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A Gut Feeling: How advocating for my health led to early detection of breast cancer

My mom was diagnosed with breast cancer in 2004 when she was 50 years old. Luckily, she caught it at an early stage and after a mastectomy and hormone therapy, she’s been living cancer-free ever since.

It was scary watching my mom go through such a big health scare when I was just 23. In the following years throughout my 20s, I understood that I likely had a higher risk for breast cancer than the average person because of my family history. I knew I’d probably have to start mammograms a little earlier than my peers, but other than that, I didn’t know what else I could do — besides wait and hope for the best. I believed breast cancer was something that happened to women much older than myself, so I pushed it out of my mind, thinking I had many decades before it would ever become a real concern.

My diagnosis

Fast forward to about nine years later. I was getting ready for a big OK Cupid date. In the shower, my hand happened to graze against the side of my breast, and I felt a very distinct, hard lump that I somehow had never noticed before. In that moment, I knew. I knew exactly what it was, but I’d never expected to find it at 32 years old.

I did go on the date, but needless to say, I was a bit distracted. That week, I made an appointment to see my gynecologist – I figured he was the doctor to see, since he was the one who did my breast exams. My hands were shaking as I drove to his office, fully expecting a dramatic reaction when he felt the lump. However, I was surprised when my doctor casually dismissed my concerns, stating I was too young to be worried and that the lump was surely a cyst or something called a fibroadenoma. I wanted more reassurance than that, so I pushed for further testing, and he finally agreed to order an ultrasound just for “peace of mind.”

Since no one seemed too worried, it took almost a month to get on the schedule for an ultrasound. What was meant to be a quick morning appointment before work turned into an entire day of multiple ultrasounds, my first mammogram, and ultimately, a biopsy. A couple of nerve-wracking days of waiting later, my fears were confirmed: I had stage two invasive ductal carcinoma – breast cancer.

Upon hearing my news, my aunt ran to get a delayed mammogram she’d been putting off, and she was also diagnosed with early stage breast cancer.

My treatment

After diagnosis, I immediately faced a whirlwind of doctor appointments and life-altering decisions that needed to be made, and quickly. I hoped for kids one day, so I did two rounds of freezing my eggs, since treatment can affect fertility. I struggled with the surgery decision and whether to do a single mastectomy, double mastectomy, or lumpectomy. My genetic testing came back and since I did not have a BRCA mutation, I opted for a lumpectomy, which was followed by seven weeks of daily radiation. Because my cancer was estrogen positive, I have to be on hormone therapy for 10 years. I take a daily pill and get a monthly shot that keeps my body in menopause, because any estrogen floating around can theoretically feed lingering cancer cells. Although dealing with the side effects of menopause in my 30s has NOT been fun, I know I am fortunate to be alive.

The importance of early detection and advocating for one’s health

Early detection made a huge difference in my treatment and my survival – and my mom and my aunt’s. Even though my doctor initially brushed me off, I knew in my gut that something was wrong. I am so grateful I didn’t wait and that I spoke up, and thank goodness I did. My only regret is not noticing subtle changes in my breast more quickly. Looking back, I realized I’d had some pulling of the skin near my armpit prior to diagnosis (basically a crease that hadn’t been there before), but the change was so slow, it didn’t raise any red flags. I also had chest pain that I attributed to stress, but later realized was actually pain from the tumor. Knowing your normal is SO important so that if something does change in your body, you are able to recognize it and bring it to your doctor’s attention. If you know something’s not right but your doctor isn’t listening, never hesitate to speak up or to get another opinion.

I just hit six years as a survivor and I’m doing fine, and that’s in large part thanks to early detection. It’s one of the reasons I’m so passionate about the Rivkin Center’s mission. Not only do we want to educate women, but even more importantly, we want to provide tools for all of you to take charge of your health and to be your own advocate. It’s not all about my story, it’s about all of YOURS – and your moms, your aunts, sisters, and friends. It’s about empowering everyone to be proactive with our breast and ovarian health.

Jenny Schuster is a breast cancer survivor and Rivkin Center education program team member.

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Higher Risk in the Ashkenazi Jewish Population

In the general population, around 1 in 400 people carry a BRCA1 or BRCA2 mutation. People of Ashkenazi Jewish ancestry have a 1 in 40 chance of carrying a BRCA mutation, making them 10 times as likely to carry a BRCA mutation as someone in the general population. Whether you’re a man or a woman, if you have a BRCA mutation then there is a 50% chance of passing the mutation on to your children, whether they are boys or girls. It’s important to note that these mutations significantly increase risk, but are not a guarantee a person will get cancer.

Why is the Ashkenazi Jewish population at higher risk?

