Sunday, February 28, 2010

Mastectomy & Reconstruction...

Both of these procedures have made immense progress since my Mom underwent her first surgeries 15 years ago. At the time of my Mom's procedures she first had a biopsy, then later she had a unilateral mastectomy. This means that she had one of her breasts removed while the other remained. To keep her natural shape and look she chose to use a prosthetic. This was simply a silicone gel type contraption that resembled the shape of a breast. Mom had a bra with a pocket that she slipped the fake breasts into, and she looked as though she had two normal breasts. There were draw backs though. It was heavy, and it tended to move wherever it chose. Imagine trying to run with a gel weight attached to the front of your chest with bra straps. After chemotherapy and a little time for recovery, Mom chose to have the other breast removed and reconstructive surgery preformed. I do not remember for sure exactly how her implants where placed. Either way though, she did undergo an expansion process meaning they slowly inflated the implants to achieve a desired size. Mom's implants were very hard, and she had scars across her chest from the original surgery. Over time the scars would have faded, but the overall feel of her breasts would not have changed much. That gives you a slight idea of what my Mom's were like, now we will discuss the process of mastectomy and reconstruction.

Every case will be slightly different because of personal choice, and what doctor we choose. Katie and I will be using the same doctors for our bilateral mastectomy (both breasts) and reconstructive procedures, but there are still factors of personal choice to be considered. First of all we have an Oncologist, a physician of cancer, who preforms the mastectomy or removal of breast tissue. The second portion of the surgery is preformed by a plastic surgeon who is qualified in the reconstructive process. For Katie's surgery, which was performed in February, her procedures took around five hours. This seems like quite a long time, but the combination surgery is beneficial in many ways. Lets break it down a little to get a better understanding about the options.

There are typically two conditions under which mastectomy is considered. The primary reason being the presence of cancer, and the second, which is being seen more and more these days, prophylactic or preventative mastectomy. When cancer is already present your doctor has a great deal of influence on what choices are made. A biopsy or lumpectomy is usually preformed to determine if cancer is present, and if so what type of cancer it is. This portion of diagnosis is very important, because this is the point at which your doctor gives your their recommendations. Typically when cancer is invasive it is recommended to have the complete breast removed to ensure that all breast cells that could contain cancer are taken out of the body. Lumpectomy, or removal of just the cancer cells and small amount of tissue surrounding them, is preformed when cancers are non-invasive and have clear margins. When a lumpectomy is preformed it is usually paired with radiation to ensure that any other cancerous cells are killed. Even when lumpectomy is an option, you still have the choice of mastectomy. Once a woman has had cancer in her breast she is at a slightly higher risk of recurrence, so the decision to keep or remove your breast tissue is yours. Reconstructive surgery is also available to maintain symmetry after lumpectomy.

Back to mastectomy. There are the three types of mastectomy - unilateral (removal of one), bilateral (both), and prophylactic (removal of healthy tissue). Depending on the doctor you choose, there are also different methods of preforming the mastectomy. The method chosen depends a great deal on your doctor, as well as, your individual case. Simple or total mastectomy includes the removal of the nipple, areola, and all of the breast tissue. Modified radical mastectomy is similar to the total mastectomy, but also involves the removal of lymph nodes for pathological testing. Subcutaneous mastectomy removes all of the breast tissue while leaving the nipple and areola intact. These methods can be skin sparing if the choice is made to preform reconstructive surgery at the same time as mastectomy. Katie had a skin and nipple sparing (subcutaneous mastectomy) paired with lymph node removal. At the time of her surgery they removed as much of her breast tissue as possible, and also placed an expander under her pectoral muscles. Slowly over the next several months she will have saline injections into her expander's to stretch her muscle tissue and skin to eventually fit an implant. If a person knows that they will be having reconstructive surgery this method is a good choice. The other option would be to have a non-skin sparing mastectomy. In this procedure they remove your skin tissue along with the breast tissue. Women who have not made the decision about reconstruction, or have decided not to undergo reconstruction have this procedure. You will still have the option of later on deciding to have an expander process or a flap process preformed.

