By Janis Siegel, JTNews Correspondent
The American Cancer Society says that Washington State has the highest incidence of breast cancer in the nation.
But while the average woman has a 12 percent risk of developing breast cancer in her lifetime, one in 40 Ashenazi Jewish women, or 2.5 percent—those who have one of the three BRCA 1 and BRCA 2 mutations shown to increase their risk—have a 40 to 87 percent greater chance of developing the disease, and their risk of developing ovarian cancer falls somewhere between 16 and 60 percent.
Dr. Julie Gralow and Dr. Eve Rodler from the Seattle Cancer Care Alliance and the Fred Hutchinson Cancer Research Center told a packed room of mostly Jewish women at a lunchtime meeting on Oct. 3 at the Columbia Tower Club that genetic testing, lifestyle choices, prevention strategies, and hereditary risk factors can all make a huge difference in the incidence of cancer for both Ashkenazi Jewish women.
Despite the unsettling statistics, Rodler wanted to put women at ease as she set the tone about the issue.
“Studies have shown that, if anything, people tend to overestimate their risk,” Rodler said while speaking with JTNews from her office at the SCCA.
Rodler is an oncologist and an assistant professor of medicine at the Seattle Cancer Care Alliance and the University of Washington. She works in the high-risk clinic with breast cancer and sarcoma patients.
“[Both] men and women can have BRCA genes, and there are hundreds of genetic mutations found in these genes. But there are three mutations that are most commonly found in Jewish people that increase your risk of getting breast cancer,” said Rodler. “The important thing about having BRCA mutations is that you are inheriting risk; you are not inheriting cancer.”
If a woman is shown to have the specific genetic mutations, Rodler added that it doesn’t mean an inevitable cancer diagnosis.
“Whether or not you develop cancer pertains to your family history,” Rodler said. “If the gene is present in your mother, your father, your sibling or your child — you then have a 50/50 chance of inheriting the gene. If it’s a grandparent, an aunt, a niece or a nephew, then the risk of inheriting the gene is 25 percent. The women with a higher risk were those who had families with five or more close relatives who had breast or ovarian cancer.”
The weapons used in the fight against breast cancer include drugs like Tamoxifen, which has been proven to reduce the first incidence of cancer in younger women who take it proactively, and the second occurrence in women after they have been diagnosed.
“You can decrease your risk up to 50 percent after five years of taking it and you don’t have any increase in side effects like blood clots,” said Gralow. “For a younger woman in her 40s, it’s all the potential benefit with almost no negative.”
Even taking the drug in your 30s can still impact your risk for developing breast cancer in your 50s and 60s, she added.
Another lifestyle choice that studies have shown produces startling benefits against developing breast cancer is exercise.
Gralow was excited to present published research by Mary-Claire King, a breast cancer prevention researcher at the University of Washington who studied Ashkenazi Jewish women with breast cancer on Long Island. After they isolated and studied the group with the specific BRCA 1 and 2 mutations, they found that women who reported exercising in their 20s and 30s had a 10-year difference in the age they were diagnosed.
“The women who said they didn’t exercise were diagnosed, on average, at age 40, and the group that reported that in their younger age they had exercised, they had an average diagnosis at age 50,” said Gralow. “This study wasn’t capable of saying that exercise prevented cancer, but 10 years longer until they were diagnosed means the exercise was having some impact. This study shows that lifestyle choices can impact genetics.”
Gralow said that any exercise can have a significant effect. She recommends that women just set a goal, no matter what their fitness level, and try to achieve it.
“Any woman who has had a personal diagnosis of breast or ovarian cancer should get genetically tested to prevent getting another cancer,” Rodler said.
A full genetic profile sequencing costs about $3000, and is not typically covered by insurance, Rodler said. But to test only for the specific BRCA mutations, the cost is substantially lower, around $400.
Rodler said there is some evidence that a woman’s risk declines after the age of 70, but she recommends that women who don’t know their family history or have a very small family with little information also get tested, just to be sure.
“There are 180,000 cases of breast cancer a year. It’s the second most common cancer in women, but right now, in general, hereditary cancer is only 5 — 10 percent of all breast cancers,” said Rodler. “That means that 60 percent of women, with no other risk factors, have what we call sporadic cancer, which means that by being a woman and getting older — those are your biggest risk factors for getting breast cancer.”
“Then you have the 30 percent that have familial cancer,” she said. “That is a combination of multiple genes and environmental factors that are working together, but they don’t have the gene that’s being passed on from generation to generation. So, we are talking about a small percentage, but a significant percentage, because their risk for breast cancer becomes much higher.”
The screening recommendations for patients who test positive for the BRCA 1 and 2 mutations include mammograms and MRI screenings.