Network News - Winter/Spring 2010 - Canadian Breast Cancer ...

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A more recent case-control study looked at 472 postmenopausal BRCA1 mutation carriers. 3 Women who developed breast cancer (cases) were compared with women who didn’t (controls) and researchers tried to determine whether prior HT use had influenced cancer risk. They found that use of HT was not a risk factor for developing breast cancer. In fact, women who used estrogen alone had a lower risk of breast cancer compared to women who did not use estrogen at all. It is not known whether results from this study also apply to BRCA2 mutation carriers. BRCA1 cancers are commonly negative for estrogen and progesterone receptors, so they may be affected less by hormones. A model was designed to calculate life expectancy gains after rrBSO in BRCA 1 or 2 mutation carriers between 30 and 40 years of age. 4 Data used to calculate risk of breast cancer associated with HT was from a general population of postmenopausal women, not BRCA mutation carriers or women who had undergone rrBSO. The analysis found that HT did not change life expectancy gains of rrBSO if women stopped taking the hormones by age 50. In this model, the gain in life expectancy with rrBSO ranged from 3.34 to 4.65 years, depending on age at oophorectomy. The change in life expectancy with HT ranged from +0.17 years to -0.34 years when HT was stopped at age 50. Bioidentical Hormone Therapy There are many HT products available in Canada. Hormone therapy must be individualized based on the effect it has on symptoms and any adverse effects that occur. Different products can have different effects and what works well for one woman doesn’t necessarily work as well for another. Many women have heard about “Bioidentical Hormone Therapy” (BHT). It may be promoted as a safer, more natural type of HT. The term “bioidentical” refers to a hormone that has the same chemical structure as one produced by the body. Examples include estradiol, estrone, estriol, progesterone and testosterone. Bioidentical hormones are commercially available in several well-tested Health Canada approved prescription products. BHT may also refer to custom compounded HT preparations that are mixed up at a compounding pharmacy. All BHT products, whether commercially manufactured or custom compounded, may help symptoms of surgical menopause. There is still no strong evidence that one type or brand of estrogen is safer than the others when it comes to breast cancer risk. Vaginal estrogen and testosterone Women with symptoms of vaginal dryness may use a vaginal estrogen product. Absorption into the body is minimal at recommended doses. Vaginal estrogen may be used along with systemic HT if necessary. Women may be interested in using testosterone for low sexual desire. Whether testosterone should be replaced after rrBSO is controversial. Many things affect sexual function in women, including relationship factors, stress, fatigue and overall health. Estrogen therapy may improve sexual desire and response by improving blood flow to the vagina and increasing lubrication. There are no commercially manufactured testosterone products available in Canada for women due to lack of longterm safety and efficacy data. Effect of testosterone on breast cancer risk is not known. An individual decision Many aspects of the effects of HT on breast cancer risk in BRCA mutation carriers are unknown. Caution is still advised. If HT is “bioidentical,” this does not guarantee that it is a safer HT without risks. Women should decide about short-term HT based on quality of life issues and consider stopping HT around the time when natural menopause would have occurred. Most importantly, the decision whether or not to use HT following rrBSO is an individual one. • References 1. MacLennan et al. Cochrane Database Syst Rev. 2004;18(4) 2. Rebbeck et al. J Clin Oncol. Nov 2005;23(31):7804-10 3. Eisen et al. J Natl Cancer Inst. Oct 2008;100(19):1361-7 4. Armstrong et al. J Clin Oncol. Mar 2004;22(6):1045-54 Jodi Wilkie, B.Sc.Pharm., is a pharmacist and North American Menopause Society credentialed Menopause Practitioner. She obtained her Bachelor of Science in Pharmacy with distinction from the University of Alberta and worked for many years as a community pharmacist with Safeway Pharmacy. This is where she developed an interest in women’s health and pursued this as a specialty. Jodi currently works in outpatient Women’s Health clinics, including Menopause and Obstetric Medicine clinics, at the Grey Nuns and Royal Alexandra hospitals in Edmonton. Subscribe to our e-letter, Outreach! Outreach is the Canadian Breast Cancer Network’s free e-letter, which contains action alerts, info about our activities, programs and projects. You can find out about opportunities to join panels, do surveys, order reports, and much more! It is only available by e-mail. To subscribe, send an e-mail to cbcn@cbcn.ca or call Maureen at 1-800-685-8820 to sign up. 16 Network News Winter/Spring 2010
