Saturday, October 11, 2008

Your Cancer Risk: How Much Do You Want to Know?

Sometimes medical advancements can give us more information than we want to know. With the discovery of the BRCA 1 and 2 genes, mutations of which are responsible for breast and ovarian cancer, women can now find out their risk of developing these two cancers. That is both good and bad news. There are many factors to consider before being tested. Is there a history of either disease in your family? Do you belong to one of the ethnic groups at a higher risk?

The test is expensive, and may or may not be covered by insurance, and there is still a chance of discrimination if you find out you do carry the gene mutation, though Congress did pass an anti-discrimination law this year to protect against this problem. Perhaps most difficult, though, are the decisions you will face if you find that you are positive. Would you have prophylactic surgeries, removal of your ovaries and breasts, to reduce or eliminate your chances of getting cancer? Many women have.

What if you are single? Want to have kids? How do those factors weigh into a decision that may save your life? It’s really an unfair position to be put into, and at the same time, gives us a new power to preserve life that wasn’t available before. One young woman, Joanna Rudnick, currently in her early thirties, documented her experience of carrying the burden of knowing, as well as that of others in her film In the Family.

The film is currently being screened at events around the country and on PBS during October for Breast Cancer Awareness Month. You can also watch it online here through the end of the month. In the film, Rudnick struggles with her own desire to have children, juxtaposed against the chance that she could die if she waits too long to take preventative measures. In her thirties and single, she hears the ticking of a potential time bomb in addition to the proverbial biological clock.

I recognized, as someone also stated in the documentary, that women and men who test positive for this gene mutation feel the same as those of us who are cancer survivors. Many of the same emotional and psychological issues apply. You are forced to acknowledge your mortality, and to make medical decisions that will “mutilate” your body, but could save your life. It is an impossible position, really.

I can understand Joanna’s need to do so much research and talk to other women faced with the same decision. Her search allows us to go along for the ride, and will help many women who are also struggling with finding their own path. At one point in the film, Joanna’s boyfriend wonders, “Does she only like me because she wants my babies, and she wants them quick?” All single woman of a certain age have probably dealt with this stereotype at some point, and those with a cancer history or probability likely feel it more acutely. As if finding the right person weren’t already difficult enough, the added pressure of a deadline is just so unfair!

I recently received my second cancer diagnosis. As always, the wait for test results can be the worst part. I knew when they asked me to call them for my biopsy results that it was “bad” news. If it had been all clear they would have just said so on the voicemail. Then when I told the receptionist my name, there was a long hold. I figured they were getting the doctor to deliver the verdict. Turns out it was a nurse.

Luckily this one was much less serious than my first. A small basal cell carcinoma (skin cancer) on my shoulder/back was dealt with in a minor office procedure at my dermatologist’s. Five stitches later, I will have a small scar, but we got all the margins, so it’s all gone this time. I have had two other scary-looking moles removed, but both biopsies were negative. This one was a tiny, innocuous-looking pink bump that I noticed back in the spring and was just too busy to worry about until fall. Meeting a melanoma survivor in July at the LIVESTRONG Summit in Ohio lit a fire under me to find a dermatologist when she told me her diagnosis began with a small pink bump on her shoulder in her early twenties.

My chances of getting more of these is higher now, so I will have to be even more vigilant about watching for changes in my skin and using sunscreen. I always figured skin cancer was in my future. I’m fair-skinned, and I life guarded for eight years starting at sixteen. I grew up on a lake, guide whitewater canoe trips, and I live in Colorado, where the elevation puts us closer to the sun’s rays and we get more than 300 days of sunshine a year.

Whether getting a genetic test or taking part in recommended screenings, there are many things you can do to reduce your risk of getting cancer. Go here to read more about them.

Find out more about genetic testing here.

Even if you missed the television event on September 5th, it’s not too late to Stand Up to Cancer. Find out how.

Watch a three-minute preview of In The Family here.