The BRCA gene mutation: Linking breast and ovarian cancer

505891629by Mary Barringer, WHNP-BC

This October, Dearborn and other cities across the country turned pink in observance of National Breast Cancer Awareness Month; a month dedicated to educating men and women alike about the importance of early detection of breast cancer. With more than 220,000 women in the United States diagnosed with breast cancer in 2011, it is, no doubt, a worthy cause.

But there is another threat to women’s health that is closely linked with breast cancer – and often doesn’t get the same kind of attention: ovarian cancer.

This year, the American Cancer Society estimates that nearly 22,000 women will be diagnosed with ovarian cancer and more than 14,000 will die as a result. Ovarian cancer ranks fifth in cancer deaths among women, accounting for more deaths than any other cancer of the female reproductive system. A woman’s risk of getting ovarian cancer during her lifetime is about 1 in 73. Her lifetime chance of dying from ovarian cancer is about 1 in 100. (These statistics don’t count low malignant potential ovarian tumors.)

Risk factors for ovarian cancer
There are several important risk factors for ovarian cancer that women should be aware of, including:

  • Age
  • Obesity
  • Reproductive history
  • Birth control
  • Gynecologic surgery
  • Fertility drugs
  • Estrogen therapy and hormone therapy
  • Talcum powder
  • Diet
  • Analgesics
  • Smoking and alcohol use

The link between breast cancer and ovarian cancer
A family history of other types of cancer, including colorectal and breast cancer, is also linked to an increased risk of ovarian cancer. This is because of an inherited mutation (change) in certain genes that causes a family cancer syndrome. About 5 to 10% of ovarian cancers are caused by family cancer syndromes resulting from inherited mutations in two types of genes: the BRCA1 and BRCA2 genes.

The family cancer syndrome caused by a BRCA1 or BRCA2 mutation is linked to a high risk of breast, fallopian tube, primary peritoneal, pancreatic and prostate cancer. It is also responsible for most inherited ovarian cancers. When these genes are normal, they help prevent cancer by making proteins that keep cells from growing abnormally (they act as tumor suppressors). For those who have inherited a mutation in one of these genes from either parent, this cancer-preventing protein is less effective. The lifetime ovarian cancer risk for women with a BRCA1 mutation is estimated at between 35 and 70%.

Who Should Get Tested for BRCA Gene Mutation?
Because BRCA1 and BRCA2 gene mutations are relatively rare in the general population, most experts agree that women without cancer should only be tested when their family history suggests the presence of a mutation. This could include a family history of:

  • Breast cancer diagnosed before age 50 years
  • Cancer in both breasts
  • Both breast and ovarian cancers
  • Multiple breast cancers
  • Two or more primary types of BRCA1- or BRCA2-related cancers in a single family member
  • Cases of male breast cancer
  • Ashkenazi Jewish ethnicity – Mutations in BRCA1 and BRCA2 are about 10 times more common in those who are Ashkenazi Jewish than those in the general U.S. population.

Beyond family history, a personal history of breast cancer is another risk factor for ovarian cancer. There are several reasons for this, which may include an inherited mutation in the BRCA1 or BRCA2 genes. Additionally, some reproductive risk factors for ovarian cancer, such as not having children and late onset of menopause, may also affect breast cancer risk. The risk of ovarian cancer after breast cancer is highest in those women with a family history of breast cancer.

What are some benefits of genetic testing for breast and ovarian cancer risk?
The benefits of genetic testing for those at high risk are two-fold:

  • A negative result can provide a sense of relief and indicate that special checkups, tests or preventive surgeries may not be needed.
  • A positive test result can allow women to make informed decisions about their future, including taking steps to reduce their cancer risk. In addition, those with a positive test result may be able to participate in medical research that could, in the long run, help reduce deaths from breast and ovarian cancer

How can a person who has a positive test result manage their risk of cancer?
Several options are available for managing cancer risk in individuals who have a known
BRCA1 or BRCA2 mutation. These include enhanced screening, prophylactic (risk-reducing) surgery and chemoprevention. Oral contraceptives may also lower the risk of ovarian cancer in women with BRCA1 or BRCA2 mutations.

Mary Barringer, WHNP-BC

Mary Barringer, WHNP-BC

If you or your family have a history of breast cancer or other types of gynecologic cancer, be sure to talk to your physician about your risk for ovarian or other cancers. Also, don’t forget about the importance of screenings – while there is no screening specific to ovarian cancer, an annual mammogram for women over 40 (or younger, depending on family history) is an important step toward early detection and overall health maintenance.

