Genetic testing helps families get a crucial jump on cancer

In the war against cancer, one of the most effective weapons may simply
be information.

Six years ago when Dana Stiskin was diagnosed with breast cancer, she was worried about her own future. But she also faced a fear that she would never realize her dream to have a child.

Her Mills-Peninsula gynecologist, Lisa Dyer, M.D., shared with Dana and her husband, Howard, some encouraging news about a new drug called Lupron that could preserve Dana’s fertility during cancer treatment.

Less than two years after successful cancer treatment, Dana became pregnant and then gave birth to a healthy boy, Ryan, now a vivacious 3-year-old.

Today, another advance in cancer medicine might help Dana protect Ryan’s future children.

According to Mills-Peninsula medical geneticist Patricia T. Kelly, Ph.D., cancer risk assessment in combination with genetic mutation testing often helps people like Dana better understand their own risk of developing certain types of cancers and whether or not they might pass on that risk to future generations.

Rather than looking for a certain cancercausing gene, this type of genetic testing is designed to detect a change in a gene due to a mutation, Kelly says.

“The number of cancers tied to strong hereditary factors is actually small,” the doctor said. “In fact, they account for only 10 percent of cancers or fewer.”

The genetic tests Dr. Kelly conducts help determine how likely it is that a cancer is due to strong hereditary factors – and could be passed on to future generations – as well as whether a person has an increased risk of developing other cancers.

Before she discovered her breast cancer at age 33, Dana knew there was a strong history in her family of breast and ovarian cancer.

“I knew of my family history, but still I didn’t think it would happen to me,” she says.

When she decided to have the cancer risk assessment, Dana was thinking of her son.

“I realized genetic testing is also a tool to determine if my children will have the gene and could pass it on, and it is also more information for my brother and his family,” Dana said.

Because boys, just as easily as girls, can inherit the genetic mutation for breast and ovarian cancer and can pass a mutation on to their children, Dana feels it is important to know whether he might carry the mutation.

“A lot of people are concerned about breast cancer, but don’t realize that the same genetic mutation that increases breast cancer risk also increases risk of ovarian cancer,” Dr. Kelly said.

Sophisticated tools have improved early detection of breast cancer – a key to survival – but other cancers remain harder to detect.

“With MRI and mammography, we now have good ways of finding breast cancer before it is life threatening. However, we don’t have reliable ways of finding ovarian cancer before it is life threatening,” she says.

“When you know you have a genetic mutation that puts you at a higher risk, you can take steps to keep yourself safe.”

Even if she does not test positive for the gene mutation, Dana plans, at the advice of her doctors, to have her ovaries removed as a precaution due to her family history. The genetic test result may influence how soon she needs to take that step.

Another key benefit of genetic testing is to help people gain a deeper understanding of risk.

“When I talk to patients, I focus on their risk in the next 10 years. It is very important to understand the real risk over time,” Dr. Kelly says, which can help to put these risks into perspective.

“The actual risk, not the relative risk, is what people really need to know,” Dr. Kelly said. “What is the risk this year, next year and over the next 10 years? Having a better understanding can help the whole family take care of themselves better,” Dr. Kelly said.

That understanding of risk, and its power to protect health, is what Dana hopes to give to her family and their future families.

Read more about Dana’s story

For more information about programs at Mills-Peninsula’s Dorothy E. Schneider Cancer Center, visit www.mills-peninsula.org/cancer.

Helping women beat breast cancer

More than 70 percent of women diagnosed with breast cancer at Mills-Peninsula’s Women’s Center are at Stage 0 or Stage 1, when survival is as high as 99 percent. This exceeds the National Cancer Database average by 9 percent, a measure that includes more than 1,500 health care organizations.

Services are provided at the Women’s Center located at Mills Health Center in San Mateo 650.696.4140, and a satellite center in South San Francisco 650.873.1050.

Digital mammography
Studies have shown digital mammography improves detection in women with dense breast tissue, those under the age of 50 and those in pre- or post-menopause. The Women’s Center uses the advanced technology for all women.

Stereotactic and ultrasound guided biopsy
Ultrasound biopsy uses sound waves that outline the tissues, creating images that help the doctor guide the biopsy needle to the site. Stereotactic biopsy pinpoints the area of concern using X-ray images from more than one direction.

Breast MRI
Magnetic resonance imaging allows even more accurate diagnosis for women with special needs, such as previous breast cancer history or other risk factors.

Multidisciplinary review
A panel of expert physicians, including internal medicine doctors, surgeons, medical and radiation oncologists and pathologists, meets weekly to review all new diagnoses.

Second opinion service
Experts review and discuss your mammogram results and treatment recommendations from other providers.

Genetic counseling
Help for determining your risk based on family experience. Recommendations for women at higher risk might include testing for genetic mutations.

Breast Cancer Clinic
All the doctors you need to help make treatment decisions come together for you in one appointment. Individual consultations are provided with a surgeon, medical and radiation oncologists and plastic surgeon, as appropriate. A nurse specialist guides the process.

Community donors contributed more than $5 million to breast cancer technology at the Women’s Center over the last six years, including state-of-the-art ultrasound and MRI equipment.