As a medical assistant in the genetic center at Akron Children’s Hospital, Lisa Broadway is described as “the organized one.” She’s the team member who’s always on top of everything – and her check-ups were no exception.
When she turned 40 this year, she wasted no time scheduling her first mammogram.
What wasn’t expected was the result.
The radiologist at Akron General Medical Center saw suspicious spots on her mammogram. This prompted more imaging, followed by a needle biopsy.
On Aug. 17, with her husband, Alan, at her side, Lisa learned she had breast cancer in one breast.
“I just didn’t think it would happen to me,” said Lisa, the mother of a 12-year-old son and 22-year-old stepson. “I did self-exams and I couldn’t feel lumps. I have very little family history of cancer. It was a shock.”
Lisa had lots of questions for Lance Grau, a genetic counselor and coordinator for Akron Children’s hereditary cancer program.
Lance talked to Lisa about genetic testing and the importance of discovering her potential risk before making a decision about surgery.
After analyzing her family history, Lance gave Lisa a moderate risk estimate for her chances of carrying one of the cancer genes – BRCA1 or BRCA2 – or one of the 19 more rare gene alterations.
“I told Lisa that gene testing is indicated when you see breast cancer in women under 45 but testing is always a personal decision,” Lance said.
Breast cancer affects 1 in 8 women in the United States. Only about 10 percent of these cancers are hereditary or passed down in families.
In the past, it was all about BRCA1 and BRCA2, which are detected more often in younger women and account for 30 percent of hereditary breast cancer.
Now, numerous cancer susceptibility genes have been discovered and researchers have a better understanding of how these gene alterations affect cell growth and repair.
Lisa’s family history revealed that her maternal aunt died of breast cancer at 53. According to Lance, this fact wasn’t as risk producing as her age of onset. Her doctor encouraged genetic counseling to help with surgical decision-making.
Lisa decided to get the breast/ovarian panel. About 2 weeks later, she was about to leave work when Lance told her he had the results. He sat down with her again and revealed that Lisa carried the BRCA1 gene.
Lisa knew this meant an increased recurrence risk and risk for other cancers. Women positive for this gene have a 57 to 87 percent lifetime risk of breast cancer, 24 to 40 percent risk of ovarian cancer, and an increased risk for other types of cancer such as colon, stomach and pancreatic cancer.
“I was stunned. I couldn’t believe it,” Lisa said. “All I could think of was that this couldn’t be happening to me.“
Mastectomy vs. lumpectomy
Lisa’s thoughts turned to cancer prevention and risk reduction. For Lisa, this meant considering a total mastectomy with breast reconstruction instead of a lumpectomy, and even a future hysterectomy as her risks for ovarian cancer increased as well.
According to Lance, many breast surgeons believe mastectomies are better than lumpectomies for risk reduction – especially in younger women. With reconstruction and better techniques, they are more widely accepted than in the past, primarily because the risk of breast cancer recurrence is reduced by as much as 95 percent.
“I told Lisa none of this is good or bad information – it’s just information,” Lance said. “If it’s positive for a cancer gene, you have more information to monitor and prevent. If it’s negative for a cancer gene, you may still have a mystery gene we haven’t identified yet.”
On the eve of Lisa’s surgery, she was calm and upbeat, but you could hear the crack in her voice when she talked about her biggest concerns.
“This might change a big part of who I am,” she said. “Even though I’m going to have breast reconstruction, it still may affect the person inside me.”
Lisa is thankful for her genetic center colleagues, who were there for her when she needed to talk and backed off when she needed her space.
The day before surgery, they presented her with a basket filled with a soft blanket, a robe and nightgown, slippers, lotions and candles.
Fighting breast cancer
In 2005, the genetic center saw 96 referrals for hereditary cancer, and the staff projects they’ll see about 1,000 families this year.
Lisa had a mastectomy on Sept. 24. The surgery took longer than expected because they found metastasis so they also removed her lymph nodes. She’s currently waiting for the final pathology report, which will determine her therapy regime.
Her advice to others heading towards 40 or who have a family history of breast cancer: “Don’t blow off your mammogram, and talk to a genetic counselor if you have any questions about risks and genetic testing.”
Genetic counseling for hereditary cancer is more than test results on a piece of paper.
“Genetic counseling covers not only your risks and what they mean, but also the benefits and limitations of testing as well as information for treatment,” Lance said.
With the help of family, friends and her genetic center family, Lisa is recovering at home and waiting for one more report.
Meanwhile, she still keeps on top of things as she reminds us that October is National Breast Cancer Awareness Month.
For more information or to make an appointment with the hereditary cancer program at Akron Children’s Hospital, call 330-543-8792.