Mary Barringer, WHNP-BC is a certified women’s health nurse practitioner. Along with J. Anthony Rakowksi, DO, she is part of Oakwood Gynecologic Oncology Associates.

The BRCA gene mutation: Linking breast and ovarian cancer

505891629by Mary Barringer, WHNP-BC

This October, Dearborn and other cities across the country turned pink in observance of National Breast Cancer Awareness Month; a month dedicated to educating men and women alike about the importance of early detection of breast cancer. With more than 220,000 women in the United States diagnosed with breast cancer in 2011, it is, no doubt, a worthy cause.

But there is another threat to women’s health that is closely linked with breast cancer – and often doesn’t get the same kind of attention: ovarian cancer.

This year, the American Cancer Society estimates that nearly 22,000 women will be diagnosed with ovarian cancer and more than 14,000 will die as a result. Ovarian cancer ranks fifth in cancer deaths among women, accounting for more deaths than any other cancer of the female reproductive system. A woman’s risk of getting ovarian cancer during her lifetime is about 1 in 73. Her lifetime chance of dying from ovarian cancer is about 1 in 100. (These statistics don’t count low malignant potential ovarian tumors.)

Risk factors for ovarian cancer
There are several important risk factors for ovarian cancer that women should be aware of, including:

  • Age
  • Obesity
  • Reproductive history
  • Birth control
  • Gynecologic surgery
  • Fertility drugs
  • Estrogen therapy and hormone therapy
  • Talcum powder
  • Diet
  • Analgesics
  • Smoking and alcohol use

The link between breast cancer and ovarian cancer
A family history of other types of cancer, including colorectal and breast cancer, is also linked to an increased risk of ovarian cancer. This is because of an inherited mutation (change) in certain genes that causes a family cancer syndrome. About 5 to 10% of ovarian cancers are caused by family cancer syndromes resulting from inherited mutations in two types of genes: the BRCA1 and BRCA2 genes.

The family cancer syndrome caused by a BRCA1 or BRCA2 mutation is linked to a high risk of breast, fallopian tube, primary peritoneal, pancreatic and prostate cancer. It is also responsible for most inherited ovarian cancers. When these genes are normal, they help prevent cancer by making proteins that keep cells from growing abnormally (they act as tumor suppressors). For those who have inherited a mutation in one of these genes from either parent, this cancer-preventing protein is less effective. The lifetime ovarian cancer risk for women with a BRCA1 mutation is estimated at between 35 and 70%.

Who Should Get Tested for BRCA Gene Mutation?
Because BRCA1 and BRCA2 gene mutations are relatively rare in the general population, most experts agree that women without cancer should only be tested when their family history suggests the presence of a mutation. This could include a family history of:

  • Breast cancer diagnosed before age 50 years
  • Cancer in both breasts
  • Both breast and ovarian cancers
  • Multiple breast cancers
  • Two or more primary types of BRCA1- or BRCA2-related cancers in a single family member
  • Cases of male breast cancer
  • Ashkenazi Jewish ethnicity – Mutations in BRCA1 and BRCA2 are about 10 times more common in those who are Ashkenazi Jewish than those in the general U.S. population.

Beyond family history, a personal history of breast cancer is another risk factor for ovarian cancer. There are several reasons for this, which may include an inherited mutation in the BRCA1 or BRCA2 genes. Additionally, some reproductive risk factors for ovarian cancer, such as not having children and late onset of menopause, may also affect breast cancer risk. The risk of ovarian cancer after breast cancer is highest in those women with a family history of breast cancer.

What are some benefits of genetic testing for breast and ovarian cancer risk?
The benefits of genetic testing for those at high risk are two-fold:

  • A negative result can provide a sense of relief and indicate that special checkups, tests or preventive surgeries may not be needed.
  • A positive test result can allow women to make informed decisions about their future, including taking steps to reduce their cancer risk. In addition, those with a positive test result may be able to participate in medical research that could, in the long run, help reduce deaths from breast and ovarian cancer

How can a person who has a positive test result manage their risk of cancer?
Several options are available for managing cancer risk in individuals who have a known
BRCA1 or BRCA2 mutation. These include enhanced screening, prophylactic (risk-reducing) surgery and chemoprevention. Oral contraceptives may also lower the risk of ovarian cancer in women with BRCA1 or BRCA2 mutations.