I have only really mentioned one of the available reconstructive process today, but I think I need to break this up into two days. Tomorrow I will discuss the different processes in more depth. This morning I will leave you with this information. There are many websites available from plastic surgeons who preform reconstructive surgery. If you are interested in seeing pictures I would recommend that you visit a few and see what is available. Understand though, that every persons results will be different and dependent on the individual. If you are not considering the surgery please don't visit the sites. This is a very important decision, and should not be taken lightly.

Friday, February 26, 2010

Ovarian Cancer

Each year in the United States, more than 21,000 women are diagnosed with ovarian cancer and about 15,000 women die of the disease. The American Cancer Society estimates that about 21,550 new cases of ovarian cancer will be diagnosed in the United States during 2009. 14,600 deaths are expected to be caused by ovarian cancer in the United States in 2009. (Ovarian Cancer National Alliance)

The statement above is grim, but there are even more depressing statistics available from the Ovarian Cancer National Alliance or I will be honest with you here, I do not have a great deal of personal knowledge about ovarian cancer. Last night I spent about an hour looking through on-line resources many of which I printed off and added to my binder. Talk about astonished, I knew that everyone says that the tests and screening available for this type of cancer were not good, but I had no idea about the statistics and facts related to it. Just the idea of being at high risk for ovarian cancer is a bleak one.

Let me go ahead and scare you a little. Early diagnosis of ovarian cancer is achieved in less than 20% of all cases meaning that 80% of women diagnosed are in the advanced stages of cancer. If you are one of the lucky 20% you have a much higher overall survival rate. Those not diagnosed in the early stages look forward to a 46% chance of surviving 5 years, and an even lower 39% chance of seeing an additional 10 years after diagnosis. Ovarian cancer is the fifth leading cause of cancer deaths in women. This is scary!

Why is the outlook so bleak? Detection. Overall symptoms of ovarian cancer can also be classified with other digestive and bladder disorders. Commonly women are diagnosed with another more common condition before finding they have cancer. The Mayo Clinic lists the following as available screening, but also states that none of these have been proven to give an early diagnosis and often they can lead to false positives. Pelvic exams preformed by your doctor to screen for masses or growths in your vagina, uterus, rectum, and pelvis. Ultrasound or high-frequency sound waves used to produce images from the inside of your body. This allows for an accurate way to look at the ovaries, but is not able to give definitive diagnosis of cancerous or non-cancerous masses. It is only able to establish if a mass is present. The last method of screening is the CA 125 blood test. You go in and have your blood drawn. This is probably the easiest of all of the screening methods, but it may also be the most variable by individual. Typically women with ovarian cancer have elevated levels of CA 125 protein in the blood. There are other conditions that can also cause higher CA 125 levels that are not associated with ovarian cancer, this can cause false positives and even result in unnecessary surgery and worry. CT and MRI are also available screening methods, but are not typically used as initial screening methods.

So what happens if one of your tests come back and it is necessary to confirm a diagnosis one way or the other. There are two typical methods used. A laparotomy can be performed where a surgeon makes an incision into your abdomen. Once the incision has been made samples are collected and tissue can be removed for pathological testing. The second less invasive method is laparoscopy. A couple of smaller incisions are made and small tools and a light source are used to explore and remove tissue once again to be sent for testing. If cancer is confirmed a larger incision may be necessary to remove as much cancerous tissue as possible.

It seems to me that more often than not, ovarian cancer or the possibility of ovarian cancer is directly associated with hysterectomy. Many women who are even facing the thought of cancer have a complete hysterectomy performed in lieu of tissue samples and testing.

If your pathology reports come back and you have cancer cells present you are looking at three possibilities. Common epithelial tumors make up 85 - 90% of all ovarian cancers and are unfortunately not usually found until they are in advanced stages. These cancerous tumors begin in the cells that cover the outer surfaces of the ovaries. Germ cell tumors involve the cells that produce the ova or eggs. Most occurrences of this cancer are in teenagers and women in their twenties. These types of cancers can be cured and fertility preserved if found in the early stages. The third type are known as stromal tumors. These are rare and involve the connective tissue which keeps the ovary in tact, and also the cells that produce the hormones estrogen and progesterone. Stromal tumors are usually considered low grade cancers and present as stage 1 being limited to one or both ovaries.

