BRCA testing: Are the medical options sensible?

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1. Mastectomy is not without risks also. Upto 70% report chronic pain afterwards. And 10-15% of women have severe long-lasting pain.

   ‘What is the risk of complications following contralateral preventive mastectomies with breast reconstruction?
   Surgical complications and rates of additional surgery in breast reconstruction range from 10-50%.
   Implant reconstructions are associated with a higher risk of reoperations than tissue transfer reconstructions.
   Reoperations are performed for various reasons: postoperative complications (i.e. infections, hematomas etc.), implant-related issues, aesthetic concerns (non-implant related), etc. Implant contracture is the most common indication for reoperation.
   Most reoperations occur within the first year of the reconstruction.
   Chronic pain (persisting at least 2 years) after mastectomy and reconstruction is a frequent problem, affecting up to 70% of women. This can negatively impact on sleep (in 36% patients) and daily activities (in 22%). 10-15% of women can experience severe, long-lasting pain.’

   http://www.integrativeoncology-essentials.com/2013/05/the-rising-tide-of-the-contralateral-prophylactic-mastectomy-know-the-facts/

2. Hi Cate,

   Wonderful post!! We were supposed to have dinner when Dave Asprey was in town (Patrik, RIchard, etc). We missed ya!

   What I never hear in this discussion about BRCA is the faulty gene expression RE: lack of DNA corrections and increased DNA oxidative produces like 8-hydroxy 2′ deoxyguanosine, which there are many modalities to improve (anti-inflammatory low lectin diets, antioxidants, melatonin, vitamin C, polyphenols, berry extracts, etc).

   I was compelled to also dispel BRCA ‘mythology’….

   BRCA1/2 is a defect in DNA repair including lymphoblasts and fails to fix 8OHdG (oxidative DNA damage product, 8-hydroxy-2’deoxyguanosine)
   http://www.ncbi.nlm.nih.gov/pubmed/17288454

   BRCA1/2 raises risk in men of breast, prostate, pancreatic, gastric and hematologic cancers

   BRCA1/2 raises risk in women of breast (73%), ovarian (41%), colon (2-fold), pancreas (3-fold), stomach (4-fold) and fallopian tube (120-fold) cancers

   BRCA1/2 like all mutation genes is under epigenetically controlled regulation — for example, silencing of the gene occurs with polyaromatic hydrocarbons (pollution), insulin, and hypomethylation (lack of methyl donors — either depletion or dietary deficiency — or COMT, MTHFR, etc variants). Best food sourced methyl donors are methylB12, choline and methylfolates (free range egg yolks, liver, meat, seafood — sorry no plant sources you crazy vegans). Insulin 101: Insulin is a growth hormone and one function is to induce stimulation of female ovaries to increase testosterone secretion. Unfortunately, in both men and women, normal levels and excess testosterone may be converted into estrogens under insulin induction by P450-aromatase (aka, CYP19), in many tissues including fat tissues, breast cells, endothelial cells and prostate cells…. Certain gene variants accumulate significantly more estrogens than non-carriers (COMT, CYP19).
   Compared with noncarriers, women carrying at least one CYP19 8r allele had 20% higher estrone (P = 0.003), 18% higher estradiol (P = 0.02), and 21% higher free estradiol concentrations (P = 0.01). Women with the COMT Met/Met genotype had 28% higher 2-hydroxyestrone (P = 0.08) and 31% higher 16?-hydroxyestrone concentrations (P = 0.02), compared with Val/Val women. Cancer Epidemiol Biomarkers PrevJanuary 1, 2004 13; 94.

   BRCA1/2 silencing may be epigenetically avoided by diet, resveratrol and other antioxidants

   BRCA1/2 needs a genetic ‘cofactor’ like MTHFR, COMT, CYP19 (aromatase which converts testosterone to estrogens), CYP1B1 (pathway increases 16OHE1, estrogen carcinogen adduct) and CYP1A1 to be carcinogenic according to emerging evidence. These genetic polymorphisms are all related to raised toxic estrogen metabolites and creation of estrogen dominant states.

   Metametrix has the lab test for 8OHdG — ION and Organix… other labs also offer (urine, salivary).

   http://drbganimalpharm.blogspot.com/2013/05/the-great-cholesterol-fairy-tale.html

3. Genetic counseling is highly recommended prior to BRCA testing for a variety of reasons including future insurance implications for the individual being tested and their family members.

