BRCA diagnosis leads to tough decisions for women

Cancer had been prevalent in Jody Lynne Jackman’s family tree. But it wasn’t a big concern for the active young woman. She ate well and exercised, logging long hours as a successful executive in a sales-oriented company. When she screened positive for the BRCA1 gene in 2008, the shadow of cancer fell across every part of her well-organized life.

“I had to stop and really educate myself,” she said. “People may have heard of this (gene), but they aren’t educated. Being educated could save your life. It did for me.”

Jackman’s mother died at age 77 of stage 4 ovarian cancer. Other close female relatives had also been diagnosed or succumbed to breast or ovarian cancer by the time Jackman was in her 40s.

She was urged to get tested by a family member 10 years ago. Insurance didn’t cover the $3,500 test, and only one lab tested for the mutation at that time, she said.

“It was the only lab back then, and no one was really talking about it,” said Jackman, a patient of the Comprehensive Cancer Centers of Nevada since moving to Las Vegas 10 years ago. Jackman is half Ashkenazic. About one in 40 people of Ashkenazi Jewish ancestry carry the BRCA gene.

More than 750,000 women in the United States have the BRCA mutation. This genetic inheritance elevates the risk of developing breast and ovarian cancers.

The BRCA mutation is a mutation of the tumor suppressor genes BRCA1 and BRCA2. Those with the mutation have five times greater risk of breast cancer and up to 10 times of a greater risk of ovarian cancer.

“If you have BRCA, you have to be prepared to make some tough decisions,” Jackman said.

Upon genetic counseling and talks with her oncologist, Jackman had a bilateral mastectomy with reconstruction.

“I needed to do that from a very proactive standpoint, which so many people don’t do,” she said. “After it was done, I felt safe. It’s an uncomfortable (surgery), but it was the best decision I could have made for my physical health and mental health.”

Since then she has been tested every month with results coming from two labs to verify her negative cancer screens.

“I have two labs to make sure the numbers (coincide),” Jackman said. “I’m very proactive.”

In fall 2015, her doctor called concerned about one of the lab’s findings. She was quickly diagnosed with ovarian cancer and has since had a full hysterectomy, removal of her ovaries and fallopian tubes. She is working with the physicians at Comprehensive Cancer Centers to continue to stay healthy as she undergoes treatments prescribed by her doctors paired with holistic treatments.

“I’m in my second round of remission,” she said. Due to BRCA1’s proclivity for cancer, she is doing her best to stay healthy to prepare for future treatments that may be needed. “I’m not optimistic, but I am doing my best to live as long as I can.”

Knowing whether or not you have the BRCA mutation can save your life, but some women are still reluctant to get the testing, said Stephani Christensen, a medical oncologist for the Comprehensive Cancer Centers of Nevada. Christensen and the Comprehensive Cancer Centers of Nevada are continually involved with clinical trials to assist in the care and cure of cancer.

“As we understand more about the genome, we’ll be better able to (assist) women at risk,” Christensen said. “It’s getting more interesting.”

Direct consumer testing has been more common recently, with women able to do testing without ever stepping into a lab. It has also become a lot less expensive, with more labs able to process the tests.

“If you have a family history of breast or ovarian cancer, you should talk to your physician about being tested,” she said.

If you have a family history of cancer, don’t be anxious. It isn’t likely that every person in the family inherited the BRCA gene. Once you have been screened positive for the gene, Christensen recommends you see an oncologist and genetic counselor sooner than later.

“Step back and think of the gene, a tumor suppressor,” she said. “When that is not functioning normally, tumors can grow unchecked rather quickly. It can happen anywhere along the gene and sometimes these genes can be detrimental, they can cause harm.”

Once you have been tested and found to have the BRCA gene, your physician will counsel you on how to proceed. Not all BRCA1 and 2 are the same.

“Once we get the gene panels back we can understand what the gene mutation is,” Christensen said. “BRCA1 or 2, they are completely separate. BRCA1 has more breast cancer, pancreatic and colon cancer. BRCA2 has to do more with melanoma and breast cancer.”

Patients are counseled on the terms of their risk factors. Menopausal status, childbearing considerations, age and family history all play into how to go about treating the BRCA gene mutation in each person.

Some women opt for a bilateral mastectomy, removal of both breasts, while others opt to wait out the gene with strict and continuous screenings for cancer.

The Jolie factor, which went into effect after actress Angelina Jolie had both breasts removed and eventually her ovaries after finding she had the BRCA1 mutation, has brought BRCA to the forefront of conversation among women. Jolie’s mother died of ovarian cancer at age 56.

“Post Jolie, more people have now heard of the BRCA gene and are requesting testing,” Christensen said. “It is our strong recommendation that you be evaluated for genetic testing if you have a high-risk family history.”

And do your homework before opting for invasive treatments or surgeries.

“We don’t want patients to have a lot of surgery, we want them to have the right surgery,” she said.

As a woman with experience, Jackman offers this advice for those who may be considering getting tested or dragging their feet.

“Don’t do the BRCA test unless you are ready to do something about it,” she said. “By getting tested, you are making yourself a priority. Just be prepared.”

Now retired, Jackman is currently building a foundation to educate and support those who find they have the mutation.

“Just give up your vanity, it’s so important,” she said. “Live your life and don’t wallow in your pity. Take whatever energy you have and live your life and feel good.”