BRCA Gene Mutations and Pancreatic Cancer

Cancer Awareness ribbons. BRCA gene mutations and cancer awareness. BRCA gene mutations and pancreatic cancer

This is a transcript of Episode 5 of the BRCA Gene Mutation and Cancer Awareness podcast.

Intro

Welcome to the BRCA gene mutation and cancer awareness podcast.  I am Christina Henry of Midlifestylist.com.  I am a Registered Nurse with a BRCA2 gene mutation.  My podcast will raise awareness of BRCA 1 and 2 gene mutations and their link to an increased cancer risk.  BRCA gene mutations affect males and females equally, but there isn’t a lot of awareness in the community of the cancers that male carriers are at risk of.  My podcast aims to change that.  I will also discuss other topics of interest such as genetic counselling and testing, cancer screening and prophylactic surgery.  If you would like to know more about BRCA 1 and 2 gene mutations, this podcast is for you.  Thanks for joining me.

The Link Between BRCA Gene Mutations and Pancreatic Cancer

The third most common cancer associated with a BRCA1 or 2 gene mutation is pancreatic cancer.  Pancreatic cancer is the fourth most common cause of cancer death in the US and Australia, and has the worst five year survival rate (<9%).

A family history of pancreatic cancer is found in 5-10% of pancreatic cancer patients.  Of the known genetic mutations involved in familial pancreatic cancer, BRCA1 & 2 are the most common.  BRCA2 mutation carriers have a 3.5 fold risk of developing pancreatic cancer.  The risk associated with BRCA1 is unclear – some studies suggest a 2.2 fold risk, others say there is no increased risk.

Currently surgery is the only curative measure, but only 15-20% of patients are diagnosed with resectable disease.  Even if the cancer is resected, 75% of patients will experience disease recurrence within 5 years.  These statistics are a grim reality for people with BRCA gene mutations, and one that I find very concerning.  Because my father died from pancreatic cancer, I am at high risk.

Pancreatic cancer awareness ribbon.  Caption:  Pancreatic cancer facts.  4th most common cancer death in Australia and USA.  Worst 5 year survival rate
Pancreatic cancer facts. 4th most common cancer death in Australia and USA. Worst 5 year survival rate

Risk factors associated with BRCA1 and 2 gene mutations:

As well as a mutation in the BRCA1 or 2 gene, certain risk factors can increase the likelihood that cancer will develop.  For pancreatic cancer, an increased risk is associated with the following:

  • cigarette smoking,
  • chronic pancreatitis,
  • diabetes (especially type 2 diabetes),
  • liver cirrhosis,
  • obesity,
  • age,
  • being male,
  • exposure to certain chemicals used in metal refinery,
  • stomach infection with Helicobacter Pylori (which causes stomach ulcers)
  • and a high fat, meat based diet. 

A decreased risk is associated with a low-fat, high fruit and vegetable diet and quitting smoking. The single environmental factor associated with pancreatic cancer is cigarette smoking, which is estimated for approximately 25-30% of all pancreatic tumours.

High risk patients are first degree relatives of someone with pancreatic cancer, have Reutz-Jeghers Syndrome, or have mutations in BRCA1 or 2, ATM, PALB2, or Lynch Syndrome genes, and have first or second degree relatives with pancreatic cancer.

Pancreatic cancer awareness purple ribbon.  Caption:  The third most common cancer associated with a BRCA gene mutation is pancreatic cancer.  Pancreatic cancer awareness
The third most common cancer associated with BRCA gene mutations is pancreatic cancer.

We do have an opportunity to reduce our risk of many types of cancer, but not pancreatic cancer.   Lifestyle choices can help but we can’t have risk reducing surgery. Watch for symptoms such as the following:

Symptoms of Pancreatic Cancer:

  • Loss of Appetite
  • Fatigue
  • Abdominal and mid-back pain
  • Changes in bowel movements
  • Unexplained weight loss
  • New-onset diabetes.  Symptoms of diabetes may include excessive thirst, a high or low blood sugar level, increased urination or blurred vision
  • Jaundice – yellow skin or eyes
  • Itchy skin
  • Enlarged gall bladder
  • Changes in taste
  • Blood clots.

Like ovarian cancer, the symptoms are vague and may indicate a number of health issues.  Early stage pancreatic cancer rarely causes symptoms which makes it difficult to diagnose.  Seek medical attention early if you suspect that something is wrong.  Be an advocate for your own health,  be proactive with screening and maintain a healthy lifestyle. 

