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Pam's Journal: It's In The Genes

November 10, 2002

Editor's Note: 7NEWS Meteorologist Pam Daale is grateful to all of the viewers who have expressed their best wishes as she wages her fight against breast cancer.

Daale has chosen to use TheDenverChannel.com as her way of keeping the public updated on her health. New journal entries will be posted weekly.

When I think about the genetic traits I've inherited from my parents, I'd have to say the most noticeable things come from my dad. I was always a tomboy (Mom says I even cut off the bows on my first bra because I thought they were too foo-foo). I loved driving the tractor during baling season.

One of my favorite childhood activities was to take the syringes that my dad used for vaccinating cattle and "vaccinate" "sick" crickets with my cousin.

I spent lots of time down by the creek near our house looking for minnows and bringing home all sorts of plant life. And now as an adult, I hold a job that is predominately held by men. Mom gave me some good stuff too, like being able to cook and bake, although I'll never do it as well as she does.

A couple of weeks ago I discovered something else that I may have gotten from one of my parents. If you have or know someone who has breast cancer you've likely heard of the BRCA1 and BRCA2 genes. I have a mutation in the BRCA1 gene, and it's not 100 percent certain that it came from either parent. It's possible that I had a spontaneous mutation which means it just kinda happens.

Yes, my mom did have breast cancer 16 years ago, but hers was very different from mine, and doctors admit they're a little baffled by that. And, my mom and I are the only ones on either side of the family to have breast cancer. (I believe it's about 80 percent of women who get breast cancer have no family history anyway!) My mom never did the gene test, and it could have come from my dad too!

So, what does it mean when you've been tested positive for a mutation in one of the BRCA genes? By the age of 70, you have as much as an 87 percent risk of getting breast cancer. But wait, there's more. If you have the BRCA1 mutation, your risk of ovarian cancer increases by as much as 44%, and with BRCA2 it's as much as 27 percent higher. (All my info, by the way, is coming from a newsletter put out by Myriad genetics of Salt Lake City, UT.)

Okay, so I already have breast cancer. I was in that 87%. What now? Does it even matter?

YES! Not only is there a high risk of getting one diagnosis of breast cancer, I also have as much as a 64% risk of getting a second breast cancer.

Now, I never did very well in my statistics classes in college, but even I can see that those odds don't look all that appealing. Sure there's a chance I won't ever get another cancer again. But one thing I'm certain of is that I don't want to have to go through chemotherapy again. I'm not miserable because of the treatments, but I'm not completely comfortable either.

What choices am I left with?

1) Do nothing 2) Have a final lumpectomy/lymph node biopsy with radiation and leave it at that 3) Have a bilateral mastectomy (and reconstruction) with the lymph node dissection and radiation 4) Have a bilateral mastectomy (and reconstruction) with lymph node dissection and radiation, and remove the ovaries (oophorectomy)

Obviously, choice 1 really isn't an option.

Choice 2 is a possibility, but I'd have to be very diligent in my self exams, have more than regular check-ups, and pray that I don't get another cancer, or that we can catch it so early that I don't have to have chemo.

Choice 3 would give me a much better peace of mind about getting another breast cancer, but choice 4 all but eliminates my chances of getting either another breast cancer or ovarian cancer. In fact, if I go with choice #4, my chances of getting ovarian cancer basically drop to nill because there are no ovaries to get cancer in. My breast cancer recurrence risk drops to only about 2%. I'm liking those odds.

I had a consultation with my surgeon last Friday to discuss all these things. I went into her office thinking I didn't want to be sliced and diced any more than was necessary. I knew I needed more surgery, but I wanted it to be as minimal as possible. But after hearing the discouraging recurrence odds and the ovarian cancer risk, I'm leaning toward option #4. After all, it's one-stop-shopping! I don't think it will be 3 surgeries for the price of one, but I do like the idea of getting it all over with at once.

There's much more to be said on this topic, but I think it will have to wait for another journal entry. Something else my surgeon said that surprised me was that unless a newly diagnosed breast cancer tumor is very small, women are having to go through chemotherapy. Not only is finding your lump early important to your survival, it's also important if you don't want to have to go through chemo. So are you getting to know your breasts?!

Until next time...

Pam Daale The Happy Cancer Patient

You can e-mail Pam Daale at Pam_Daale@TheDenverChannel.com.


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