The Most Important Conversation for Your Mother’s Day Brunch

Exploring Your Family History of Breast Cancer

generations celebrating the holiday together talking about family history
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What is the perfect gift to give your Mom for her special day? The Internet is loaded with suggestions. What may truly be the "perfect" gift, however, is one most people won't think about. For one thing, it's free, so you won't see it advertised. For another, it may sound irreverent without an explanation.

What Does Mother's Day Mean?

Mother’s day is a day to honor our Mothers—that’s a given. But have you ever asked yourself, what exactly we are honoring?

Our gifts tell us much. From the time-honored traditions of serving breakfast in bed to buying her flowers, we step into the shoes our Mother's wear the other 364 days of the year. We are honoring her selfless sacrifice which is often taken for granted.

Rather than simply repeating—for one day—what a Mother does most of the time, perhaps we should look beyond the specific activities to her motivation for doing what she does.

Why do our Mother's serve us healthy (yet tasty) meals? Why do they make sure we stay warm? Why do they recommend we spend some time outside while they create an environment in which we can thrive? The answer is very simple. They love us. Their selfless behavior arises from a desire to ensure the health, happiness, and well-being of their brood.

How can you ensure your Mother's health and happiness in return? To understand where we're going with this let's focus, for a moment, on those Mother's who are missing out on this day.

Mother’s Missing Out on Mother’s Day 

While many people find Mother's day a day of joy, there are many who feel the pain of being motherless. We aren't talking about the Mothers who passed at the end of a long life, where the day might bring a sad but warm remembrance. Instead, we are talking about the Mother's who have lost the chance to Mother their children, and someday welcome grandchildren.

Those Mother's where the pain remains a bit sharper.

According to the CDC, the leading cause of death for women between the ages of 35 and 64 is cancer. And of cancers, breast cancer is the most common for mothers who are actively mothering. 

We know that survival is higher when cancer is caught in the earlier stages, but many of these women have yet to reach an age when screening is recommended. That is, unless, they are aware they have a family history. But to know this some detective work may be needed.

A Mother's Day Conversation Which Can Keep on Giving

What we propose is having a Mother's day brunch conversation to explore your family history of cancer. We know that eating a healthy diet can make a difference, but having an accurate family history is something many people lack while they sip their smoothies and drink their green tea.

According to Dr. Huma Q Rana of the Dana-Farber Cancer Institute, as quoted in Harvard Men's Health Watch, "Family history can be one of the first lines of defense in preventing cancer."

Are you ready to reinforce the walls of your mother's fortress? Family gatherings, such as Mother's day, are a unique and unparalleled time to write out your family history of cancer.

Not only does the suggestion alone show your love, but we know it can work, as one woman can attest.

A Word on Breast Cancer

If you've noted the pink ribbons on everything from tennis balls to kitchen mixers, you may think that there is plenty of "awareness" for breast cancer. 

Yet for all of the awareness, there is less awareness that breast cancer isn't always curable with surgery and chemotherapy. While a study found that 50 percent of the population believes breast cancer is curable, that is far from the truth. Roughly 40,000 women lose their lives to breast cancer each year.

There is also less awareness that most of the women who die from breast cancer don't do so because they failed to follow screening guidelines.

 Many women who die from breast cancer haven't yet reached the age at which screening is recommended, and many more die from breast cancer recurrences after an early breast cancer is detected and treated.

For those who have metastatic breast cancer (stage 4 breast cancer) the story is far from done. While there are some long-term survivors, the median survival rate for people with stage 4 breast cancer is only 18 to 24 months. How can you reduce your Mother's, and your family's risk of being added to these statistics? 

How to Take a family History

Taking the time to take a family history during your Mother's day brunch is easy. Grab a notebook and pen (or a printed family history form listed below) and ask questions. You may wish to take a comprehensive family history of all conditions, but try to at least cover cancer at first.

Write down these things:

  • Any relatives with cancer and their relationship to you
  • Birthdates and dates of death if applicable
  • Cancer types (and other medical conditions if you choose) - Make sure to record as many details as possible. The type of cancer if known, the treatments received if known (often a cancer can be identified by the types of treatments used,) and any other information available, such as the estrogen receptor status of breast cancers, or the molecular profile of a tumor.