On a lighter note studies have shown that prophylactic oophoremtomy significantly reduces the risk of ovarian cancers. The Mayo Clinic states that risk can be reduced by up to 95% for ovarian cancer, and up to 50% for breast cancer. There is typically a trade off though. You can reduce your risk for breast and ovarian cancer, but usually you may increase your chances of other health conditions later on. Now that we know a little more about ovarian and breast cancer we can discuss what we will have to worry about later on if we choose to have preventative surgery.

Wednesday, February 24, 2010

What's to come...

As of lately, it seems as though I am living in two worlds. The one I truly adore comprising of our life at home and the trials of raising two toddlers. Life number two a whirlwind of doctors offices, radiology technicians, and medical terminology. When the two collide my mind is a mess. I know that this year is going to be tiresome and at times a blur, but I would like to include you in all of this. We as a whole have a lot to learn and experience. There are going to be many things happening in the Timmons house in the next year, and I hope we can give you a little peace of mind and if need be encouragement.

There are many things that I am planning to share, and I hope all of you will come back and continue to read. I would also like for you to feel comfortable asking questions if you have any. This continues to be a learning process for me, and I am doing my best to educate myself right now. If there ever comes a time you would like for me to research or elaborate on a specific topic let me know. Also, if you come across a resource you think I would enjoy please share.

I believe that knowledge is power, but I also feel there is a higher power that helps us make those decisions that must come from the heart. Over time I am also planning on sharing some of my experiences and how I have managed to cope with them.

In the past two weeks I have been to a plethora of different doctors appointments, and even scheduled myself for a preventative surgery. There have been many topics discussed at these appointments, and I am taking notes and intend to share what I have learned with you. From what you should expect when you go and see your doctor to what side effects can be expected if you choose a prevention method. I would also like to share recommendations on dealing with those side effects, and what I will be trying myself. Katie has also given me permission to discuss her situation with you. Hopefully we will be able to see some of the differences in prevention versus actually dealing with cancer.

Once again, if you ever have an questions or input please feel free to share! Hope you all have a wonderful day, and we will be talking soon.

Tuesday, February 23, 2010

Why do I think this is Important?

I have been thinking about this alot lately. It is easy to give you the statistics, information, and published word from the professionals. On the other hand, though, it is impossible to give you my experiences. The reasons why I am passionate about this topic, and why prevention is so important to me.

At the beginning of my mom's fight I really did not know what was going on, but towards the end you would have had to be a fool not to recognize what was happening. The last year with mom was a roller coaster, we all had hope and she was going to get better. In February and March the surgeons removed her two brain tumors, and shortly after she started radiation treatments. Cody, my husband, first met mom in April. She had what resembled a very badly executed Mohawk. Her hair was about five to six inches long all over her head with the exception of the front left and right side behind her ear. She still had long scars in both areas from where they had gone in and removed the tumors. Mom's face was swollen and full from the steroids, and her mind was very much like that of a child. At the time I was so happy that Cody was able to meet her, but she was not the vivacious confident Dana Deaton that I had known all of my life. The hardest part is that I really think moms mind was still completely in tact, she was just unable to express herself as she always had.

Over the course of the summer Cody and I spent as much time in Denver City as possible. One of my fondest memories from that summer was an evening Cody and I took mom to the farm. Mom had been dying to drive a car, but her surgeons had frowned upon the idea each time she asked. Cody had a little white dodge pick-up that we took out to the farm, after exiting the pavement he stopped and handed mom the keys. Her eyes lit up, she was like a kid in a candy store. Several minutes passed of adjusting seats and checking to make sure she was familiar with everything. She finally switched the gear to drive and putted along never breaking twenty. Her eyes stayed focused and she remained extremely serious about the task at hand. Mom was so proud of herself. Cody and Mom had a bond after that day, and always enjoyed each others company. Before we knew it the summer was over, and it was time for our sophomore year of college. Mom seemed very stable, overall there hadn't been any changes as far as we could see. The cancer had continued to weave its way through moms body throughout the months. Minuscule cells that the radiation had somehow missed had moved from her brain to her spinal fluid. In late October mom was finding it harder to walk and had new pain in her back. Her and dad traveled back to Lubbock on Halloween, fifteen days later mom was gone.

