Friday, October 31, 2014

Danger DNA

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A high-profile diagnosis sheds light on the high rates of a deadly breast cancer gene among Hispanic women.

At 27, Monique Sisneros was young when she developed breast cancer, but she was also lucky. Lucky her mother lived through the disease two years prior and pushed Sisneros to visit the doctor. Lucky her mother insisted Sisneros request further testing when doctors suggested waiting six months to see if the lump grew. Lucky to have insurance when today – like many other Valley Hispanic women – she doesn’t.


“She had always been on me to get checked,” Sisneros, an Avondale resident, says of her mother. “I didn’t really know how extreme it was or that it would happen to me.”

Breast cancer ranks as the top killer of Hispanic women in the United States, according to the Centers for Disease Control and Prevention – more lethal, even, than heart disease, the top killer of white and black women. Hispanic women develop breast cancer less frequently than white women but face a 20 percent greater risk of dying from the disease, according to a University of Louisville study.

Researchers have uncovered one contributing factor: higher rates among Hispanics of a gene mutation called BRCA, for which Sisneros tested positive after her 2008 diagnosis. Coupled with factors like lack of medical coverage and cultural stigmas, BRCA creates a perfect cancer-storm for Hispanic women, who constitute roughly a third of Maricopa County’s female population.

BRCA – which sharply increases a woman’s risk of breast and ovarian cancer – gained notoriety in May when Angelina Jolie announced she carried it and that she removed both breasts in hopes of avoiding malignancy. BRCA-positive women face on average a 60 percent lifetime risk of breast cancer and up to a 40 percent risk of ovarian cancer, while women in the general population have a 12 percent lifetime risk of breast cancer and a 1.4 percent risk of ovarian cancer, according to the National Cancer Institute.

BRCA also amplifies the lethality of breast cancer. According to NCI, most breast cancers occur in women older than 50, while BRCA-related cancers often develop earlier, when tumors tend to be more virulent. Moreover, BRCA1, the mutation most commonly found in Hispanics, often leads to “triple negative” breast cancer, which proliferates quickly and resists chemotherapy, says Dr. John Luis Bibb, an oncologist with Arizona Oncology and a second-generation Hispanic.

To minimize chances of cancer, BRCA-positive women often opt for preventive surgeries. Sisneros removed both breasts after her diagnosis, although just one had cancer. Two years later, she excised healthy ovaries.

Early-stage diagnosis increases odds for remission, leading Bibb to rank low access to care high among reasons breast cancer kills so many Latinas. Countywide, nearly 31 percent of Hispanics lack health insurance coverage, compared to 18 percent of the total population, according to the Census Bureau.

Early stage breast cancer lacks symptoms, also hindering diagnosis. “Going to the doctor when you don’t feel sick may not seem like the most important thing,” says Dr. Ian Komenaka, an oncologist at Maricopa Medical Center, which serves low-income people. “Everything costs money, and without insurance [preventive medicine] has got to be paid out-of-pocket.”

Traditional Hispanic families also often avoid discussing medical issues, Bibb says. “Talking about negativity and illnesses, and especially cancer, is taboo.” Fear of doctors, diagnoses or treatment often spurs reluctance in seeking attention.

For BRCA-positive patients, Bibb often recommends aggressive preventive measures, such as removing the non-cancerous breast. Sisneros says her family supported her decision to seek care, but many traditional Hispanics are apt to “just let it be.” For Sisneros, knowing she carried the BRCA mutation both narrowed and simplified her options, but the choices were agonizing. She elected for the most drastic measures possible to increase her chances for a healthy, long life.  “I do have a choice, but I don’t have a choice,” she says.

** These statistics from the Journal of the American Medical Association illustrate BRCA1 prevalence rates among roughly 1,700 women diagnosed with cancer before age 65.
 
Ashkenazi Jewish: 8.3 percent
Hispanic: 3.5 percent
Non-Hispanic White: 2.2 percent
African-American: 1.3 percent
Asian-American: 0.5 percent

 

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