patient’s risk of developing cancer that can be used to tailor
their individual prevention program.
For example, it is now known that women who have
inherited a mutation in one or both of the two tumor
suppressor genes, BRCA1 and BRCA2 (BReast Cancer
Associated genes 1 and 2), have a 50 to 85% risk of
developing breast cancer over their lifetimes, as well as a
markedly increased risk of ovarian cancer (meet three-time
inherited cancer survivor Zora Brown, p. 67). Men who
inherit these mutations are also at increased risk of
developing breast cancer, and have an increased risk of an
aggressive form of prostate cancer. Inherited BRCA
mutations are only responsible for about 5 to 10% of all
breast and ovarian cancer cases that occur. Currently,
however, other genes have been discovered that can be
inherited in a mutated form, which confers a marked
increase in the risk of developing certain cancers. Unlike
these inherited mutations, the vast majority of breast and
other cancers are caused by acquired, or somatic, mutations
that accumulate during one’s lifetime.
Although currently there is no way to correct these inherited
cancer gene mutations, the knowledge that individuals are in
a high-risk category can induce them to modify their
behaviors to reduce risk from other factors, intensify their
screening or early detection strategies or, under certain
circumstances, consider the option of preventive removal of
the organs that are at greatest risk for cancer.
“Educate yourself about clinical trials,
because cancer science is evolving every day...
Become an advocate for yourself and others.
And never give up hope.”
For me, cancer was a journey that began before I was born. Both my
great-grandmother and grandmother were diagnosed with breast
cancer at a time when little was known about this disease—and
there was little reason for hope.
Mammography had not yet been invented; genetic factors were
unknown; radical mastectomy was virtually the only treatment
option; and the survival statistics were grim. No one knew what
caused breast cancer, so it was something to discuss in whispers.
A secret shame.
So much has improved since then, even during my own lifetime. We
know today, for example, why cancer has affected 5 generations of
women in my family: A genetic mutation of the BRCA1 gene, handed
down from mother to daughter, predisposes us to breast and ovarian
cancer (see Molecularly Based Prevention, p. 65). We also know
that, as African-Americans, the women of the Brown family and
others like us are at risk for more aggressive cancers that strike
earlier and have higher fatality rates (see Sidebar on Disparities,
Understanding my family and racial histories taught me to be alert
and proactive about my health. Although this knowledge did not
render me immune from breast cancer, it did facilitate early detection
of the disease—first in 1981 when I was just 32, and then again in
1997. That early detection helped me survive and take back my life.
As members of a high-risk family, my sisters and I, and now my
nieces, have come to understand that we have been given not a
genetic curse, but the gift of knowledge and the inspiration to use
that knowledge to address the challenges of cancer, and to imbue
other survivors with hope.
Now in the midst of my third round with cancer—stage III ovarian
cancer, which was detected in 2005—I know all too well what a
serious adversary I face. But I also know how to be an advocate for
myself, arm myself with information, and surround myself with
support and the best that science has to offer.
As a result, I continue to thrive day after day. I have seized the
opportunity to take part in a clinical trial for patients who have the
BRCA1 gene, and the experience is not only allowing me to receive a
cutting-edge treatment, but also to contribute to research that will
advance the scientific understanding of cancer and benefit future
women like myself.
The Brown women are a living testament to the power of scientific
research to significantly reduce the ravages of this insidious disease.
Generation by generation, we are evidence of how far medical
research has taken us, and I believe in its power to someday put an
end to this cycle of disease once and for all.
Adapted from Zora Brown and LaSalle D. Leffall, Jr., MD, 100
Questions & Answers about Breast Cancer, 2003: Jones and Bartlett
Publishers, Sudbury, MA. www.jbpub.com.