I don't want JB and Taylor to experience what I did with my mom. After mom died I put on a happy face, but I did not feel happy. The next several years were a struggle for me. At the time I would not have admitted that to anyone, I was fine and there was nothing wrong. Cody talks lightly of this time and calls it his "anger management intervention." We laugh about it now, but he was right I was angry. It seems so ironic that I was so unhappy during some of the happiest experiences of my life. Cody and I got married and I graduated from college. Both of these were huge milestones in my life, but deep down inside I was angry because my mom was not there. I am not sure exactly when it happened, but in the middle of all of this I had to grow up.

I have grown up, but it has not been easy. Thousands of tears have been cried, relationships have been strained, and feelings have been thoughtlessly hurt. Why do I think prevention is important? Cody, JB and Taylor, they are why this is important. I would do anything to ensure their health and well being. Being there for their milestones is so important. I intend to be there for JB and Taylor's graduations, weddings, births and birthdays of children, and everything else that is important to them. My heart would break if my children or Cody ever thought I had not tried to do everything in my power to ensure that I could be in their lives as long as possible.

Monday, February 22, 2010

What is Breast Cancer?

Healthy Women gives the following definition for breast cancer -
A disease in which malignant (cancerous) cells are found in breast tissue.

Sounds so simple doesn't it. Lets dive in a little deeper. Within a woman's breast there are "lobules (milk-producing glands), ducts (tiny tubes that carry the milk from the lobules to the nipple), and stroma (fatty tissue and connective tissue surrounding the ducts and lobules, blood vessels, and lymphatic vessels)." (American Cancer Society) We first need to know what makes up the breast in order to understand the different types of breast cancer. Most begin in the lining of the ducts, while fewer start in the lining of the lobules.

There are several types of breast cancer, and honestly I would not recommend starting out with just a list of technical terms. If we will first take the time to understand the words typically used when describing a cancer diagnosis it makes it much easier and less intimidating than just looking at the medical descriptions. So, I have decided to take a slightly different more simplistic approach. Lets tackle some vocabulary.

Carcinoma - cancer that begins in the lining layer of organs such as the breast. These are cancers that begin in the outer cells of the lobules or ducts. By looking at the picture above we can see where these would be. Breast cancers nearly all fall into this category.

Adenocarcinoma is a type of carcinoma that starts in the gladular tissue. Glandular tissue includes those that make and secrete substances, in this case breast milk. Once again we are looking at the ducts and lobules.

Carcinoma in situ - this simply means cancer in its earliest stages. The cancer is limited to the original cell that it started in, and has not invaded any of the surrounding tissue.

Invasive (infiltrating) carcinoma - this is the opposite of the carcinoma in situ meaning that the cancer has spread to surrounding tissue outside of its original cell.

Sarcoma - these are cancers starting in connective tissue. Connective tissue being muscle, fat, or blood vessels. These are rare when talking about breast cancer.

By first looking at the vocabulary it is much easier to understand the types of cancer. Typically the type of cancer will use a combination of the above to comprise a label. An example of this would be Ductal carcinoma in situ. By breaking this down we know that the cancer is located in the ductal region and is in its early stages. Wouldn't it be nice if our doctors used the broken down version. The second description seems a great deal less intimidating.

Types of cancer:
Ductal carcinoma in situ
Lobular carcinoma in situ
Invasive ductal carcinoma
Ivasive lobular carcinoma

These are the most common types of cancer. There are several less common types of cancers, and I will try and devote another day to describing those when I have better educated myself on them.

