I Have A BRCA Gene Mutation... Now What?

What you can do to help prevent breast cancer if you have been diagnosed with a BRCA1 or BRCA2 gene mutation in observance of Breast Cancer Awareness Month.

Every year in October, amongst the football games, the cooler weather, and the pumpkin spice everything, the color pink shows up as a reminder of how breast cancer affects our lives. Almost every individual has been affected by breast cancer in some way or another, and I'm thankful not only for the reminder every year but also for the chance to celebrate our survivors, like my own amazing mom and my Aunt Melinda. Last October, I took the chance to write a little bit about how you can use nutrition to help prevent breast cancer.

Yet not all forms of breast cancer are created equal, and not all of them are preventable through lifestyle factors like nutrition. This is especially true for those who inherit certain genetic mutations that make them more vulnerable and more likely to develop breast and ovarian cancers. The testing for these genetic mutations, on the BRCA1 and BRCA2 genes, has recently become more widely available and covered by health insurance, making it easier to determine if you have a genetic mutation that increases your risk of cancer. Since my mom was diagnosed with cancer young, she was eligible to receive genetic testing. The test revealed that she indeed had the BRCA1 gene mutation, which made my sister and I eligible to receive the test and have it covered by insurance. Since my mom was positive, there was a 50% chance that my sister and I would also be positive. Luckily, my sister does not have the genetic mutation, but I, like my mom, have the BRCA1 gene mutation.

What does this all mean? The genetic counselor at my doctor's office broke it down for me, but in short, it increases my chances of having breast cancer at some point in my life to 60-80%(1) and increases my chances of having ovarian cancer to 30-45%(1). That's a pretty scary realization.

Some who get this news are very upset, understandably, but I don't necessarily feel that way. Knowing that I have the genetic mutation and an increased risk of cancer has empowered me to be proactive with my health and take action. I'm thankful to have the knowledge that I am at increased risk and the nutrition knowledge that I have so that I can take the necessary steps to prevent and screen for cancer more rigorously. I'm also fortunate that I have a very supportive husband who also didn't freak out, and that I live in a time where we have advanced medical technology and a better understanding of cancer.

So what can you do if you've been diagnosed with a genetic mutation, like the BRCA1 and BRCA2 that puts you at an elevated risk for breast cancer? While each individual is different, and their approaches may be different, here is what I am doing to make sure I am the most proactive in my approach to prevent cancer, and what you can do as well:

Get screened regularly.  This is one of the most important things all women can do, but it's especially important for women with BRCA1 and BRCA2 mutations. Since we are at such high risk, we must be vigilant about screenings. For me, my doctor has recommended annual MRIs starting at age 25, and then annual mammograms in between starting at age 30, alternating between the two every 6 months. I also need to make sure I get an annual well-woman exam and do self-breast exams monthly. Even if you don't have a genetic mutation, it's important to still get regular mammograms and NOT skip them! Make the time for your health, ladies!

While breast exams are fairly advanced and reliable, that's not really the case with ovary screening. There just isn't a tool out there that is very effective at detecting ovarian cancer in women, so my doctor has recommended having my ovaries removed once I am done having kids. Say what?! I'm only 24 years old! Luckily, my Mr. Table and I already knew we wanted kids early, so it's not a big deal right now, however, I know there are many changes that come with such a drastic procedure, and this part may be more overwhelming.

Eat a healthy diet. For me, this one is a no-brainer. I've got the nutrition knowledge to eat right for cancer prevention. I go into more detail on the nutrition in last year's Nutrition for Breast Cancer Prevention post, but the basics of good nutrition for breast cancer include maintaining a healthy weight, eating at least 2 ½ cups of fruits and vegetables a day (especially those in the brassica family: broccoli, cabbage, brussels sprouts), and limiting alcohol to 1 drink per day for women. Research is still conflicted on red and processed meats, omega-3 fatty acids, and soy, but my personal approach is to avoid processed meats (mostly because I don't really like them), eat red meat in lean cuts (usually once or twice a week) with the rest of my animal protein coming from either chicken, fish, eggs, or dairy. I also take fish oil supplements, and I don't actively avoid soy but I know it is present in many highly processed foods, which I don't really eat much of anyway.

Not going to lie to you, I know nutrition changes can be hard, especially when you have established habits. Reducing my alcohol intake is probably the hardest one for me since I love wine and winding down with a glass or two most nights (it's heart-healthy!). I'm also living back in my college town with friends coming in most weekends for football games, so I just try to do my best. One thing my husband and I talked about was not letting the gene mutation ruin the quality of life. We are taking preventative action, but we also have to be happy and have a sustainable lifestyle, and that means still socializing with friends. That's not permission to ignore my health, but I'm not going to beat myself up if I'm not perfect, either.

Exercise on most days. Exercise is so important not only for maintaining a healthy weight but also for stress reduction. My doctor recommended an hour a day, 4 days a week. My routine is a mix of running and yoga every weekday (when my arm isn't fractured), but it's important to find an activity you enjoy so that you look forward to exercising and it can be a part of daily life.

Talk with your doctor. As soon as it was confirmed that I had the BRCA1 gene mutation, the genetic counselor suggested that I find an oncologist to talk to. There are a lot of options to drastically reduce the risk of breast cancer, including mastectomy and preventative chemotherapy. I know that I don't have to make a decision right now, but it's important to have a discussion with an expert so that you know what your options are and how you can be proactive, whether it's screening, lifestyle changes, or even surgery. You can't make a decision without first knowing what's available.

Cancer is a scary, ugly disease and we are all affected by it in some way. While modern medicine and research have made huge strides when it comes to cancer, there is still a lot that doctors just don't know about it. It's important to take charge and control the factors that you can when it comes to breast cancer and your health. I'm certainly trying to, and I hope I've also motivated you to do the same. If you've been diagnosed with A BRCA gene mutation, I've provided a few resources below that my genetic counselor gave to me, but feel free to reach out for more or just to chat!

• Bright Pink
• The Basser Research Center for BRCA1&2
• BRCA Positive Decision Guidance Tool
• Prophylactic Mastectomy Video Series by Glamour Magazine

Resources:

1. Understanding Your BRCA Risk – Abramson Cancer Center. (n.d.). Retrieved October 19, 2016, from https://www.pennmedicine.org/cancer/navigating-cancer-care/programs-and-centers/basser-center-for-brca/patient-education/understanding-your-risk.