Elizabeth Wurtzel, 52, author of the bestselling 1994 memoir, "Prozac Nation: Young and Depressed in America," died on Tuesday in New York of metastatic breast cancer, the most advanced stage of the disease.
When breast cancer is diagnosed early, survival rates in the U.S. are highly favorable, ranging from 68% to 98%, even at stage 3, according to Susan G. Komen. But metastatic breast cancer, which means the disease has spread outside the breast to other parts of the body, sometimes before it’s even diagnosed, is far more aggressive. Although it’s possible for women with later-stage breast cancer to do very well for long periods of time, the disease, which affects 154,000 U.S. women, is incurable.
Read More‘I Could Have Skipped the Part Where I Got Cancer’
Wurtzel later became an advocate for BRCA testing after learning she carried the gene mutation that put her at extremely high risk for developing breast cancer. "I could have had a mastectomy with reconstruction and skipped the part where I got cancer," she wrote. "I feel like the biggest idiot for not doing so."She addressed the BRCA gene mutation in a January 2018 essay she wrote for The Guardian: “I have breast cancer as a result of the BRCA gene, so it was preventable. All Ashkenazi Jewish women should get tested for the BRCA mutation, we now know, because half the time there is no way to know that you have the gene, and one in 40 Ashkenazi Jews carries it. At one time it bothered me that I have a disease I could have avoided through prophylactic mastectomy.”
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The essay was typical of her in-your-face writing style. “I hate it when people say that they are sorry about my cancer,” it began. “Really? Have they met me? …I now have stage-four upgrade privileges. I can go right to the front.”
Research Claims All Breast Cancer Patients Should Get Genetic TestingIs It True?
Research claiming that all women diagnosed with breast cancer should get genetic testing has caused some confusion.
As of now, the National Comprehensive Cancer Network's established guidelines for who should get genetic testing in relation to breast cancer is limited. And since these guidelines influence how much insurance will pay for such testing, they matter for women. However, a study published in the Journal of Clinical Oncology shows that the limitations of these guidelines are doing a disservice to many people diagnosed with breast cancer and should potentially be broadened.
The study looked at over 1,000 women aged 18-90 who were diagnosed with breast cancer. These women each underwent an 80-gene panel, meaning their DNA was tested for 80 possible genetic markers. Of the women tested, approximately 50% met the NCCN's current criteria for genetic testing, and the other 50% did not. In a surprising result, 9.39% of women who did meet these guidelines tested positive for a "pathogenic/likely pathogenic (P/LP) variant" (an indicator that their breast cancer was hereditary in nature), but a similar amount, 7.9%, of the women who did not meet the guidelines also tested positive for a P/LP variant.
In other words, the current NCCN-established guidelines excluded nearly half the women who had breast cancers that were, in fact, caused by hereditary factors.
The guidelines were developed when the BRCA-1 gene (the type that Angelina Jolie had when she decided to get her prophylactic mastectomy) and the BRCA-2 gene were the only two markers doctors looked for when it came to testing for hereditary breast cancer, according to one of the authors of the study, cancer surgeon Dr. Peter Beitsch.
There are now as many as 30 genetic variants that have been shown to be linked to breast cancer, as well as 11 gene mutations, he continues; similarly, testing has become less cumbersome and expensive since these guidelines were established.
So what does this mean? Dr. Beitsch says that it means all women who are diagnosed with breast cancer should be tested for such genetic factors. This can not only impact the treatment those women receive, he says, but it can also influence how their immediate family members look at their cancer risk and manage that risk throughout their lives.
For High-Risk Women: Mastectomy as Prevention
This decision to have a preventive mastectomy, as SurvivorNet has found, is deeply personal. For many women who fall into the high-risk category, removing the breasts relieves them of a lifetime of anxiety and worry over getting breast cancer or having an earlier cancer reoccur. For this reason, some women elect to have a double mastectomy after finding a lump in one breast. The freedom from a life of worry is the overarching factor in choosing this option.
“A woman may have a significantly increased risk of breast cancer in their lifetime because of their family history,” Dr. Elizabeth Comen, a medical oncologist at Memorial Sloan Kettering Cancer Center, told SurvivorNet. “And perhaps they’ve inherited a BRCA1 or 2 mutation. Some women with a BRCA1 or BRCA2 mutation or other hereditary mutations associated with breast cancer may end up getting prophylactic surgeries.”
Prophylactic Mastectomy for High-Risk Women
Dr. Elizabeth Comen of Memorial Sloan-Kettering talks about mastectomy as a preventive measure.
If you have a very high risk of developing breast cancer, you may have the option of getting what's called a prophylactic mastectomy, Dr. Comen also told SurvivorNet. You may be high-risk if you have a strong family history of breast and/or ovarian cancer, and have certain mutations in the BRCA1 or the BRCA2 gene, or mutations in several other genes associated with breast cancer risk.
The actress Angelina Jolie made her decision to have a prophylactic double mastectomy public after she tested positive for the BRCA1 gene. (Her mother died from ovarian cancer at the relatively young age of 56.) Other women may elect to have a double mastectomy after they find a lump in one breast. It's a very personal decision. For some women, removing the life-long anxiety about getting breast cancer, or having the cancer recur in the breast if they're already been diagnosed, is the overarching factor in choosing this option
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