The world of cancer is intimidating and scary. Try not to be discouraged. If at anytime you don't understand what you are being told, then ask for a better or simpler description. You do not have to be satisfied with something you do not understand. If you are still unsure take notes and do some research on your own. There are so many resources out there that will literally dumb it down for you. I am working on a list of resources that I have found extremely helpful, and I am planning on posting it soon!

Until next time, keep smiling and don't get discouraged!

Tuesday, February 16, 2010

The negatives -

Earlier this week we talked about why you would want to undergo preventative surgery. It was easy to focus on the benefits of mastectomy and oophorectomy (removal of ovaries), but it is important to get all the facts. Today we are going to discuss the negative implications associated with these two methods of prevention.

However small or large, saggy or perky, or otherwise described we can all say one thing about our breasts. They are mine! Over the years they have developed with us, and have always been a part of our bodies. To say goodbye to them would be emotionally challenging. There are many choices available regarding reconstruction, and all of them have improved dramatically over the years. Even with advances these newly constructed breasts will never be the same as those God originally gave us.

So what is the purpose of reconstructive surgery? Aesthetics, and that's about it. Reconstruction gives us back our feminine characteristics and shape. For many women a completely flat or slightly concave chest is unacceptable. In exchange for peace of mind and a lower risk of having breast cancer we lose alot, but we can still look good in a bikini and fill out favorite little black dresses.

When considering removing your breasts there are many things you will be giving up. Since the surgeon will be removing the tissue that can be affected by cancer you will be losing several of the functions of your breasts. During the procedure, the surgeon will remove all of the essential inner mechanisms related to breast feeding. This factor alone makes breast removal a very hard decision, especially for those of you who have not completed your families yet. Not being able to feed and nourish your baby can be devastating. For some women the trade of breast for a bottle is still the best option to ensure that you will be there even when your baby is having children of their own. Next to consider is the loss of sensation, the loss of feeling in and around your breast tissue. Depending on the reconstruction method chosen there will be nerves cut and a certain amount of immediate loss of feeling. With some methods sensation can be regained over time, while with others very little sensation remains even over time.

Oophorectomy is recommended for women with a high risk of ovarian cancer, and when cancers are estrogen receptor positive. What happens when we remove our ovaries? I believe one of the biggest factors to consider before removal is your family. Have you completed your family? After surgery YOU will not be able to have children. This is a very serious decision that needs to be given a great deal of thought. The other factors to consider are the side effects caused by removal. Often women will experience surgical menopause. Hot flashes, night sweats, mood swings, and other typical symptoms of menopause may hit you like a brick wall. In many cases of premenopausal women theses symptoms come on with a vengeance, while others experience very few of them and only mildly. Other effects to worry about are depression and osteoporosis. Overall, with the exception of childbearing, these side effects can be reduced and managed by talking with your doctor about your options and finding what works best for you.

Every persons circumstances are different, therefore, the course of action for each of us may be different. What I am willing to do may not be realistic for someone else right now. I believe the most important part is to educate yourself, and to talk with your health care provider. If you are open about your concerns they will be addressed. My thoughts are that I am in control when it comes to prevention!

Let's get the facts...

Yesterday, I asked a very controversial question. Why would a woman choose to remove her breasts and ovaries? I think you need to know the science behind this question. Today I am going to start out at

A - ducts
B - lobules
C - dilated section of duct to hold milk
D - nipple
E - fat
F - pectoralis major muscle
G - chest wall/rib cage

Most breast cancers begin in the lobules or ducts. Lobules produce breast milk; ducts deliver it to the nipple. (The Breast Reconstruction Guidebook)

By removing breast tissue you can dramatically reduce your overall risk. Consider this number, mastectomy alone can reduce your 87% lifetime chance of breast cancer by 90%. This surgery alone will bring your risk down to about the general populations. It does not take your risk away completely though. Another factor to take into consideration is that not everyone who is at risk will develop cancer. This makes it a very tuff choice.

