Earlier this year, Angelina Jolie, Oscar-winning actress and mother of six, shared her personal story and connection with breast cancer.
Jolie's mother had been diagnosed with both breast and ovarian cancer by the time she was 48. Her mother, Jolie's grandmother, died of ovarian cancer at age 45. Jolie's maternal aunt was diagnosed with breast cancer in her 50s.
Recognizing her strong family history of both breast and ovarian cancer led Jolie to genetic counselling and gene testing. She was found to carry a "faulty" gene, a BRCA1 mutation, which significantly increased her likelihood of developing both breast and ovarian cancers.
As a result, Jolie opted to have a double mastectomy, followed by breast reconstruction to reduce her risk of developing breast cancer.
Jolie's story certainly helped raise awareness about family history and breast cancer. After she went public, the number of referrals for genetic counselling regarding breast cancer risks to the Winnipeg Regional Health Authority's Hereditary Cancer Clinic more than doubled (from 108 to 243 in the four months following her statement compared to the same period in 2012).
Yet many women remain uncertain about the role family history plays in the development of breast cancer or whether they, too, should be concerned about "faulty" genes.
Here is where the WRHA's Breast Health Centre can help. As the only multidisciplinary breast health clinic in the city, it provides diagnostic and surgical consultations and education and support services. It is a great resource for women seeking to navigate the issues surrounding their breast health.
Women (and men) are encouraged to investigate the history of cancer on both sides of their family and discuss it with their health-care provider. A referral for genetic counselling and cancer risk assessment to the Hereditary Cancer Clinic, part of the WRHA's Genetics and Metabolism Program, may be warranted if there is a strong family history of early onset breast cancer.
It is important to remember that having a family history of breast cancer does not automatically mean you have inherited the "flawed" gene or will develop the disease.
Consider these facts. Statistics show one in nine women will develop breast cancer in their lifetime. Only five to seven per cent of breast cancers and 10 per cent of ovarian cancers are hereditary. In other words, you are more likely to develop breast or ovarian cancer for other reasons. The biggest risk factor is aging -- more than 50 per cent of breast cancer occurs in women 50 to 69 years old.
When a breast cancer develops due to inherited factors, it is usually through mutations in one of two genes -- BRCA1 and BRCA2. Yet the chances of carrying a BRCA mutation remain low, even for women with a history of breast or ovarian cancer in the family.
For those women who do inherit a BRCA gene mutation, research shows they have an estimated lifetime risk of 50 to 87 per cent for developing breast cancer and a 10 to 60 per cent risk for ovarian cancer.
In Manitoba, individuals with a personal and/or family history of breast or ovarian cancer meeting established criteria are offered BRCA gene testing, which is covered by provincial health care.
About 100 Manitobans are offered full BRCA gene analysis each year. Only a small percentage (20 per cent) will have a disease-causing BRCA gene mutation. In Manitoba, approximately 50 per cent of women with a BRCA mutation choose to undergo a double preventive mastectomy.
While the procedure is not a guarantee against breast cancer, it will reduce the risk by more than 90 per cent. Women who forgo surgery will need close surveillance, including regular breast exams, mammography and MRI to potentially diagnose cancer at an early stage. Some women opt for medication to reduce their risk, but these drugs have side-effects and are not well studied in this group. Choosing one option or another is not easy. It will depend on a person's experiences, stage in life, perceptions about risk and attitude about body image. What was the right choice for Jolie may not be for others. Angelina Jolie's story underscores the fact no one is exempt from the threat of breast cancer, and it also shows the difficult choices women who carry a BRCA gene mutation are willing to make.
Susan Dennehy is a clinical nurse specialist at the WRHA Breast Health Centre. Kim Serfas is a cancer genetic counsellor with the WRHA Genetics and Metabolism Program.