Screening for Pancreatic Cancer

At present there is no clear consensus on the optimal screening method for pancreatic cancer, the age to initiate and stop screening, how often to screen and the ways to treat patients with a tumour.  Screening may include MRCP (magnetic resonance cholangiopancreatography), or an endoscopic ultrasound.  The American College of Gastroenterology recommends that high risk patients should be screened yearly. They recommend a EUS and/or MRI beginning at age 50 or 10 years prior to the earliest age of pancreatic cancer diagnosis within the family.

The Pancreatic Cancer Action Network (PanCAN) recommends that all pancreatic cancer patients receive genetic testing for inherited mutations as well as genetic counseling.  For those with cancer, BRCA mutations can inform and improve treatment.  Cancer cells with a BRCA mutation may respond particularly well to a certain type of chemotherapy as well as a targeted therapy called PARP inhibition.  The PARP inhibitor Olaparib is recommended for patients with metastatic pancreatic cancer who have a BRCA1 or 2 gene mutation and whose tumour previously responded to a platinum based chemotherapy.

Pankind, the Pancreatic Cancer Foundation of Australia, is currently running a campaign because they aim to triple the survival rate of pancreatic cancer by 2030.  Through funding research, particularly into screening for pancreatic cancer, Pankind hope to improve the current outcomes for patients and their families.  Medical research is the single most important factor improving patient survival.  I will add a link in my blog to Pankind’s website where you can donate if you wish.

The Australian Pancreatic Cancer Genome Initiative is conducting one of the research studies currently in Australia. The trial is using EUS (endoscopic ultrasounds) to screen people at high risk of pancreatic cancer.  Hopefully the results of this research will improve detection and survival rates for people with pancreatic cancer.  There is a link to this information on my website.

Purple ribbon for pancreatic cancer awareness.  Caption:  The best protection is early detection.  Pancreatic Cancer Awareness
Purple ribbon for pancreatic cancer awareness.

My Experiences With Pancreatic Cancer Screening

Unlike breast and ovarian cancer, I can’t have prophylactic surgery to reduce my risk of pancreatic cancer.  My best bet is to have screening which will hopefully catch it at its earliest stages, when it is able to be resected.  My gastroenterologist has recommended a MRCP, possibly alternating with EUS.  Unfortunately when you have a BRCA2 gene mutation the fear of cancer is always there, but being proactive with screening will hopefully be enough to keep it at bay.

A couple of weeks ago I had an MRCP which is an MRI of the pancreas and surrounding areas.   MRIs are horrible.  I’ve had breast MRIs in the past which are extremely unpleasant as you need to lie still while lying face down with your breasts dangling through holes cut out of a board which applies pressure to your upper chest.  Your arms are extended above your head in such a way that your shoulders cramp up but you aren’t allowed to shift position to relieve the pain, or even breathe deeply.

I thought the MRCP would be a bit easier than the breast MRI because I’d be lying on my back.  But it wasn’t.   My arms were still extended above my head for the entire torturous 30 minutes. The fear of stuffing the test up and having to redo it caused an anxiety attack and claustrophobia.  My muscles in my neck, shoulders, arms and upper back went into spasm. Next time I’m requesting a sedative as every time I have one my reactions get worse.

Waiting For Test Results

Waiting for the results never gets any easier.  The reality of having a BRCA2 gene mutation is that we need frequent screening,  most of it painful, unpleasant and sometimes scary.  Last week I had a gastroscopy and colonoscopy.   The prep for that was brutal!  Thankfully those tests came back clear as well.

When you’re cleared of cancer once again it’s almost a euphoric feeling.  It’s hard to describe the constant underlying anxiety of having a gene mutation that increases your risk of cancer.  At times I wonder if I’m a hypochondriac or overthinking this, but my doctors reassure me that my paranoia is justified.  The main reason I decided to have prophylactic surgery to remove my breasts and ovaries, was to reduce my risk of cancer and to avoid these stressful and painful screening tests. My risk for ovarian and breast cancer is now less than the general population. 

