Breast Cancer: A Heavy Burden to Bear

With no history of breast cancer, I was shocked to learn that I was the first in my family to be diagnosed with the disease. As the mother of three daughters and grandmother of two granddaughters, I was consumed with fear when I received my initial diagnosis. Just knowing that I might be the one to pass on this terrible disease to one of my loved ones made me shudder. As parents, we want to pass on good things to our children. We’re proud when they exhibit hereditary family traits such as beautiful thick hair, perfectly straight teeth or big brown eyes, but heaven forbid we pass on hereditary tendencies toward genetic imperfections and disease. It was a very heavy burden to bear.

I talked with my oncologist about my concerns. He assured me that since my mother or grandmother didn’t have breast cancer, the likelihood of my carrying one of the gene mutations that contribute to breast cancer was very small. But even after speaking with him and sharing my concerns, I still worried. I didn’t want one of my girls to ever experience what I’d been through. I never wanted any of them to discover a lump in their breast. The only way I knew to help them was to become very knowledgeable about the risk factors associated with breast cancer and to share what I found with them. Since there was no evidence of a history of breast cancer in my family, my oncologist did not feel it necessary to test me for genetic mutations. I wasn’t sure he was making the right decision, but I trusted him and he definitely knew much more about breast cancer than I did.

In an article by the National Institute of Health, the following is stated:

“Most cases of breast cancer are not caused by inherited genetic factors. These cancers are associated with somatic mutations in breast cells that are acquired during a person's lifetime, and they do not cluster in families. In hereditary breast cancer, the way that cancer risk is inherited depends on the gene involved. For example, mutations in the BRCA1 and BRCA2 genes are inherited in an autosomal dominant pattern, which means one copy of the altered gene in each cell is sufficient to increase a person's chance of developing cancer. Although breast cancer is more common in women than in men, the mutated gene can be inherited from either the mother or the father. In the other syndromes discussed above, the gene mutations that increase cancer risk also have an autosomal dominant pattern of inheritance. It is important to note that people inherit an increased likelihood of developing cancer, not the disease itself. Not all people who inherit mutations in these genes will ultimately develop cancer. In many cases of breast cancer that clusters in families, the genetic basis for the disease and the mechanism of inheritance are unclear.”

I felt a little better after reading that article, but wanted to understand more about risk factors associated with breast cancer and how they might affect my children. If there was anything I could do to protect them from the possibility of contracting the disease, I wanted to do it. I continued to dig for answers and found that there are many risk factors associated with breast cancer. Some of those factors are within our control and some are not. On this website the following are listed:

· Age: Most cancers develop in women over the age of 50, and the risk of developing breast cancer increases as a woman ages.

· A family history of breast cancer: Breast cancer may be hereditary in a family if one or more of these characteristics are found: First-degree relatives diagnosed with breast cancer or ovarian cancer before the age 50, a family member with breast cancer in both breasts or a male relative with breast cancer.

· An inherited risk: There are several genes linked to increased risk of breast cancer. The most common gene mutations are BRCA1 or BRCA2. Other genes may also cause an increased risk of breast cancer and these may be discovered through genetic testing.

· A history of ovarian cancer: A personal history of ovarian cancer may indicate an increased risk of breast cancer if the cancer was due to an inherited mutation.

· Exposure to hormones: Estrogen and progesterone control the development of women in puberty. They are also very important for a healthy pregnancy. A woman’s production of these hormones decreases with age. Long-term exposure to estrogen and progesterone increase the risk of developing breast cancer. Women who began their menstrual cycle at an early age, usually before 11 or 12, or those going through menopause after the age of 55 have a slightly higher risk of developing breast cancer due to breast cells being exposed to estrogen and progesterone for a longer period of time. Women who had first pregnancies after the age of 35 or those without a full-term pregnancy are at higher risk of developing breast cancer.

· Use of hormone replacement therapy: The use of hormone therapy containing estrogen and progestin after menopause increases a woman’s risk of breast cancer.

· Use of birth control pills: There are studies that have suggested oral contraceptives may slightly increase the risk of breast cancer. Research is still being done in this area.

· Lifestyle: Studies have shown that there are various lifestyle factors that can contribute to the development of breast cancer. These include diet and other socioeconomic factors.

· Obesity: Postmenopausal women who are obese have an increased risk of breast cancer, and have a higher risk of having the recurrence of cancer after treatment.

· Physical activity: Increased physical activity has been shown to decrease the risk of developing breast cancer, and studies have shown there is a lower risk of a recurrence of cancer after treatment. Physical activity may help protect against breast cancer by helping women stay at a healthy body weight, by lowering the levels of hormones, or by changing a woman’s metabolism or immunity.

· Alcohol: Studies indicate consuming more than one or two alcoholic drinks per day can raise the risk of breast cancer or cancer recurrence.

· Exposure to radiation: Exposure to radiation at a young age may increase the risk of breast cancer.

· Dense breasts: Dense breast tissue can make it difficult for tumors to be seen on standard imaging tests such as mammograms.

There have been many breast cancer risk assessment tools developed. One of the best tools available, I believe, is the Gail mModel, available on the National Cancer Institute’s website. By entering some personal information, the tool can provide an estimate of the risk of developing invasive breast cancer over the next five years or longer. This is a valuable diagnostic tool, but it’s very important for a woman to talk with her doctor to discuss all risk factors related to her health.

I wanted my girls to feel secure so I talked to them and asked how they were feeling about my breast cancer. Since we don’t know if I carry a gene mutation like BRCA1 or BRCA2, I asked if they were afraid of being diagnosed in the future. My oldest daughter is 34 and knows next year she’ll need to have her baseline mammogram performed. She told me she thinks about cancer everyday but doesn’t want to live in fear. My middle daughter is 32. She hasn’t talked about her feelings on the subject at all, and that really bothers me. I wonder if she is afraid to voice her concerns because she feels like she’d be blaming me for possibly passing the genetic predisposition toward breast cancer on to her, or if she’s just keeping quiet to avoid facing the reality that perhaps one day she or one of her sisters may be diagnosed. My youngest daughter told me she worried about getting cancer all the time. At 28, she’s already thinking about having to plan her first mammogram, even though my oncologist said she could wait until 35 to start having them. It upsets me knowing I’ve caused them undue stress and worry. I’m hoping by understanding their risks they’ll be able to stay focused on things they can do to help prevent or lower their chances of developing cancer.

I’ve shared every aspect of my breast cancer journey with my girls because I wanted them to know the difficulty of each step of the fight. They know first-hand how traumatizing and life changing cancer has been for me. By allowing them to witness my challenges and struggles, I hope I’ve given them a clear view of the inner strength needed to get through each phase of treatment. They know breast cancer is serious business, but they also know it can be overcome with determination and diligence.

Carrying the burden of breast cancer is a hard one to shoulder. I pray that none of my loved ones ever have to encounter the ugliness of this beast, but if they do, I’m hoping I’ll still be around and I can be a cheerleader in their corner encouraging them to keep on fighting. Life is worth fighting for and whatever it takes, that’s what we have to do. We have to keep on fighting!