How Family History Shapes Your Cancer Risk
- Joyelle Fleming’s wedding plans took an unexpected turn when both she and her father were diagnosed with breast cancer. They leaned on each other while going through treatment and survivorship.
- Joyelle underwent surgery and chemotherapy for treatment. While some patients believe a double mastectomy offers the best protection, experts emphasize that survival rates are similar between mastectomy and lumpectomy with radiation, depending on individual factors like tumor size, genetic mutations, and cancer location.
- A double mastectomy typically takes about two hours for tissue removal, but reconstruction—especially when using tissue from another part of the body—can extend surgery to 6–12 hours.
- Chemotherapy is an effective tool for oncologists to help treat cancer by stopping cancerous cells from growing, dividing, and spreading to other organs. Chemo works by traveling through the bloodstream, killing cancerous cells. However, healthy cells are also impacted in the process, leading to notable side effects, including fatigue, hair loss, and nausea.
- “Part of the chemotherapy prescription includes a set regimen of anti-nausea medications,” says Dr. Renata Urban, a gynecologic oncologist at the University of Washington in Seattle. “We also ensure that patients have medications at home that they can use should they develop nausea after treatment.”
- Experts say that treating male breast cancer is largely the same as treating female breast cancer. While men have some special considerations, treatment options depend greatly on various factors, including the size of the tumor, how far the cancer cells have spread, and biological and genetic factors that may be powering your cancer.
- Having a family history of breast cancer is one of several risk factors, like older age and having children later in life, that increase a woman’s chance of getting breast cancer.
In early 2023, Joyelle Fleming, now 33, was gearing up for her wedding later that summer. She had been dating her fiancé, Michael, for a while, and the happy couple’s love was filled with laughter, relaxing travels, and a plethora of good times. Joyelle shared a host of photos on social media of herself and Michael traveling throughout the U.S., as well as Japan and Singapore. However, a mammogram she received at the beginning of 2023 revealed that she had breast cancer, which came as a complete shock because she did not present any symptoms.
Read MoreView this post on Instagram
Joyelle shared a video blog of her breast cancer journey on her Instagram channel, where she revealed she was diagnosed in January 2023.
“I had gone for my annual gynecology visit, and she noticed a lump in my breast, and that kinda started this whole process,” Joyelle said. She added that she underwent egg retrieval to preserve her fertility and began six rounds of chemotherapy by March 2023.
By the summer of 2023, Joyelle underwent a double mastectomy (removal of both breasts). After breast cancer surgery, she received an additional 14 rounds of chemotherapy.
“Now I’m on maintenance treatment, so I have tamoxifen that I take every day. I’m on Lupron every three months,” Joyelle added.
“ Tamoxifen is a drug that has been used to treat breast cancer for decades. It is a medicine that is used for women who have estrogen receptor-positive breast cancer,” medical oncologist Dr. Elizabeth Comen tells SurvivorNet.
WATCH: Tamoxifen for Breast Cancer
Lupron (leuprolide): – a type of hormone therapy for breast cancer – acts as an ovarian suppression drug that stops the ovaries from making the hormone estrogen.
Lupron is usually given by injection into a muscle once a month or every three to six months. The length of treatment varies, and your doctor can determine that information.
Some known side effects of Lupron may include tiredness or fatigue, hot flashes, spotting, and muscle or joint pain.
WATCH: Understanding hormone therapy for breast cancer.
Hormone therapy is used for hormone receptor-positive cancers. When a tumor is “hormone receptor-positive,” it means tests reveal the cancer is positive for either the estrogen and/or progesterone receptor. Cancers of this type need estrogen and/or progesterone to grow.
In addition to these ongoing treatments, she still receives regular check-ins with her doctors to monitor her progress.
“The most important thing, I caught it early, treatment was successful, and I can say that I’m a survivor,” Joyelle said.
View this post on Instagram
According to Cancer Cell International, “Triple-positive breast cancer (TPBC), a unique subtype of luminal breast cancer, is characterized by concurrent positivity for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2).”
This subtype accounts for only 5–10% of all breast cancer cases and typically requires a multi-pronged treatment approach, including chemotherapy, HER2-targeted therapy, and hormone (endocrine) therapy.
She postponed her wedding to undergo treatment, which involved chemotherapy and a double mastectomy.
“I did six rounds of chemotherapy, then a double mastectomy,” Joyelle Fleming told Straight Arrow News.
“Once I recovered, I had 14 more rounds of chemo – and then I was done,” she said.
View this post on Instagram
Chemotherapy is an effective tool for oncologists to help treat cancer by stopping cancerous cells from growing, dividing, and spreading to other organs. Chemo works by traveling through the bloodstream, killing cancerous cells. However, healthy cells are also impacted in the process, leading to notable side effects, including fatigue, hair loss, and nausea.