Mary Barringer, WHNP-BC

Mary Barringer, WHNP-BC

If you or your family have a history of breast cancer or other types of gynecologic cancer, be sure to talk to your physician about your risk for ovarian or other cancers. Also, don’t forget about the importance of screenings – while there is no screening specific to ovarian cancer, an annual mammogram for women over 40 (or younger, depending on family history) is an important step toward early detection and overall health maintenance.

Mary Barringer, WHNP-BC is a certified women’s health nurse practitioner. Along with J. Anthony Rakowksi, DO, she is part of Oakwood Gynecologic Oncology Associates.

Ebola: What is it and who is at risk?

Given the nature of the current Ebola virus outbreak in West Africa and the recent cases in the United States, Oakwood’s Infection Prevention & Control Department has been working for the past several weeks to ensure Oakwood is prepared for potential Ebola patients. Priscila A. Bercea, an Ebola infection control specialist at Oakwood, and Joanne McKay, Oakwood’s administrator of clinical services working with the Emergency Departments, provide more information.

What is Ebola?
Ebola is a rare and often deadly disease caused by infection with an Ebola virus – there are five strains. This current Ebola outbreak is the largest due to the nature of where it struck in three very impoverished countries with poor healthcare infrastructure and public health.

How does someone get it?
Ebola is spread through direct contact through broken skin or mucus membranes with blood or body fluids including but not limited to urine, saliva, feces, vomit of a person who is sick with Ebola. The virus is spread through direct contact with any objects that have been contaminated (needles or syringes) with the virus. It is not spread through the air, like many other more common viruses. A person is only contagious when symptomatic.

Who is at risk and is there a danger of Ebola spreading in the US?
Only people who have recently traveled to West Africa or have had close contact with someone who has traveled there and is symptomatic are at risk. The risk of it spreading in the U.S. is very low. We have a totally different context of health care in the U.S. compared to those in impoverished nations. We are much more prepared to handle any kind of suspected Ebola patient and prevent further contamination, given our strong health care system and the resources we have to contain these patients and properly isolate them.

Ebola Virus

Ebola virus attacking a cell.

What protocol does Oakwood have in place?
As soon as any patient enters our ER they are going through a screening process. Part of our screening process now is a new travel screening that we have implemented that asks patients if they have traveled outside of the U.S. in the past 21 days, or have been in close contact with someone who has traveled outside of the U.S. in the past 21 days. If they answer yes they click the button in our electronic health record and it opens up to specific questions about whether they traveled in the last 21 days to any of the countries in West Africa. At that point in time we have it narrowed down to their specific symptoms. If they answer yes to those questions, the nurse gets an immediate notification that tells them to place the patient immediately into both airborne and contact isolation and then to alert the physician and their site infection control department.

Why is it important that the staff screen all patients?
There are so many different diseases that people have now, including the common flu, and the symptoms are very similar. Many people come in with a fever or a cough so we have to ask the question about travel because that is what differentiates Ebola. We wanted to be proactive and plan ahead so with the partnership between the emergency rooms and the infection control department, we were able to create this travel screening which we can utilize for not only this emerging disease but future diseases.

What can people do to reduce the risk of contracting the disease?
The best thing to do is avoid travel to these West African countries where the Ebola outbreak is occurring. If you do have to travel abroad, follow infection control prevention practices.

What should someone do if they have recently traveled to one of these regions and are experiencing symptoms?
Immediately go to a hospital or your local emergency room and notify a healthcare worker. If you are not symptomatic but have traveled recently or are in contact with someone who has traveled recently, monitor yourself for 21 days. If you develop symptoms, go to your local hospital immediately. Our primary goal is to identify and isolate suspect patients as early as possible to ensure we stop the further transmission of Ebola. The biggest thing the public can do to help stop the spread of Ebola is communication.

For more details about Ebola and the steps Oakwood is taking to prepare for potential Ebola patients, listen to the following clip from a recent WJR Champions of Care segment.

 

Minor lifestyle changes can reduce your breast cancer risk

 Although one in eight women either has or will develop breast cancer in their lifetime, there are steps you can take to reduce your risk and improve your chances of making a full recovery.

Letacia Thomas, MD, a family medicine physician with offices in Canton, said even minor changes to your lifestyle can help you lead a longer, healthier life.