My Father’s Pancreatic Cancer

Watching my dad die of pancreatic cancer was soul destroying.  He had been unwell for years, mostly due to prostate cancer.  He needed an indwelling catheter to drain his bladder but it kept getting blocked with blood clots.  This lead to frequent hospital admissions and very poor quality of life. He also had many urinary tract infections.  During one of those hospital stays he had a CT Scan which showed his pancreatic cancer,  quite by chance.

Dad’s health declined rapidly and he lost a lot of weight as the pancreatic cancer wrecked havoc with his appetite.  His oral fluid intake was restricted because his sodium level was dangerously low.   This meant he couldn’t enjoy two of his favourite things, food and alcohol.

During his final hospital stay he was hallucinating because of the low sodium. His hands were swollen and painful because he couldn’t take his gout medication.   He was praying constantly that God would end his suffering.  To see my strong dad in this way was heartbreaking.   It took just seven months for pancreatic cancer to take him.

Dealing With The Emotional Side of Cancer Screening

My fear of getting pancreatic cancer is justified because it’s hard to diagnose in the early stages  and has one of the highest mortality rates.  Being aware of this means I will do the screening, no matter how much I hate it.  During the long, sleepless night before the colonoscopy I cried for my dad.  It’s so unfair that this genetic mutation has ripped my family apart.

My way of dealing with days when I feel upset or depressed, is by keeping focused on maintaining my health.  I keep searching for information about BRCA gene mutations because there are currently many research studies being done worldwide.  The knowledge I gain will help me to stay as healthy as possible and hopefully minimise my risk of cancer.  Take a look at my resource page as I have included links to many of these sources.

My next episode will focus on prostate cancer and its link to BRCA gene mutations. As I have mentioned already, my father was a BRCA gene mutation carrier who had prostate cancer as well as pancreatic cancer. My grandfather passed away from prostate cancer and my brother was diagnosed with Stage 4 Prostate Cancer last year. During my nursing career I have worked in urology wards and have cared for many men with prostate cancer. I look forward to sharing this information in my next episode.

Outro

Do you want to learn more about BRCA gene mutations and cancer awareness?  Find me at Midlifestylist.com where you can read about this and living a healthy lifestyle.  Please subscribe to the podcast so that you don’t miss an episode.  If there is a topic you would like me to talk about you can contact me via Midlifestylist.com.  Thank you for listening.  

Shared on Weekend Coffee Share on Natalie the Explorer’s blog and Life This Week Linkup on Denyse Whelan’s blog

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I will GO PINK for Cancer Research

GO PINK for Cancer Research

I do some strange things while scrolling through my phone at night. My insomnia keeps me awake for hours sometimes with only my screen for company. I wake up the next day with buyer’s remorse, usually because I’ve bought shoes or clothes that never fit me, or an appliance that never gets used. But this time I woke up with a sinking feeling in my gut because I had signed up to GO PINK, and agreed to dye my hair pink for breast cancer research.

I’m pretty conservative and have never dyed my hair any shade that could be considered flamboyant or radical. As an introvert I hate to stand out in a crowd. The thought of it makes me blush so I’ll probably end up looking like a flamingo with cheeks to match my hair. I needed some courage and that came in the form of my beautiful niece Ally who LOVES to stand out in a crowd and possesses such a lively spirit that she’ll boost my confidence when I need it the most. Ally has been a wonderful support to me over the last few months. She was the person I turned to when I knew I was having my mastectomies because she’s been through breast surgeries herself. Having someone to talk to who has been through this has been a blessing.

My Niece Ally and I.  We will be fundraising together for the GO PINK for cancer research event.  Ally has been a wonderful support for me
My niece Ally and I. We will be fundraising together for the GO PINK for cancer research event. She’s been a wonderful support to me over the last few months

Why Breast Cancer Research is Important to Me

I’m doing this challenge because it’s to fundraise for a cause that is very special to me. I have written about my genetic disorder BRCA2 which increases my risk of breast, ovarian, pancreatic and prostate cancers and melanoma. I inherited it from dad who died from prostate and pancreatic cancer (both caused by BRCA2). I’m at home recovering from bilateral prophylactic mastectomies. It is a risk reducing surgery along with the removal of my ovaries which I had done in March.

The very fact that I could have risk reducing surgeries is entirely due to the discovery of BRCA2 in the mid 1990’s. Before that, entire families were devastated by breast and ovarian cancer striking again and again through multiple generations. It’s now commonplace for family members to be tested for genetic conditions when there appears to be a genetic link. Discovering this gene mutation in 1995 was a game-changer for breast cancer research.  It allowed people like me to discover their inherited risk for cancer and do something about it.  Increased screening, prophylactic surgery and medications to reduce the risk are all possible now thanks to breast cancer research.