There have been several discussions around my parents dining room table about this very topic. I am very passionate about this subject, and I definitely have my opinions. One of the most debated items is that I have no way of knowing for sure if I will get cancer. Katie has it, but that does not guarantee that I will with or without surgery. So lets look at it this way, there is a 13% chance that I will never get cancer. Meaning I do not necessarily have to remove anything, I can talk with my doctors, be diligent in the surveillance procedures, and continue to be perfectly cancer free until the day that I keel over from old age. Sounds like a pretty good option to me, but the decision is ultimately yours.

Lets talk about ovaries. As you dive into my world you will eventually see that there are differences in BRCA1 and BRCA2. Typically BRCA1 positive patients have a higher risk of developing ovarian cancer than their BRCA2 counterparts. Those with BRCA1 mutations remove their ovaries ultimately to reduce their risk of ovarian cancer. An 85% reduction in risk to be exact. This is a positive thing in my mind, but once again no one is guaranteed they will get cancer. Those with the BRCA2 mutation remove their ovaries for two purposes. First to reduce the risk of ovarian cancer, but second because breast cancer related to BRCA2 mutation is more likely to be estrogen-receptor-positive. By removing your ovaries you reduce the amount of estrogen produced by your body dramatically. Why do we need to reduce the amount of estrogen our bodies make? The presence of estrogen in ER-positive patients increases the growth of cancerous cells and tumors. Basically, the cancer feeds off of estrogen. By cutting off the food source, you can restrict growth and sometimes even prevent it.

How young is too young creeps back into my mind here. Genetic testing is available when you turn 18, but how many of us have completed our families by then. In our career driven society many women have not even started having children at my age. There are other options to reduce the amount of estrogen in our bodies. Many of these relate to our birth control. Once again, talk to your doctor.

It may not be the right time for you to consider prophylactic surgery. As time goes by each of our circumstances change, and what seemed unrealistic yesterday may be our best option tomorrow. As I have mentioned before, Cody and I have been very open about this topic since my mom passed away 9 years ago. We made several of our decisions about having our children early and close together because of these discussions. I guess you could say that I have been planning my life around testing positive for this mutation. Many of you will say that is a little on the neurotic side. If it is OK then, but know this I have big plans for my life.

*The percentages given will vary between studies.

Monday, February 15, 2010

So whats next?

A positive test result provides information only about a person's risk of developing cancer. It cannot tell whether an individual will actually develop cancer or when. Not all women who inherit a harmful BRCA1 or BRCA2 mutation will develop breast or ovarian cancer. (National Cancer Institute)

With that in mind lets discuss our options. There are three possibilities to consider: surveillance, prophylactic surgery, and chemoprevention. Today we will discuss two of the three. Lets start out with survellance.

Very simply surveillance means cancer screening. Using standard methods that are already popular to look for and detect cancer. These include mammography, breast exams, ultrasound, and magnetic resonance imaging (MRI). For ovarian cancer the methods include CA-125 antigen(a blood test), transvaginal ultrasound, and clinical exams. These are something you should discuss with your doctor if you believe you might be at a higher risk for breast or ovarian cancer. I know that not everyone reading this is ready to take the plunge and be tested for the genetic mutations tomorrow, but you must talk to your doctors. Your health care providers are not mind readers. If you do not tell them you think you are at risk, how will they ever know? The techniques above are much simpler and less costly than getting cancer.

Mom was first diagnosed with breast cancer at age 35. It is recommended that screening is started 10 years prior to this age for Katie and I. That would mean that we should have started "surveillance" at 25. Katie has been diagnosed at age 30, this means that Lexi, Katie's daughter, needs to start screening at 20.

Our next option to consider is prophylactic surgery. Whack em' off, and pull em' out. Ok, maybe that was a little crude. This means removing as much of the tissue in your body that is at risk for developing cancer as possible. Voluntarily removing healthy breast tissue, and your egg producting ovaries. Let me just say it for you, WOW!!! Who as a woman really wants to remove the two items that define us most as a WOMAN?