“Part of the chemotherapy prescription includes a set regimen of anti-nausea medications,” says Dr. Renata Urban, a gynecologic oncologist at the University of Washington in Seattle. “We also ensure that patients have medications at home that they can use should they develop nausea after treatment.”
Breast Cancer Surgery Decisions
When it comes to breast cancer surgery, there’s no one-size-fits-all approach. Choosing between a lumpectomy and a mastectomy is a deeply personal decision—one that depends on a range of medical and emotional factors.
“As a breast surgeon, my job is to help patients understand that their long-term survival with mastectomy is equivalent to that with lumpectomy and radiation,” says Dr. Sarah Cate, Chief of Breast Surgery at Stamford Hospital.
Still, many women request a double mastectomy (removal of both breasts), believing it offers the best protection against recurrence. But that’s not always the case. The size of the tumor, its genetic profile, and a patient’s family history all play a role in determining the most appropriate surgical path.
WATCH: Should I Have a Lumpectomy or Mastectomy?
“Mastectomy has very specific indications,” Dr. Cate explains.
“Some of the things that would predict a mastectomy are things like a large tumor size to breast ratio, or having cancer in more than one area of the breast, or having a genetic mutation.”
WATCH: What Goes Into a Double Mastectomy
“A double mastectomy typically takes about two hours for the cancer part of the operation, the removal of the tissue,” says Dr. Elisa Port, Chief of Breast Surgery at Mount Sinai Health System.
“The real length, the total length of the surgery, can often depend on what type of reconstruction [a patient] has.”
Today, most women choose to undergo some form of reconstruction, which can significantly extend the duration of surgery—especially when tissue is transferred from another part of the body.
“When you take tissue from another part of the body and transfer it to fill in the empty space where the breasts are, this is a very long operation,” Dr. Port says.
“It can take anywhere from six to 12 hours because it’s really like having a tummy tuck and then transferring the tissue and grafting the tissue, connecting the vessels, so those tissues have blood flow to live in,” Dr. Port adds.
For women with a strong family history or a known genetic mutation—such as BRCA1 or BRCA2—the decision to undergo a preventative mastectomy may be the most effective way to reduce their risk.
“Risk-reducing mastectomies are an operation where we take women at, usually, very high risk for getting breast cancer,” Dr. Port explains. “For genetic mutation carriers, who are the ones at the highest risk, there’s unfortunately only one way to actually prevent breast cancer.”
WATCH: Getting a Preventive Mastectomy
Women who test positive for a BRCA mutation typically face two options.
“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,” Dr. Port says. “But that’s not prevention, that’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.
View this post on Instagram
Joyelle’s Father’s Chest Pain Led to a Breast Cancer Diagnosis
Later that year, her father, Alton Fleming, discovered a lump in his chest while on vacation in Hawaii.
“I just felt a pain in my left breast,” Alton told ABC News.
After undergoing a mammogram, he was diagnosed with stage 2 breast cancer.
“It was a shock,” Alton said.
View this post on Instagram
“I reacted worse to his diagnosis. I was concerned if he was going to be okay,” Joyelle said of her father’s prognosis.
Alton stepped boldly into her breast cancer journey because he saw how his daughter managed it.
“My daughter had just gone through this, and she showed me how to get through it,” he said. “The encouragement she gave me throughout the process was fabulous.”
Joyelle had her wedding a year later, and two days after Alton walked her down the aisle, he underwent a mastectomy.
Today, both Alton and Joyelle are now “cancer-free.”
Helping Patients Cope with a Breast Cancer Diagnosis
- Understanding a New Breast Cancer Diagnosis: An Introduction
- Acupuncture Promising for Pain Relief from Some Breast Cancer Treatment
- Advances in Metastatic Breast Cancer Treatments Over the Last Year Offer New Hope for Those Fighting
- Metastatic Triple-Negative Breast Cancer Treatments To Consider
- Chemo for Triple Negative Breast Cancer
Understanding Male Breast Cancer
Like women, men have breast tissue and can develop breast cancer. Breast cancer starts when cells in the breast start growing out of control, typically forming a tumor that’s felt as a lump.
WATCH: Men Get Breast Cancer Too
A man’s risk of developing breast cancer may be higher if there’s a history of breast cancer in the family. Typically, male breast cancer manifests as lumps in the chest area. Factors like a patient’s race can impact the prognosis. Five types of standard treatment are used to treat breast cancer in men:
- Surgery for breast cancer in men mirrors the procedure in women. A modified radical mastectomy removes the whole breast with cancer. The result may involve removing the nipple according to the National Cancer Institute.
- Chemotherapy involves cancer-killing drugs to prevent the cancer cells from growing. Chemo drugs are usually taken orally or intravenously.
- Hormone therapy involves removing hormones or blocking their ability to help cancer cells grow.
