Crucial mutations

“There are red flags that doctors and OBGYNs should be aware of,” she said. “If you had someone in your family on your mother or father’s side who developed cancer, particularly if they developed breast or ovarian cancer at a young age, then you should be tested — even more so if you’re of Ashkenazi descent. Some of the breast cancers associated with BRCA 1 and 2 are very aggressive, so one of the most important things you can do is to be tested because there are several options if you’re positive.”

Sadly, she said, “Many doctors and OBGYNs do not suggest this testing even when there are red flags everywhere.”

Speaking by telephone, Ashikari emphasized that there were “no absolutes.” If someone did test positive for BRCA 1 or 2 and had a family history of ovarian cancer, he said, he would nevertheless strongly suggest they get their ovaries and tubes taken out “before the age of 40.”

Why? “Because unlike breast cancer where there is an 80 per cent success rate with treatment, in ovarian cancer cases there is an 80 per cent mortality rate. The cancer is very difficult to detect, and those with ovarian cancer don’t become symptomatic often until the cancer is in a late stage.”

If BRCA 1 or BRCA 2 mutations are found in a patient who also has a history of breast cancer in the family, Ashikari said there were several alternative paths which could be pursued. One was to be “monitored very closely, at a younger age [if detected] and more frequently with MRIs, sonograms, mammograms,” he said. Another option was “to stay monitored and not get treated until you have been diagnosed with breast cancer.”

There is also prophylactic surgery. Those at risk can choose to have a bilateral mastectomy and reconstructive surgery all at one time (this could even include having ovaries taken out during at the same time) to reduce their risk of developing cancer. One of the benefits to having the prophylactic surgery, besides greatly reducing the risk of getting cancer, is that “the person isn’t forced to go through chemotherapy and radiation, which have risks and side effects of their own,” said Ashikari. A surgical oncologist, he along with his father pioneered a breast reconstruction procedure that in a single surgery allows removal of cancerous or potentially cancerous breast tissue, adds breast implants, and often spares the nipple.

“My breasts came out looking better than when I came in, a size bigger, and I was able to greatly reduce my risk of cancer with one two-and-a-half-hour surgery,” said Sara Jakobitz of Gardiner. She had a family history of breast and ovarian cancer, tested positive for BRCA 1 and 2, and is of Ashkenazi descent. She said she decided to “be proactive rather than spend years worrying and waiting that I’d develop cancers that killed so many women in my family.”

Ashikari was quick to note that having BRCA 1 or 2 doesn’t give the person any worse outcome then a non-BRCA 1 or 2 individual dealing with the same cancer. “But being BRCA 1 or 2 positive unfortunately does make one more statistically prone to types of cancers that we call triple-negative,” he said. “These are hormone-insensitive types of cancer that are very aggressive.”

Ashikari will be answering questions at his talk on Nov. 12. There’s a $5 fee. For information on the presentation, call (845) 255-9817. And to learn more about BRCA 1 and BRCA 2 in relation to Ashkenazi Jews go to www.sharsheret.org or www.facingourrisk.org. To learn more about Ashikari you can go to http://www.ashikaribreastcenter.com/

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