Many women do all they can to live a healthy lifestyle, making choices that minimize their chances of developing cancer. But for a small percentage, increased risk seems to run in the family.
Women who inherit certain genetic mutations face a much higher risk of breast and ovarian cancers than the typical woman does. There are tests and prevention strategies available to them. But these women also may need specialized support.
Deborah J. MacDonald, Ph.D., R.N., A.P.N.G., assistant professor in the Division of Clinical Cancer Genetics, is developing a counseling tool to help these women, as well as some women going through breast cancer treatment.
eHope: How do genetics play into a woman’s risk for breast and ovarian cancers?
|Deborah MacDonald (Photo by p.cunningham)|
Deborah J. MacDonald, Ph.D., R.N., A.P.N.G.: For the majority of women, the chance of developing breast or ovarian cancer prior to age 50 is very small: only about 2 percent. But about 5 to 10 percent of these cancers are due to a single gene that can contribute a very high risk for these cancers; and for breast cancer in particular, the disease is much more likely to develop at a younger age. These women may or may not have a family history of these cancers. Genetic risk could come from either their mother or father’s side of the family, something many women — and some doctors — may not recognize. Among this group, a woman who’s already developed a breast or ovarian cancer would also be at increased risk for a second cancer. Fortunately, there are options to reduce this risk or find cancer at an earlier stage.
EH: What psychological and social aspects of genetic risk are you studying?
DJM: In Clinical Cancer Genetics, we are studying psychosocial factors; my current focus is on reproductive-age women who are dealing with issues associated with premature menopause and early loss of ovarian function.
For women who are at high risk for breast or ovarian cancer, having their ovaries removed at an early age is an option that lowers that risk, but then they enter menopause at a stage in their life when they’re not prepared for it.
It’s not only women at genetic risk who face these issues, though. Younger women who’ve had breast cancer treatment may also face early menopause as a result of chemotherapy.
EH: What can be done to help these women?
DJM: I’ve been interviewing women to learn more about the critical issues they face so we can intervene to help them early on, before these issues adversely impact their quality of life.
From the information we’ve gathered, we’re developing counseling tools to address each woman’s specific needs immediately and also provide her with information and resources she can take home to help manage other issues that may arise as time goes by.
EH: What are some of the insights you’ve gained?
DJM: Women who experience early menopause face challenging symptoms such as hot flashes and cognitive and sexual changes at a young age, often more abruptly and intensely than in women who go through natural menopause. We’re trying to learn more so we can find ways to prevent or minimize these symptoms in ways that are acceptable to these younger women.
Some women want to have children in the future. We want to know how we can support them in this desire while still helping to lower their risk for cancer. Similarly, for women who have breast cancer, we want to be able to offer options to preserve fertility before they start chemotherapy.
Beyond the challenges related to early menopause, many of the women we see are in the midst of a new breast cancer diagnosis. They’re young, scared and overwhelmed. They’re thinking about their family. If they have young children, they’re concerned about what this means for them now and in the future. We want to support these women and work with them to enhance their problem-solving and stress-reduction ability.
EH: So you start by uncovering the wider range of concerns and then customizing information for each woman?
DJM: Exactly. Our goal is to work with each woman to develop a plan to best address her specific concerns. We want to help women focus on their immediate needs and address those right away, before they become major issues.
In this way, our research findings can be applied immediately to our clinical care. We want to know, “What do you need? How can we better help you? How can we better support your families?” That’s really what we’re here for.
For more information about managing cancer risk, please visit the Cancer Screening & Prevention Program’s℠ website at www.cityofhope.org/cspp.