- In radiation therapy, high-energy beams such as X-rays are aimed at cancer cells to kill them.
- Targeted therapy treatment uses drugs designed to target specific cancer cells.
WATCH: Marc Futterweit shares his breast cancer journey.
When Marc Futterweit was told by his doctor to get a mammogram, he was in disbelief.
“I said, What do you mean by a mammogram?’ I don’t have breasts,” Futterweit recalled saying.
However, a second opinion from another physician confirmed Futterweit had breast cancer.
“When I was first diagnosed, I didn’t tell my wife. I thought I was holding it together,” Futterweit said.
When his family learned he was battling breast cancer, they supported him. Having a support group filled with loved ones is an important part of a cancer patient’s journey toward survivorship, according to experts SurvivorNet has spoken to.
He realized that with their support, having male breast cancer is nothing to be ashamed of.
“Men are basically standing in the shadows, they’re ashamed or embarrassed,” Futterweit says. “Just remember, it’s nothing that you have done to cause you to get breast cancer. It’s nothing to be embarrassed about. It’s not a woman’s disease,” he continued.
Family History & Breast Cancer Risk
Although breast cancer can happen to anyone, there are certain factors that can increase a person’s risk of getting the disease. The known risk factors for breast cancer include:
- Older age
- Having a gene mutation such as the BRCA1 or BRCA2
- Added exposure to estrogen
- Having children after the age of 30
- Exposure to radiation early in life
- Family history of the disease
RELATED: Dr. Elizabeth Comen breaks down factors that may increase your breast cancer risk.
“Some people think that breast cancer is only inherited through genes on the mom’s side, but it can also be related to a genetic mutation that can be found on the father’s side,” SurvivorNet medical advisor and breast oncologist Dr. Elizabeth Comen explained.
Help Coping With a Breast Cancer Diagnosis
If you are facing a breast cancer diagnosis, your emotions are likely to run high, which is completely normal. Psychiatrist Dr. Lori Plutchik says emotions are often fluid when coping with a diagnosis.
“The patient or person going through the stressful event should accept that emotions will be fluid. You may feel fine one day and then feel a massive wave of stress the next. It’s also important for those you look to for support, whether that’s a therapist, friends, and family, or both, to understand the fluidity of stress-related emotions,” Dr. Plutchik said.
WATCH: How to cope with complex and changing emotions.
If a stressful event affects how you think and feel, it may be time to seek mental health treatment. This could mean traditional talk therapy, medication, changing lifestyle habits (like exercise and diet), seeking a support group, or many other approaches.
SurvivorNet experts suggest that patients needing a little extra help coping with a breast cancer diagnosis.
- Let your family and close friends know, and let them help. So many cancer survivors tell us they want and need support, but are often too preoccupied to make specific requests. Urge those close to you to jump in with whatever practical help they can offer.
- Keep a journal. It can be extremely cathartic to let those feelings loose on paper. Grab a pen and a nice journal and chronicle your thoughts throughout the day.
- Join a cancer support group. Groups in nearly every community offer opportunities to connect with others going through a similar journey. You’ll learn constructive insight from others who can tell you what to expect and how to stay strong on tough days.
- Consider seeing a therapist. Ask your doctor to refer you to a therapist so you can discuss your fears and concerns in a safe space. Often, vocalizing your thoughts and feelings rather than internalizing them can provide relief.
Breast Cancer Symptoms & Self-Exams
Women are encouraged to do regular self-exams to become familiar with how their breasts feel normally, so when something unusual, like a lump, does form, it can be easily detected. A self-exam includes pressing your fingertips along your breast in a circular motion.
For some women, that means going to their doctor and walking through what a self-breast exam looks like, so they know what normal breast tissue feels like, so if they do feel something abnormal, whether it’s a lump or discharge from the nipple, they know what to ask and what to look for.
In the case of men, periodically checking the chest for anything unusual or painful can help detect issues worth further exploration with your doctor.
Below are common symptoms to look out for:
- New lump in the breast or underarm (armpit)
- Any change in the size or shape of the breast
- Swelling of all or part of the breast
- Skin dimpling or peeling
- Breast or nipple pain
- Nipple turning inward
- Redness or scaliness of the breast or nipple skin
- Nipple discharge (not associated with breastfeeding)
Questions for Your Doctor
If you are facing a breast cancer diagnosis, whether you’re a man or a woman, here are some questions you can ask your doctor to learn more about it.
- What kind of breast cancer do I have?
- Has the cancer spread to other parts of the body?
- What stage is my cancer in?
- What other tests should I seek to better understand the cancer before deciding on treatment?
- What are your treatment recommendations and their likely side effects?
- What other doctors can give me additional opinions?
Contributing: SurvivorNet Staff
Learn more about SurvivorNet's rigorous medical review process.