Knowledge is Power Interview with Jane Jankovic By Ovarian Cancer Canada Jane Jankovic “couldn’t roll up her sleeve fast enough” to get a blood test that would tell her if she was genetically predisposed to ovarian cancer – the disease that claimed the lives of her mother and grandmother. Yet once she learned – on 9/11 – that she carries a genetic mutation of the BRCA1 gene, it took the television producer two years to decide on a prophylactic oophorectomy – surgical removal of the ovaries and fallopian tubes in a bid to prevent ovarian cancer. Despite the fact that her lifetime risk of developing the disease was as high as 40% and she was also at high risk for developing breast cancer, it took time for her to decide on a course of action. “I was playing the odds,” says Jane. Part of the delay involved coming to terms with not having children. She also didn’t want to be thrown into menopause at age 41. When she did opt for surgery, what she considered a tactical preventive move may have actually saved her life. After several analyses of her tissue, pathologists found Stage II serous ovarian cancer. “I didn’t feel anger. I didn’t feel scared. I felt relief,” recalls Jane. “I had lived with the threat of cancer for so many years that being able to focus on the enemy seemed simpler than living in fear of an ambush. Now that I knew I had it, I could focus. “In ovarian cancer, the cancer’s biggest advantage is that you don’t know it’s there until it’s too late. I was Stage II. And I knew it was there. The advantage was mine.” Within a week, Jane began chemotherapy followed by radiation therapy that was part of a clinical trial. That was in 2004 and Jane has been well ever since. She continues to be monitored for recurrence and screened for breast cancer. Jane Jankovic Women who are diagnosed with early-stage ovarian cancer and treated have survival rates as high as 80% to 90%. Unfortunately, due to a lack of a screening test for the disease, most women are diagnosed in the late stages when survival rates can be as low as 20%. Jane is grateful for genetic counselling and testing – something that was not available when her grandmother and mother were alive. The BRCA1 and BRCA2 genes were identified in the mid-1990s after both of these women had died. When genetic counselling and testing were available in the new millennium, Jane took advantage of these advances. “I didn’t have to think about doing the test at all,” she says. “I was not one of those people who was squeamish about knowing. I wanted to know so I could then make an informed decision about what I could potentially do to improve my chances of not getting ovarian cancer. For me, it was all winwin to know.” While she appreciates the fact that testing may not be for everybody, Jane is a person who “wants all of the information all of the time. I think it’s one thing to be afraid of having a genetic predisposition if there’s nothing you can do with that knowledge. But being tested for BRCA1 or 2 does give you an option to be preventative as much as possible.” Jane recently celebrated her 50 th birthday and over the years she has learned hard lessons about life and death, especially that “there are no guarantees.” Not only has she lost her mother and grandmother to ovarian cancer, but her father died of a heart attack weeks after receiving a clean bill of health from his cardiologist. “And my sister went to emergency with chest pains and was diagnosed with flu. She died from heart failure the next day.” Despite these experiences, Jane remains grateful for the advances that have allowed her to make decisions that keep her healthy and active. She encourages those who are eligible for genetic counselling to take advantage of it so they can decide whether or not to be tested. “This experience taught me that I can’t control everything that happens to me but I can control my response,” says Jane. “I think cancer patients can sometimes describe themselves as powerless and vulnerable. I would flip that around and say, it’s taught me that I have a lot more power than I thought I had.” • Jane Jankovic has been a producer with TVO for 15 years. A survivor of hereditary ovarian cancer, she volunteers with Ovarian Cancer Canada as a public speaker and media spokesperson. Network News Winter/Spring 2010 17
Page 1 and 2: Canadian Breast Cancer Network Wint
Page 3 and 4: e part of a remarkable Board of Dir
Page 5 and 6: CBCN Board Members, staff and parti
Page 7 and 8: carry a BRCA mutation. If you would
Page 9 and 10: January 2009 and after several scan
Page 11 and 12: What is BRCA? By Dawna M. Gilchrist
Page 13 and 14: 5. Where possible, and if patient/f
Page 15: Hormone Therapy After Risk Reducing
Page 19 and 20: Informing Women of the Risks and Be
Page 21 and 22: Susan Armel is the senior genetic c
Page 23 and 24: BRCA1/2 Testing: Navigating Through
Page 25 and 26: having surgery but is not currently
Page 27 and 28: the risk of hereditary cancer. A ri
Page 29 and 30: At present, we are recruiting women
Page 31 and 32: Familial Breast Cancer and No BRCA1
Page 33 and 34: ‘E’ is for Empowered - Are You
Page 35 and 36: Continued from Page 30 Top 10 Thing

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