Over 90% of the BRCA mutations found in the Jewish community are one of three “founder mutations”. A founder mutation is a specific gene mutation in a population that was founded by a small group of ancestors that were geographically or culturally isolated. Because the population was isolated, the rate of founder mutations in descendants is much higher than it would be if the population were larger and co-mingling with more genetically diverse populations. A large expansion in the population caused the current high frequency of the mutations in the Ashkenazi Jewish population. If you are of Ashkenazi Jewish ancestry, the chance of carrying a BRCA gene mutation compared to the general population is increased tenfold. BRCA mutations can be passed down from either your mother’s or father’s side, and may be associated with any of the following cancers:
  • Breast cancer
  • Ovarian cancer, fallopian tube, peritoneal cancer
  • Male breast cancer
  • Prostate cancer
  • Pancreatic cancer
  • Colon Cancer

Ready to take action? Knowledge is power. Take this short quiz to be proactive about your health.

Genes 101

Our bodies are made of many tiny building blocks called cells. Our cells contain a copy of our genome – all of the DNA genetic code we inherited from our parents. Our genome is organized into 46 chromosomes, 23 inherited from mom and 23 from dad. Each chromosome has hundreds or thousands of genes. Each gene has the instructions to make a protein that may control the structure or function of cells, can determine many things including how tall we are or the color of our eyes. Genes also contain instructions for many things inside of us that we cannot see, such as how our bones are formed or how our heart works. Each gene is made up of molecules called nucleic acids (A, T, C, and G). The specific sequence of the nucleic acids holds the instructions that control all the components and their functions in cells.

If the DNA sequence is changed, like a spelling mistake, the instructions may not make sense. The technical term for this change is “mutation,” meaning there is a change to the usual genetic code that may change the instructions stored in the gene. A mutation in a gene that repairs DNA damage or controls cell growth can increase the risk of developing cancer.

Sporadic vs Hereditary Cancers:

Ovarian and breast cancer can be either sporadic or hereditary. Sporadic cancers make up the vast majority (85-90%) of ovarian and breast cancers and are not associated with family history of either cancer or inherited cancer-associated mutations. Sporadic cancers arise from genetic mutations acquired in some cells of the body by events part of normal metabolism and environmental factors. This type of cancer can happen to anyone. Most acquired gene mutations are not shared among relatives or passed on to children.

Hereditary (also known as inherited, or familial) cancers are those that occur due to genetic mutations that are inherited from mom or dad. Other blood relatives may also share these same gene mutations. Parents give one copy of each gene to their children. If a parent has a genetic mutation in a gene, each of their children have a 50% chance of inheriting that mutation. Therefore, even in families with hereditary cancer, not all family members inherit the mutation that is causing cancer, and their risk of cancer is similar to the average person in the general population. Individuals who are suspected to have a family history with high incidence of ovarian, breast, and other cancers may be offered genetic testing to try to find the specific genetic mutation that may put them at risk. Importantly, individuals who do not have a known genetic mutation but have high incidence of ovarian, breast, or other cancers in their families are still considered at higher risk for developing those cancers.

Hereditary cancers often occur at an earlier age than the sporadic form of the same cancer, so experts often recommend starting cancer screening at a younger age for individuals at high risk for hereditary cancer. Hereditary cancers can also be more aggressive than the sporadic form of the same cancer. Individuals who have inherited a gene mutation may be at a higher risk for more than one type of cancer.

BRCA 1 and BRCA 2: Most Common hereditary breast and ovarian cancer

The genes that are most commonly involved in hereditary breast and ovarian cancer (HBOC) are BRCA1 and BRCA2. These genes are named for their link to breast (BR) cancer (CA), but they are also linked to ovarian cancer risk as well as other cancers. Both women and men can inherit mutations in these HBOC genes. BRCA1 and BRCA2 are tumor suppressor genes that have a usual role in our body of providing instructions on repairing DNA damage and preventing cancer. When a family has an inherited mutation in BRCA1 or BRCA2, this leads to an increase in cancer risk. Not every man or woman who has inherited a mutation in the BRCA1 or BRCA2 gene will develop cancer, but people who have a mutation do have a significanlty increased chance of developing cancer, particularly cancer of the breasts or ovaries.

While breast and ovarian cancers are the most common cancers diagnosed in people with BRCA1 and BRCA2 mutations, the risk of some other cancers is also increased. Men with BRCA1 and BRCA2 mutations have a higher risk of early-onset prostate cancer than men without mutations in either gene. Other cancers seen at increased rates, particularly in individuals with BRCA2 mutations, include pancreatic cancer and melanoma. Researchers are continuing to find new genes that are involved in hereditary breast and/or ovarian cancer so it is important to follow up with a genetic counselor on a regular basis if hereditary breast and ovarian cancer is likely in your family.

Talk to your family about your health history and take the Assess Your Risk quiz here

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