Oakwood physician Letacia Thomas

Oakwood physician Letacia Thomas, MD

“While we don’t know how to prevent breast cancer, it’s possible to lower your risk of developing it,” she said.

Knowing your family history of the disease is a good place to start, she said. You want to find out how many people on both sides of your family have had breast cancer—or any other form of cancer—and when they were diagnosed. You also need to share that information with your primary care physician.

She suggests women start scheduling regular mammograms when they turn 40 years old—or earlier, if they have a strong family history of the disease—and should perform self-examinations between annual physicals. Watch for lumps, changes in texture of your breasts and new, persistent pain.

“You can’t prevent breast cancer, but there are steps you can take to find it early,” she said. “You should get checked right away if something doesn’t seem right.”

Early detection is the key to surviving the disease, according to the American Cancer Society. Statistically, those whose cancer is detected in the first stage or earlier have a 100 percent five-year survival rate. At Stage II, that drops to about 93 percent. The percentage drops significantly after that.

In order to reduce your risks, Thomas said it’s important to maintain a healthy lifestyle. Stop smoking or, at the very least, reduce your tobacco intake. Maintaining a healthy weight, being active and reducing your alcohol consumption will help, too, as will managing any chronic conditions you have, like diabetes.

“Even small changes to improve your health and wellness can help lower your risk for breast cancer,” she said.

Women: More susceptible than men to depression

When a woman says she’s feeling down or blue, that statement deserves more attention than it would coming from a man. Feeling down or blue could be indicative of a major depressive disorder that requires treatment.

Stock depressed/tired woman

When a woman says she’s feeling down or blue, that statement deserves attention as it could be indicative of depression.

This is National Mental Illness Awareness Week. It’s designed to draw attention to the fact that more than 25 million Americans will have an episode of major depression this year.

Oakwood offers mental health services to our communities in a caring and comprehensive manner and pays particular attention to women’s needs in this area of healing.

According to the Mayo Clinic, women:

  • Are twice as likely as men to have depression
  • Can develop depression at any time in lives
  • Who develop depression will likely do so between the ages of 40 and 59

There are several causes for depression in women. Not all of the causes are due to hormonal changes.

  • PMS
  • Lifestyle, work changes or relationship problems
  • Premenstrual dysphoric disorder (PMDD)
  • Previous episodes of depression, postpartum depression or PMDD
  • Lack of social support
  • Mixed feelings about being pregnant, an unwanted pregnancy, a miscarriage or infertility

Stress is a major indicator of depression in both men and women, but it usually occurs at a higher rate in women. Women with depression often have other mental health conditions that require treatment, such as:

  • Anxiety, which commonly occurs along with depression in women
  • Eating disorders. There’s a strong link between depression in women and anorexia and bulimia
  • Drug or alcohol abuse. Some women with depression also have some form of substance abuse or dependence. Substance abuse can make depression worse and harder to treat

There are some common signs of depression for men and women. According to the Mayo Clinic, even severe depression often can be successfully treated. Seek help (a good starting point is your Primary Care Physician) if you have the signs and symptoms of depression:

  • Ongoing feelings of sadness, guilt or hopelessness
  • Loss of interest in the things you once enjoyed
  • Significant changes in your sleep pattern
  • Fatigue, or unexplained pain or other physical symptoms without an apparent cause
  • Significant weight gain or loss for no apparent reason
  • Feeling as though life isn’t worth living, or having thoughts of suicide

To learn more about women and depression, and the resources available to you, visit http://www.oakwood.org/womens-health.

How dangerous are synthetic drugs?

Several local students have recently been hospitalized after taking a synthetic drug called “Cloud 9.” It is the latest synthetic drug to hit the local market and is very dangerous.

Synthetic drugs – including Cloud 9, Hookah Relax, Bath Salts, K2 and Spice – are often sold in legal retail outlets as “herbal incense” or “bath salts.” Cloud 9 and Hookah Relax are sold in small bottles that resemble an air freshener. Cloud 9 is an illegal substance, but the chemists are constantly changing the name and chemical makeup of synthetic drugs so law enforcement has a difficult time banning each product.

Joanne McKay speaking at John Glenn High School during a community forum on synthetic drugs.

Oakwood Administrator of Clinical Services Joanne McKay, RN, MSN, CEN, speaking at John Glenn High School during a community forum on synthetic drugs.