My Family History of Cancer and BRCA2 Gene Mutation

In my case there were few cases of breast cancer in my family. That alone prevented me from being tested ten years ago. It’s not as well known that men can have the genetic mutation too. Prostate cancer and melanoma have cropped up in our family through multiple generations, including my 24 year old son who had a melanoma. My cousin was diagnosed with BRCA2 about 10 years ago. Because of that I could be tested for free. The cost used to be extremely high. Improved testing methods mean that more people can now be tested under Medicare. My sons and any other close relatives are also eligible for free testing.

I am passionate about research into genetic causes for cancer and other diseases. I signed up to the GO PINK campaign because it raises funds for breast cancer research by the National Breast Cancer Foundation. If dying my hair pink raises awareness and funds, then I’ll do it. Even though I’m feeling anxious about looking weird with pink hair! The big day is this Friday. If you would like to donate to this cause via our team The Tough Titties the link is below. (The name is Ally’s idea, because people who have cancer have to be tough).

https://fundraise.nbcf.org.au/fundraisers/thetoughtitties

https://fundraise.nbcf.org.au/fundraisers/thetoughtitties

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Beating BRCA2 – How it has Affected My Life

I have had my own challenges while the World’s focus has been on the Coronavirus. This is a personal account of how the BRCA2 gene mutation has affected my life.

While the World Has Been Focused on the Coronavirus, I’ve Been Beating Cancer

The World around us changed dramatically between my birthday and my best friend’s birthday three days later. We spent the weekend together with our husbands, the four of us celebrating by staying in a resort and drinking, eating and laughing together. After we went home the restrictions started suddenly so that it would no longer be possible to socialise in that way. Our last weekend together from 20-22 March is the last time we could eat out at a restaurant or cafe, drink in a hotel or even spend time together. It seems like the distant past now.

We still can’t eat out at restaurants together, although restrictions in our State have begun to be lifted. We are unable to cross the border to visit my family who live just an hour south. Social isolation has added another layer to my own health battles that began to unfold this year.

BRCA2 Gene Mutation and Cancer Risk

I was diagnosed with the BRCA2 gene mutation in March. You may have heard about Angelina Jolie having BRCA1 and undergoing bilateral prophylactic mastectomies and a total abdominal hysterectomy a number of years ago. BRCA2 is similar – it increases my risk for breast and ovarian cancer dramatically. It’s a case of not if I develop these cancers, but when.

I knew there was a chance of inheriting this gene about 10 years ago when I nursed my cousin who told me she has the gene. I had genetic counseling back then but it was not very obvious that the gene was on my side of the family as there wasn’t a high number of family members with cancer, especially breast and ovarian cancer. The genetic counselor thought my cousin probably inherited it from her father (no blood relation to me). Consequently, I didn’t get tested and opted for more stringent screening instead.

I’m a huge advocate for screening. I have been having early mammograms and ultrasounds for the last 10 years. Every six months I get my skin checked. My son’s melanoma was picked up during a routine skin test. This was possible because I starting taking my sons for skin checks from a very young age. My son’s melanoma was diagnosed when it was just a stage 1 cancer. Many people ignore things until they’re advanced but that’s not me. I get every little bump checked out because I’ve seen too many invasive cancers as a nurse.

My son's melanoma.  He was only 24 years old when it was diagnosed.  It was a stage 1 melanoma.  Surgery completely cured him
My Son’s Melanoma – He was Only 24 Years Old when it was diagnosed.
It was a stage 1 melanoma. Surgery completely cured him

The last few years have produced more cases of cancer in our family – my son, brother and sister have all had melanoma and my father had prostate and pancreatic cancer. It was always in the back of my mind that I should probably get tested for BRCA2. I went back to the genetic counselor to be tested. Results showed I did have the BRCA2 gene mutation. I inherited it from dad – I had a 50% chance of having it and my sons then had a 50% chance of inheriting it from me. My first reaction was not for myself, but rather for my sons – “I’ve given them a death sentence”.

