Explaining cancer: The risks, misconceptions, prevention and research
Many Jewish women face an increased genetic predisposition for certain cancers. On Feb. 25, an appreciative audience gathered to hear medical experts from UF-Health Cancer Center at Orlando Health discuss cancer risks, clarify misconceptions, explain the latest research, and give a primer on various prevention and treatment options.
Sponsored by the Jewish Federation of Greater Orlando in partnership with The Roth Family JCC, Jewish Family Services of Greater Orlando and Central Florida Hillel, the panel featured Dr. Rebecca Moroose, director of Cancer Clinical Trials for Breast Medical Oncology and director of Cancer Genetics; Ryan Bisson, genetic counselor at the Cancer Genetics Center; and Dr. Nathalie McKenzie, gynecologic oncologist. The evening was moderated by cancer activist and longtime community member Sheryl Kashuk Schwartz.
Schwartz, currently a realtor with Fannie Hillman, opened the evening by shared her compelling personal story with participants. Schwartz’s maternal grandmother and mother both had breast cancer, leading Schwartz to undergo a preventive mastectomy at age 26 and several subsequent surgeries for reconstruction. Schwartz’s younger sister, entrepreneur Sonia Kashuk, was diagnosed with breast cancer at age 47 and underwent a bilateral mastectomy to remove almost any chance of recurrence. Their family is constantly working to raise awareness and to promote a message of being proactive with breast health.
Schwartz then pivoted to ask the medical experts questions submitted by the audience. According to the panel, prophylactic mastectomies such as Schwartz’s reduce the risk of developing breast cancer by about 90 percent. Prophylactic hysterectomies, on the other hand, have not yet demonstrated enough proof of prevention of ovarian or uterine cancer to change current normative health policy guidelines. However, there is a 50 percent reduction in ovarian cancer risk with a lifetime use of oral birth control providing the formulations were after 1974; the oral contraceptives keep estrogen levels at a steady state, which is thought to help with ovarian cancer prevention.
Bisson, the geneticist, walked the audience through some genetics basics. Though only about 10 percent of cancer is an inborn genetic risk, many questions dealt with mutations in the BRCA-1 and BRCA-2 genes, which are tumor-suppressor genes that are not sex-linked. The general population has a 1-in-500 risk of this mutation. Jewish women of Ashkenazi descent have a 1-in-40 risk; there is less research on Jewish women of Sephardic descent, but the general consensus is that the baseline risk is not as high.
The panel noted that testing for the BRCA mutations may begin as young as age 25, especially for families with histories of cancer in first- or second-degree relatives, though individuals’ emotional readiness to hear results must be taken into account. It is recommended that men with BRCA mutations begin prostate testing at age 35. Bisson stressed that even those who have the BRCA mutations may not develop cancer, which may explain why cancer may seem to skip a generation in families; instead, it is that a person in the intervening generation may have carried the gene but not developed cancer from it. Additionally, there are many genes that have not yet been identified that may be markers for cancer.
The panelists recommended certain preventive measures to reduce cancer risk. Working with one’s physician and depending on one’s history, certain medications may be helpful. The drug Tamoxifen, which has been seen to be effective on patients with an identified BRCA-2 mutation, and the drug Evista, which works best in postmenopausal women, are two current options. Lifestyle choices are extremely important as well. Dr. Moroose noted that “exercise trumps everything,” and that staying lean helps reduce risk because fat cells produce estrogen, which can promote tumor growth.
Dr. McKenzie noted that 85 to 90 percent of endometrial cancer patients are obese. There is also emerging science on vitamin D and omega-3 fatty acids as helpful supplements.
Lastly, the panel encouraged the audience to work with their health care providers to ensure that their personal health histories are as thorough as possible to help make the case for risk assessment and treatment to insurance companies, whose varied and sometimes confusing policies can be made less challenging when there is a clear-cut rationale for covering treatment.