   This is an excerpt from an article written for physicians after Jolie’s letter was published.

   “It’s not something you want to automatically order,” agreed Dr. Madlensky, who says that ideally, patients should be screened in primary care for red flags that might suggest the need for referral to genetic counseling — even before a test is considered.

   “There are different types of BRCA testing, and knowing which one to order is a bit complicated, depending on ancestry, cancer diagnosis or not, known BRCA mutation in family or not,” she said, adding that a patient’s family history should not be taken at face value.

   “A lot of times, the story that is in the family is not accurate. Breast cancer reporting is pretty good, but when people report they had a relative with ovarian cancer, often when we try to get those records, we find it was not ovarian but cervical or uterine or something not related to the BRCA genes.”

4. Hi Cate, thought you would enjoy the heart felt point of view expressed by Peggy Orenstein in the NY Times magazine article about the pink-washing of breast cancer – here’s the link if you haven’t seen it http://www.nytimes.com/2013/04/28/magazine/our-feel-good-war-on-breast-cancer.html?ref=magazine

   In my own experience, personal and professional, I have been most impressed for screening on well-done (they are not all well done) thermograms – you have some good options in your area, Mill Valley specifically … what are your thoughts?

   1. Extraordinary summary. A long article but all pages are packed with powerful insights. Thank you for posting this!

5. While we will never know why she went down this path, I’d guess the loss of her mother was the true motivator. It’s true we are taught to live in fear of an array of diseases, especially cancer and then in particular, breast cancer for women. When you think about it though, we are taught to fear everything from childbirth, to kids being stolen, to unemployment, to dementia

   I would be interested to know if, in your practice, you recommend mammograms for women over 40.
   Thanks
   Jen

   1. I recommend starting at 40 for anyone who wants screening at that time, but explain the two primary reasons the schedule was scaled back from starting at 40 to starting at 50. 1: Radiation harms coronary arteries. And 2: Finding cancer early is not universally helpful, as once assumed, because the body can sometimes eradicate cancer when left alone.

      According to the country’s leading researchers in this field, one million women have been treated for cancer unnecessarily, meanwhile, some cancers seem to defy early detection with mammography. The practice changing article was published in the New England Journal of Medicine, entitled Effect of Three Decades of Screening Mammography on Breast-Cancer Incidence

      An excerpt from a related article interviewing these researchers follows (their work is largely responsible for the recent scaling back in the recommendations):

      “We need to start telling the truth,” said Welch. “We’ve promoted this as if it’s the most important thing a woman can do for her health. And the truth is that it’s a really close call.”

      Women in their 40s who feel comfortable getting annual mammograms should not be dissuaded from doing so, he said. “But women who have never felt good about it, who felt coerced into the procedure, should feel equally good about not having it.”

      Similarly, Welch said, women who do get screening mammograms and are found to have a tumor in a very early stage may want to consider alternatives to aggressive treatment — engaging in watchful waiting, for instance, or signing up for a clinical trial of drugs that may halt or slow the progression of cancer. Men have faced similar issues in deciding what to do about screening and treatment of prostate cancer, he said.

      “We should tell women about the trade-offs and we should allow them to make their own decision,” he said.

6. I made a writing mistake, I meant to say she is now on morphine.

7. A friend’s daughter, who is only 31 years, is now dying from breast cancer. I watched as she was told to go on the Paleo diet and really couldn’t adhere to it. I watched as she decided to get more and more Chemo even though there was not a chance of it working. So sad and it made her so sick. She is not on large amounts of morphine and walks around, when she can, like a zombie. It was initially given for her anxiety and now she is addicted to it also.

   Addiction to high carbohydrates foods are not to be sneezed at given that a young woman would choose chemo over having to change her diet. Just like the smoker who continues to smoke when they no longer can breathe because of emphysema they just are so addicted they can’t stop smoking.

   I am in Istanbul at the moment and as I watch these people from all over the world I am struck by one thing. They all have wheat belly. Practically every single one of them has that roll of fat, even on the young kids. Wheat in all its forms to eat, is what is seen everywhere I look. The sourdough method is no longer used and this makes it much worse.

   We need radical counselling to break free of the hypnotic spell we are all under.

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