Understanding Your Cancer Risk: A Decision That Can Make a Difference
- Country singer Morgan Wade, 30, has a knack for impactful decision-making. She decided to respond to a Craigslist ad seeking a singer in 2018, kickstarting her music career, and years later, after learning she was a carrier of the RAD51D gene mutation – similar to the BRCA gene mutation – is known to increase the risk of breast and ovarian cancer.
- Wade chose to undergo a preventative mastectomy (the removal of the breast) to lower her chances of developing cancer.
- The genetic test may involve a simple blood test, saliva sample, or tissue collected through a biopsy. Test results may also influence possible treatment.
- The results help your care team determine if you have a specific mutation that puts you at higher risk for cancer. The results help doctors tailor your treatment and are helpful for breast cancer patients.
- A double mastectomy is a procedure that removes both breasts. Some women choose this procedure to reduce their risk of cancer, especially if they have a family history of cancer or possess the BRCA1 and BRCA2 gene mutation, which also increases their risk.
Wade’s willingness to take decisive action extended beyond her music career. Upon learning she carried the RAD51D gene mutation, and like the BRCA gene mutation, it is known to increase the risk of breast and ovarian cancer—she made the proactive choice to undergo a preventative mastectomy to lower her chances of developing the disease.
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Wade’s personal health journey was deeply influenced by her mother’s battle with triple-negative breast cancer—a form of the disease that lacks estrogen, progesterone, and HER2 protein receptors, making certain targeted treatments ineffective. Chemotherapy remains the primary treatment option, ranging from oral medications like Xeloda (capecitabine) to intravenous treatments administered weekly or bi-weekly.
WATCH: Understanding triple-negative breast cancer
Given her family history, Wade sought genetic testing to assess her own risk. The simple saliva swab or blood test confirmed she carried the RAD51D gene mutation, a factor that significantly increased her likelihood of developing breast cancer.
“I decided to be proactive,” Wade revealed in an Instagram post, emphasizing her commitment to taking control of her health.
Prior to releasing her second album, Wade underwent a preventative mastectomy, a decision she has openly shared with fans. Through her recovery, she has remained passionate about fitness, using exercise as both a mental and physical outlet.
Her willingness to embrace change—whether in music or in life—continues to define her journey, inspiring others along the way.
Understanding Genetic Testing
Genetic testing for cancer is typically conducted in a medical setting, such as a primary care office or an OB-GYN clinic. However, some tests are now available for direct purchase, allowing individuals to explore their genetic risk independently.
Initially, genetic testing was recommended for a limited group of individuals based on specific risk factors, including a strong family history of breast cancer, personal cancer history, or certain ethnic backgrounds.
WATCH: Helping you understand genetic testing.
“It started out with a very narrow field of women and men who were recommended to have it based on certain risk factors, family history of breast cancer, or other cancers, and also ethnic backgrounds,” explains Dr. Elisa Port, a surgical oncologist at Mount Sinai, in an interview with SurvivorNet.
Guidelines from the National Comprehensive Cancer Network (NCCN) suggest that genetic testing should be prioritized for patients at higher risk for hereditary breast cancer. This includes individuals diagnosed with breast cancer before the age of 45, those with a strong familial history of the disease, and individuals of Ashkenazi Jewish descent.
Meanwhile, the American Society of Breast Surgeons (ASBrS) takes a broader approach, recommending genetic testing for all patients diagnosed with breast cancer.
These evolving recommendations reflect a growing emphasis on personalized medicine, ensuring that individuals at risk receive appropriate screening and guidance to manage their health proactively.
What If You Have the BRCA Gene Mutation?
Discovering a genetic mutation can be unsettling, but there are several options available to manage cancer risk effectively. These include enhanced screenings for early detection, prophylactic (risk-reducing) surgery to remove high-risk tissue and chemoprevention—the use of medications designed to lower the chances of developing cancer.
Interestingly, for individuals diagnosed with ovarian cancer, carrying a BRCA mutation may provide a treatment advantage when paired with a class of drugs known as PARP inhibitors. Approved by the FDA starting in 2014, these targeted therapies have transformed the landscape of ovarian cancer treatment.
WATCH: Understanding the BRCA Gene Mutation
PARP inhibitors function by blocking the protein PARP, which normally repairs damaged DNA. By preventing this repair process, the inhibitors selectively destroy cancerous cells while sparing healthy ones, making them a powerful treatment tool.
“The PARP inhibitor prevents the repair of the [damaged] single-strand DNA break, and your BRCA mutation prevents the repair of the double-strand DNA break,” explains Dr. Rebecca Arend, Associate Scientist at the University of Alabama, Birmingham, in an interview with SurvivorNet.
This combination of genetic insight and advanced medical therapies highlights how precision medicine continues to evolve, offering more effective, tailored approaches to cancer prevention and treatment.
What to Consider When Weighing Preventive Mastectomy?
A prophylactic, or preventative, mastectomy is an operation where the breast tissue is removed to prevent cancer from developing in the future.
“Risk-reducing mastectomies are an operation where we take women at, usually, very high-risk for getting breast cancer for genetic mutation carriers, who are the ones at the highest risk; there’s unfortunately only one way to actually prevent breast cancer,” Dr. Elisa Port, Chief of Breast Surgery at Mount Sinai Health System, tells SurvivorNet.
WATCH: What to Consider When Thinking About a Mastectomy
“Women who are found to test positive for a genetic mutation really have two options,” Dr. Port explains. “One is what’s called high-risk surveillance, which means we check them every six months or so mammograms, MRIs with the hope that if God forbid, they develop breast cancer, we pick it up early. But that’s not prevention; it’s early detection.
“Early detection is a goal; it’s not a guarantee. For the woman who wants to be more proactive about actually preventing breast cancer, or as we say reducing her risk, unfortunately, the only way to do that is to remove the actual tissue at risk, and that is the breast tissue,” she adds.
Some women decide to have their breasts reconstructed and have implants put in right after the mastectomy, while others don’t have reconstruction at all.
The benefits of a prophylactic or preventative surgery are:
- Significant reduction in cancer risk (from 80-90% to 1-2%)
- Nipples can often be spared
- Women can get reconstruction at the same time
Questions to Ask Your Doctor
If you’re facing the option of having a mastectomy, here are some questions to consider asking your doctor:
- What can I do to prepare for a double mastectomy?
- What happens before and after the procedure?
- For reconstruction, what are the benefits of using implants over my own tissue and vice versa?
- What should I know about implants? Should I opt for preventative surgery?
- What will recovery look like after the procedure?
- What are the benefits of a watch & wait approach vs. preventative surgery?
- What kind of surveillance is required after the surgery?
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