Beating the Odds

September 01, 2013

Prevention and screening measures are game-changers for women at high risk of breast cancer
WRITTEN BY LAURA ROE STEVENS

Maggie Dinome, MDAlready a leader in breast cancer treatment, the Margie Petersen Breast Center at Saint John’s Health Center will open a clinic in early 2014 aimed at serving patients with the greatest odds of developing the disease. The clinic is a natural step in the John Wayne Cancer Institute’s goal of providing personalized care by thoroughly assessing individual risk, says Maggie DiNome, MD, the clinic’s director and associate director of the Margie Petersen Breast Center.

“The High-Risk Clinic is a new addition that will help us to identify those patients at significantly increased risk for breast cancer, either based on family history or personal history, and provide them the appropriate tools and resources they need to reduce their risk and get the appropriate screening,” explains Dr. DiNome.

Preventive measures can lower the risk of breast cancer in many women. While some women will still develop the disease, enrollment in a high-risk clinic should improve the odds that any cancers will be detected early, when the disease is most curable. Preventive strategies can be as simple as adhering to a healthy diet and exercise regimen to the decision to undergo prophylactic mastectomy. The clinic will have a nutritionist, nurse navigator and genetic counselor available to assist patients.

Anyone will be able to come to the clinic for an assessment of breast cancer risk. Those with a family history of cancer or other risk factors that increase their risk, such as women who carry the BRCA1 or BRCA2 gene mutations, will have the full array of resources available to them.

“It’s not only for patients who are BRCA-positive but also for those who have high risk based on other risk factors,” Dr. DiNome explains.

There are many risk factors to assess, but due to the aggressive nature of BRCA-related cancers – which can develop at earlier ages – it’s important to identify those with inherited mutations as soon as possible, she says.

BRCA1 and BRCA2 are genes that produce tumor suppressor proteins, which help repair damaged DNA and play a role in the stability of a cell’s genetic material. When either of these genes is mutated, or altered, so that its protein product is not made or does not function correctly, DNA damage may not be repaired properly. As a result, cells are more likely to develop additional genetic alterations that can lead to cancer.

Inherited mutations in BRCA1 and BRCA2 increase the risk of female breast and ovarian cancers and account for about 20% to 25% of hereditary breast cancers and about 5% to 10% of all breast cancers.

Veronica VeraVeronica Vera wishes she’d had access to a high-risk clinic earlier in life. In 2011, the Los Angeles woman was 33 and had been married to husband Vince only three weeks when she learned she had breast cancer and carried the BRCA1 gene mutation.

“I had never heard of the BRCA gene,” Vera says. “Now, after Angelina Jolie announced she has it, more people realize how important it is to get tested. But when I was younger, no one really knew about it. Even today, few young people test for it. Cancer runs in my family, so I certainly would have benefited from a high-risk clinic earlier in life.”

Vera had no time to settle into married life before undergoing a double mastectomy, reconstructive surgery, in vitro fertilization and chemotherapy. The couple chose to have IVF and to freeze embryos before cancer treatment in case the treatments caused sterility or there were reproductive health problems later on. However, the couple conceived naturally and is expecting a baby early next year.

“It’s a happy ending to the beginning of a bumpy story,” Vera says. “Our first year was spent with surgery, complications, reconstruction, IVF, chemo – phew! It’s a miracle that I’m now pregnant. I’m so thankful to Dr. DiNome and all the physicians who worked with me.”

Are you at riskWhile her life has returned to normal, Vera says she will remain vigilant to reduce her risk of a cancer recurrence. Being BRCA-positive means she is still at higher-than-normal risk for ovarian and reproductive cancers. She will adhere to a schedule of prevention checkups and will likely undergo future salpingooophorectomies. Prophylactic removal of the ovaries and fallopian tubes lowers the risk of ovarian cancer.

This past Labor Day, Vera enjoyed a day at the beach and reflected on the “wonderful” care she received from Dr. DiNome and the confidence she has placed in her healthcare team. The future is bright.

The High-Risk Clinic is part of the Margie Petersen Breast Center at Saint John’s Health Center. Considered one of the nation’s top facilities, the Breast Center provides a comprehensive approach to diagnosing and treating breast disease with state-of-the-art diagnostic and therapeutic technology. The Breast Center offers the latest in breast cancer screening, diagnosis and treatment. By providing multidisciplinary care to patients with breast disease, women are assured of receiving the most advanced treatment.