I guess we should take a moment and look at this from Katie's perspective. After diving into the obsession of genetic testing myself, I had successfully convinced Katie to also be tested. She was patiently waiting for my results to come back when her doctor sent her for a mammogram. Two weeks later she still had not been tested, but she had cancer. Katie was not given any options. Her cancer miniscule as it was had started the process of becoming invasive. Meaning it was becoming one bad dude, that would soon be looking for its next place to invade. On February 10, Katie went into surgery to have a double mastectomy (both breasts removed), lymph nodes from under her arm extracted, and expanders installed to start her reconstruction process. Later on this week, Katie will also be meeting with a Gynecological Oncologist about having her ovaries removed.

So here is the question once again - "Who as a woman really wants to remove the two items that define us most as a WOMAN?" Maybe just maybe the ones who don't think cancer is an option.

At this point in my life I have two beautiful children, and a wonderful husband. What more could I ask for? To be completely honest, I would like to ask for Longevity, and Life. More specifically a cancer free Life!!!

Cancer Risk

This morning my head is afloat with decongestant, and an onslaught of information from books and the Internet. My hopes are to educate, and not mislead. I know that I may come across biased some times, but remember you are in control of what decisions you make. Today I scoured the National Cancer Institutes website. They have a wonderful write up about BRCA1 & BRCA2. I would recommend to anyone their link if you would like more information.
I have pulled several items from this publication that I feel are important. So here we go - Day 3.

First of all, lets talk about genetic counseling. I loved my counselor! In one sense she is like a personal concierge, but at the same time she is a friend who will hold your hand and provide all the tissues you need. At our first appointment my counselor drew up an extensive family tree. The weeks before my visit with her I collected as much information about both sides of my family as possible. With this information we were able to comprise a fairly nice looking tree. In my case specifically there were some black holes, so don't feel pressured if you cannot find out every little detail. Just try and gather as much information as you can. The next part of our discussion involved the brochure from Myriad Genetic Laboratories, Inc. This brochure contains information to educate you on testing, risk, management and surveillance. You can access this information on their website - At the end of this appointment we scheduled a date for me to come back to meet with my counselor and an oncologist. After we had talked and gone over the information again it was decision time. We opted to have my blood drawn that day. Three to four weeks late my results were in.

On January 25th, Cody and I went back to Joe Arrington Cancer Center to see my genetic counselor once again. It was time to get my results. Lets go ahead and be honest. I was absolutely nauseous, I wanted to throw-up my toenails. My appointment was at 2:00 that day, so we had enjoyed a nice morning at home with the kids. Cody had made us breakfast, and JB and Taylor were able to play before we all piled in the car to meet my mother-in-law for lunch in Lubbock. The entire 1 hour and 45 minutes to Chili's I wanted to bite off every minuscule piece of fingernail available in reach of my teeth. I believe this trip may have been the quietest trip Cody and I have ever taken together. My nerves were shot. When we finally reached the Cancer Center I was still anxious, but it was time to find out the results. My counselor and an observing student gave Cody and I the news. I had tested positive for the BRCA2 mutation. After getting the results, I was actually pretty calm. I think I was relieved.

A week before I went to get my results my sister, Katie, received some of her own. She had breast cancer. In December she had found a lump in her neck that was a little concerning. She had gone to her doctor, and he decided to send her for a mammogram. In early January Katie went for her mammogram, a few days later she was called back for a second, and the subsequent week she traveled to Lubbock for a needle biopsy. Katie is only 30 years old!!

My test results seem very minor in comparison with Katies. I don't plan on taking them for granted though. God has given both of us something that our mother did not have. For Katie he gave her early detection, and me he has given me an even more precious gift a chance to do something in advance.

Until tomorrow, best wishes & God Bless!

Sunday, February 14, 2010

Genetic Testing for Hereditary Breast and Ovarian Cancer Syndrome.

Before I give you my results, lets find out what the results mean.

In a publication, by Myriad Genetic Laboratories, Inc, it states that "Most cancer occurs by chance." This means that the majority of breast cancer diagnosis are sporadic, not by genetic mutations. Knowing this is important. The majority of people who do chose to go in for testing will NOT test positive for a genetic mutation.

