr. Port says. “If someone is suspicious of having one of these genes (mutations) and gets tested through one of what we call the direct to consumer type tests, it is important that those testing results may need to be verified before doing something irreversible based on those results.”
In other words, if you take one of these tests without your doctor’s knowledge, and you receive some concerning results, make sure you discuss those results with your doctor before taking your next steps.
The other limitation to genetic testing is genetic counseling. Dr. Port says this is the most critical part of genetic testing. What does genetic counseling mean? Well, if you get a positive result back, how are you going to cope with that news?
“If someone gets a genetic test result back, it’s really important for them to know what is this? (What does this) mean for them? Put it into context.”
“What does it mean for their family members? For their relatives? Genetic counseling to follow up genetic testing is a really, really important part of the whole process and is not always available in the direct to consumer type avenue.”
Based on your personal and family health history, your doctor can refer you for genetic counseling, according to the U.S. Centers for Disease Control and Prevention.
What to Know About Screening For Breast Cancer
The medical community has a consensus that women between 45 and 54 have annual mammograms. However, an independent panel of experts called the U.S. Preventive Services Task Force (USPSTF) is saying that women should start getting mammograms every other year at the age of 40, suggesting that this lowered the age for breast cancer screening could save 19% more lives.
WATCH: Screening for Breast Cancer
For women aged 55 and older, the American Cancer Society recommends getting a mammogram every other year. However, women in this age group who want added reassurance can still get annual mammograms.
Women who have a strong family history of breast cancer, have dense breasts, have a genetic mutation known to increase the risk of breast cancer, such as a BRCA gene mutation, or a medical history, including chest radiation therapy before age 30, are considered at higher risk for breast cancer.
Experiencing menstruation at an early age (before 12) or having dense breasts can also put you into a high-risk category. If you are at a higher risk for developing breast cancer, you should begin screening earlier.
Breast density is determined through mammograms. However, women with dense breasts are at a higher risk for developing breast cancer because dense breast tissue can mask potential cancer during screening. 3D mammograms, breast ultrasound, breast MRI, and molecular breast imaging are options for women with dense breasts for a more precise screening. It is important to ask your doctor about your breast density and cancer risk.
Although breast cancer can happen to anyone, certain factors can increase a person’s risk of getting the disease. The known risk factors for breast cancer include:
- Older age
- Having a gene mutation such as the BRCA1 or BRCA2
- Added exposure to estrogen
- Having children after the age of 30
- Exposure to radiation early in life
- Family history of the disease
About ten percent of breast cancers are hereditary, says Dr. Ophira Ginsburg, Director of the High-Risk Cancer Program at NYU Langone’s Perlmutter Cancer Center.
“We encourage only those who have a family history to really get [genetic testing],” Dr. Ginsburg previously told SurvivorNet.
“I would say that if you have anyone in your family who was diagnosed with a very rare cancer. Or if you have a strong family history of one or two kinds of cancer, particularly breast and ovarian, but also colon, rectal, uterine, and ovarian cancer, that goes together in another cancer syndrome called the Lynch Syndrome,” Dr. Ginsburg adds.
Contributing: SurvivorNet Staff
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