BRCA2 Affects Males Too

Telling them was difficult. It would have implications for when they want to start a family, and it might even be a deal-breaker for some women who wouldn’t want to have the risk of having children with a genetic disorder. They surprised me with their reaction, however. Their response was that they’d rather know if they had the gene or not. They were now aware of screening and get any changes in their bodies checked out early. They underwent genetic counseling and were tested for the BRCA2 gene mutation. The results came back negative. We were surprised and ecstatic at the results. Even my son who had a melanoma was clear which is even more surprising).

Risk Reducing Surgery

My first response to finding out I have BRCA2 was to swiftly decide to have prophylactic risk-reducing surgeries. That involves removing the organs most at risk of developing cancer – ovaries (I have a 20-40% chance of getting ovarian cancer) and breasts (60-80% chance). Having nursed women with ovarian and breast cancer for most of my nursing career, I know how devastating those cancers are and I want to avoid them as much as possible.

I had the first surgery on March 30th – a laparoscopic bilateral oophrectomy (keyhole surgery to remove my ovaries). This surgery is low-risk and most people bounce back quickly, with very little complications. Then there’s me. I seem to have the worst luck when it comes to complications to procedures – I went into complete heart block after an angiogram and required CPR. One medication landed me in hospital from a severe allergy. So to have complications after this small operation, while not surprising for me, was a shock to the system all the same.

Complications

I bruised. My abdomen became extremely distended. A lot of pain and nausea. But the worst thing – I couldn’t pass urine. I ended up going home with an indwelling catheter and it unearthed a problem with my bladder that’s probably been there for a long time but wasn’t apparent until I had pelvic surgery. I had follow-up surgery to fix it last week. While there was an improvement, there will be ongoing issues for a long time because my kidney and bladder have been damaged. All my back pain was from my kidney, not my spine after all.

BRCA2 Gene Mutation.  While the world has been focused on the Coronovirus pandemic, I have been battling my own health dramas

My next challenge is Bilateral Prophylactic Mastectomies

This week I will undergo my biggest challenge yet – a bilateral prophylactic mastectomy. After my previous operations I’m scared of having this surgery. I’m more scared of breast cancer though. Someone said to me that I’m brave to do this – I don’t feel brave. In fact I feel just the opposite. The women who have breast cancer are brave. Imagine going through this operation as well as radiotherapy, chemotherapy and medications for life. That’s brave to me.

I feel like I’m cheating cancer by doing these surgeries, but there’s still the risk of getting a different type of cancer because of this gene mutation. BRCA2 causes pancreatic, prostate and renal cancer as well as melanoma so I’ll still have to remain vigilant. Of course I can’t get prostate cancer, but pancreatic cancer is hard to detect. My dad’s was too far advanced to have any treatment. Pancreatic cancer ravaged his body. He only lasted for 7 months after it was diagnosed. Poor bugger, it was a horrible way to die.

How the Coronavirus Has Impacted Me

Attention has been on my own health issues while the world has been focused on coronavirus. I have found it hard to cope at times because it has restricted my ability to interact with the people who are my confidantes and support system. Talking on the phone is not the same. Even when I was in hospital I could only nominate one visitor for the whole hospital stay. My husband was sent away from the hospital and could only visit for 2 hours once a day. Going through mastectomies will be daunting without him there for my support. The thought of it upsets me a great deal. I won’t be able to have my sons and best friend visit at all.

Elective surgeries were cancelled in March. I feel really lucky that I knew the surgeons personally and my first operation was pulled forward. Any later it would have been impossible. I feel a little guilty that I could get this preferential treatment but there has to be some perks for nursing alongside these doctors for the last 20-30 years.

Other Concerns

Having to tell my brothers and nephews over the phone and Messenger that they too have a 50% chance of inheriting this really sucks. Social distancing sucks when you have to have these very full-on conversations. Worrying that I may get the coronavirus affects my health too, because I have co-morbidities that would mean I’d be one of the cases most likely to end up really sick from it. It’s been a very stressful time, and I’ll be glad when this is all over and we’re out the other side. The world will be a changed place when this pandemic is over.

Beating BRCA2.  While the world has focused on the Coronavirus, I have been beating cancer.  BRCA2 gene mutation increases my risk of breast, ovarian and pancreatic cancer.

Note to my followers: I’ll be out of action for a while due to my surgery this week. I may be able to post short updates via my mobile phone but my usual blog posts will be on hold for a few weeks. Thank you all for your support, I really appreciate it.

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