So why would you go in to be tested in the first place? Family history, and a few key factors fill in the blanks here. The following are questions to ask yourself when considering genetic testing...

In your family have any of the following occurred -
*Breast cancer before age 50
*Ovarian cancer at any age
*Male breast cancer at any age
*Bilateral breast cancer (cancer in both breasts)
*Both breast and ovarian cancer
*Relative with a BRCA mutation
*Ashkenazi/Eastern European Jewish descent
*Breast cancer after age 50

In my case specifically my mother was first diagnosed with breast cancer at the age of 35. Fourteen years ago 35 seemed extremely young to have breast cancer. Unfortunately, I think most of us know of women who have been given the news they have the "C" word well before the age of 35.

Knowing the parameters above I fell into the group to be tested for a mutation. Pulling information from Myriad's pamphlet again it states the following:

"Hereditary breast and ovarian cancer syndrome is an inherited condition that causes an increased risk for ovarian cancer and early onset breast cancer (often before age 50). The vast majority of hereditary breast and ovarian cancer is due to an alteration or mutation in either the BRCA1 or BRCA2 genes. These mutations can be inherited from either your mother or father."

Lets break this down a little. There is not a BREAST CANCER GENE as some people believe. It is a mutation of a gene that all of us have in our genetic make-up. The BRCA genes act as cancer fighting agents in your body. When there is an alteration or mutation present in one of our cancer fighting agents they do not work properly. Thus, there is a higher possibility of our bodies being unable to fight off cancer when it occurs.

Bottom line, the general population has an 8% chance of getting breast cancer in their lifetime. Those with a mutation have a 56% possibility of being diagnosed with cancer before the age of 50, and an 87% chance in their lifetime.

I'll let you chew on that until tomorrow!

*There are other genes known to be associated with breast and ovarian cancers. There is testing available for some of these, but the occurrence is extremely low. We also know that there are most likely other genes in our make-up that are somehow associated with increased risk. So many advances have been made in the last 10, 15, 20 years, and many more are surely to be made in the future.

Saturday, February 13, 2010

A little background...

About forteen years ago I was a Freshman in high school without a care or worry in the world. I had started my first season of golf on the Varsity team, and was on cloud nine. I believe it was shortly after spring break that my parents sat my sister and I down and explained to us that my mother had breast cancer. Looking back on it now, I had no idea what was about to happen or honestly what it even meant.

After a few quickly scheduled surgeries my mother was preparing herself for chemotheraphy. I believe we, my sister and I, were both in good spirits waiting patiently for life to return to normal. Personally, I do not think it had ever entered my mind the severity of her disease or what toll it could possibly take on our family over time.

Five years later we were planning my older sisters wedding. I had started my first year in college, and everyone in the family was busy with decorations and other tasks for the big day. Little did I, or anyone else know that Mom had started having headaches. Katie and Ronnies wedding was scheduled for December 28th, and it was getting closer everyday. With no time to spare, anything not dealing with the wedding was pushed to the bottom of the list. Needless to say, December came and went and the wedding was beautiful.

Mom went in to see her doctors after the new year had begun. The normal test were run, and she was instructed to go straight to the hospital. She had swelling in her brain, and two brain tumors to go along with it. Surgery was scheduled to remove brain tumor #1, that was the day that my mother changed forever. I'm sure I will elaborate more on this at a later date. Both brain tumors were removed that spring. Mom underwent radiation therapy, and the rest of us continued our normal lives. After the surgeries my mother was never the same person as before. In November of that year, Mom passed away at the age of 42. I was 19.

My goal with this blog is to hopefully encourage others who have felt the same feelings I have, and to share the choices I have made pertaining to breast cancer. In the last 10 years my husband, Cody, and I have had a very open and direct discussion about GENETIC TESTING. We together made the choice to have my blood drawn and tested to find out if I had a genetic mutation predisposing me for a higher risk of breast cancer. In December we went to see the genetic counselor, and my results are in...