The Wayne Westland Community School District partnered with Oakwood Healthcare System, the Wayne and Westland police departments and the Westland Youth Assistance Program to host a community forum at John Glenn High School to inform parents about the warning signs and dangerous side effects of synthetic drugs.

The panel consisted of:
• Joanne McKay, RN, MSN, CEN – Administrator of Clinical Services for Oakwood Healthcare System
• Jamie Balavitch, CPC-R – Prevention Programs Supervisor at the Oakwood Taylor Teen Health Center
• Chief Jeff Jedrusik – Westland Police Department
• Sgt. Matthew Spunar – Wayne Police Department
• Paul Motz – Director at the Westland Youth Assistance Program
• Justin Thomas – Case Manager, Westland Youth Assistance Program

Westland Police Chief Jeff Jedrusik started off the forum by explaining the severe dangers of this drug.

He said, “This is not a leisure drug. This is a deadly poison.”


Here are some other key take-aways from the forum:

How are they used?
Users are putting them in energy drinks and soda or using them with an e-cigarette or a Vape pen (an inhalation device), which is small enough to be concealed in a long shirt sleeve.

Cloud 9 is a liquid synthetic cannabinoid and often resembles small air fresheners.

Cloud 9 is a liquid synthetic cannabinoid and often resembles small air fresheners.

What are the short-term physical effects?
severe paranoia that can sometimes cause users to harm themselves or other suicidal thoughts
• agitation
• combative/violent behavior
• confusion
• hallucinations/psychosis (users have reported seeing things like monsters and demons)
• high heart rate and blood pressure
• vomiting
• chest pain
• seizures
• serious injury or even death

Users also tend to think they have super human strength.

Cloud 9 takes effect in 15 minutes or less and can last up to several days.

What screenings are available for the drug?
These drugs do not show in drug tests, so it is very difficult to detect. This makes it even more important for parents to watch for any changes in their children and monitor what they are doing.

What should parents watch for?
extreme irritability
• change in personality
• dramatic weight loss
• unexpected decline in school performance
• missing school
• trouble with the law

All panelists agreed that the most important thing parents can do is to make time to talk with their children. They recommend getting to know your kid’s friends and their friends’ parents, and monitor what they are doing. There are resources linked below for parents who would like to learn more about synthetic drugs such as Cloud 9 and the resources that are available.

Oakwood Teen Health Centers

State of Michigan OK TO SAY Hotline

Emergency services information

Office of National Drug Control

Enterovirus D68: What is it and what do I need to know about it?

The Michigan Department of Community Health revealed today, Oct. 1, that there are now 25 confirmed cases of Enterovirus D68 (EV-D68) in the state of Michigan. This virus spreads fast and is very contagious, according to Dr. Arsala Bakhtyar, an Oakwood-affiliated pediatrician and pediatric infectious disease specialist.

Here is a quick overview of what you need to know about EV-D68 from Dr. Bakhtyar:

Arsala Bakhtyar, MD

Arsala Bakhtyar, MD

What is it?
EV-D68 is one of more than 100 non-polio enteroviruses. It has been around for decades, but we are hearing about it now because of the way it has been spreading in the Midwest since school started last month.

How does it spread?
The virus spreads from person-to-person. When an infected person contaminates a surface by coughing or sneezing and another person touches it, that other person becomes infected.

Who is most at risk?
Infants, children and teens are more at risk because they do not have immunity from previous exposures. This virus in particular is infecting more asthmatic children.

What are the signs and symptoms?
Symptoms range from mild, including a cough and low grade fever, to more severe symptoms such as:

  • difficulty breathing
  • shortness of breath
  • fast heart rate and
  • fast breathing rate
  • irritability
  • body aches

What are some steps to keep kids from becoming infected?
This virus is difficult to prevent, but parents should make sure children are washing their hands with soap and water for at least 20 seconds, especially after using the bathroom. Children should also avoid kissing, hugging, or sharing utensils with infected people. It is important to disinfect frequently touched surfaces like toys and doorknobs.

Call your doctor if your child feels sick or has a fever and do not send him or her to school.

What treatment is available?
This is a virus and there is no treatment or vaccination for it – it has to run its course. Symptoms are treated as needed, such as fevers and shortness of breath.

How long does it usually last?
Most severe cases last between four and five days. Symptoms may linger for a couple of weeks, but the peak illness does not tend to last more than five days.

Listen to Dr. Bakhtyar discuss EV-D68 in detail in the Champions of Care recording below.

Find an Oakwood pediatrician

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