First person

Choices after genetic mutation finding affect fertility

 

Executive Director of the Basser Research Center discusses the BRCA genes

atorres@MiamiHerald.com

The baby shower had a nautical theme. The navy-blue tables were outside the home near Grove Isle. Red roses in silver buckets had a small sign with a sailboat that read “It’s a Boy!”

Some of the guests were friends I had spent time with at nightclubs and parties in Miami in years past. Some were pregnant.

“I was nauseous and felt so sick at first,” one said. “My back hurts. I hope it’s a girl,” another said.

A beautiful little girl dressed in white stole most of my attention. For a moment, it was all too much. I was glad I was wearing sunglasses and discreetly excused myself to the bathroom, where I sat on the floor and cried. If I had not have been diagnosed with cancer, I would be where they are.

Instead, my current dilemma was whether or not I should wait to remove my ovaries.

Having a family is important to me. When I got diagnosed with breast cancer at 33, I was at a place in my life where I felt ready to head in that direction. One day I was healthy and beautiful and the next my life had taken an abrupt turn.

My friend, Michael Maryanoff, 26, a cancer patient, sent me a message that I have thought about often.

“You are going to have to adopt a kid, which means that this horrible thing that happened to you is the greatest thing that happened to someone else.”

I hope I can get there. In the meantime, cancer is still in the picture.

Months after my diagnosis, doctors found that I was in the 5 to 10 percentile of breast cancer patients who inherit a genetic mutation known as BRCA2. The mutation increases my risk of developing ovarian cancer. There is also a 50/50 chance that my child could inherit the mutation, which means that he or she too could have an increased risk of cancer.

I had chosen not to freeze my eggs before cancer treatment, because saving my life was a priority. I did not know about the genetic mutation then. A pathology report said the tumors in my left breast fed on the female hormone estrogen. Egg freezing required hormone injections.

“So I would be feeding my body more of the hormones that are making this monster grow inside me?” I asked a doctor.

I refused. I didn’t want to wait to start chemotherapy. Since I was young, there was less chance that the chemo would induce menopause. And it did not. A few months after I completed radiation therapy, I was ovulating again. My joy was short-lived. As part of a treatment to block estrogen, I was to take a drug called Tamoxifen until 2017.

Studies have shown that the drug reduces both the rate of mortality and breast cancer recurrence in patients with estrogen positive tumors. Taking the drug for five years also means that one should not get pregnant because of the risk of birth defects. Assuming I get pregnant after I’m done with Tamoxifen, waiting until 2018 to remove the ovaries means that I increase my risk of both ovarian and breast cancer. My oncologist and gynecologist have suggested I undergo surgery now to remove my ovaries. Undergoing cancer treatment has taught me that one cannot allow emotions to get in the way of making rational decisions. But infertility scares me more than cancer; the fear is paralyzing. I have yet to set my appointment for the surgery.

I survived the baby shower. Once I released my emotions I was able to really enjoy my time with the pregnant moms. A friend who is not married seemed to feel a bit out of place too.

“I can’t wait to be pregnant and have a family,” she said.

I tried to appease her. “You will. You’ll just have to be patient.”

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