Additional sources that may help include death certificates, any medical records which you have, or even photo albums. For those relatives who can't be with you, make a point to call them in the near future or even send a questionnaire. Make sure you reciprocate by letting them know what you've learned.

Tips for Getting an Accurate Family History

Taking a family history might appear easy at first, but it's not so simple. Until just a few decades ago talking about "breasts" at the dinner table would have been taboo. While that has changed, it can play a role in recording an accurate family history.

Write down anything your relatives remember. In the past "female cancer" was used to describe anything from breast to ovarian cancer. Keep in mind that many people report the "final" place in which cancer is found. For example, if a person had a breast cancer which spread to their lungs, your family may remember this as "lung cancer."

Around 90 percent of people with breast cancer die from metastases, so make note of places where breast cancer most often spreads, such as the lungs, the liver, the bones, and the brain. Many people only remember that a loved one died from "cancer all over." Write this down, noting that the cancer must have begun somewhere.

Tools for Taking a Family History

All you really need is a notebook and pen, but for those who like charts, there are templates you can print off. Here are a few of the tools that you can access online:

Family History Patterns That Raise Red Flags

There are several patterns that may be found on your family history which may raise your risk of developing cancer. A genetic counselor is usually needed to find subtle or complex combinations which raise risk, but a few red flags include: 

  • Cancer of any kind before the age of 50
  • More than one relative with the same type of cancer
  • One family member who has more than one type of cancer
  • A family member who has cancer not typical for that gender, such as breast cancer in a male
  • Certain combinations of cancer, such as the combination of breast cancer with ovarian cancer, uterine cancer, colon cancer, prostate cancer, pancreatic cancer, or melanoma
  • Cancer in both of one organ, for example, bilateral breast cancer

Heredity Cancer vs. Family History of Cancer

When talking about the genetic risk of cancer it's important to make one distinction, a distinction which may help you understand the apparently conflicting statistics you read.

At the current time, it's felt that roughly 5 to 10 percent of cancers are related directly to a gene mutation, but genetics may play a role in another percentage of cancers. When you hear of statistics discussing genetic predisposition to cancer or hereditary cancer you may find yourself confused. An example is the best way to explain this.

While only one percent of melanomas are tied directly to genetic mutations (that we have discovered and can test for anyway) it's felt that genetic factors may play some role in around 55 percent of melanomas.

In other words, even if you are tested and do not have the BRCA1 or BRCA2 gene mutations (made common knowledge thanks to Angelina Jolie,) you may still have an increased risk of breast cancer based on findings from your cancer family history.

Genetics and Breast Cancer Risk

What do we know about family history and breast cancer risk?

  • A woman who has a first-degree relative with breast cancer has roughly a 30 percent chance of developing breast cancer (first-degree relatives include parents, siblings, and children.)
  • A woman with a second-degree relative with breast cancer has around a 22 percent chance of developing breast cancer (second-degree relatives include grandparents, aunts, uncles, nieces, and nephews.)
  • A woman with a third degree relative with breast cancer has around a 16 percent chance of developing breast cancer (examples of third-degree relatives include great-grandparents, cousins, or a great aunt or uncle.)
  • Breast cancer in younger relatives (premenopausal, or under the age of 50) carries a risk greater than older relatives.
  • Prostate cancer in male relatives increases your risk of breast cancer (again, this is more significant when the men are younger.) Learn about the breast cancer prostate cancer link.

Another important point is that most people who have an increased cancer risk don't fall into neat categories. For example, what if you have two people in your family who have had breast cancer, but one is on your father's side and one on your mother's side? This is why talking to a genetic counselor is so important. 

Discussing Your Family History With Your Provider

Many people take their family history with when visiting their primary care physician, and this is a good idea, but there is a caveat. If you see any red flags in your family history, your best bet is to talk with a genetic counselor. Genetic counselors are trained in the idiosyncrasies and details of your pedigree (your family history profile) and can give you a better estimate of any possible risk than most primary care physicians.

Finding a Genetic Counselor and Considering Genetic Testing

How can you find a genetic counselor? Your physician may be able to direct you to a good genetic counselor, but you can also look yourself online. The National Cancer Institute has a genetics services directory which lists providers by region.

Who should have genetic testing? The answer to this question is that anyone who is considering genetic testing should talk to a genetic counselor, and for several reasons.

  • Genetic testing is still in its infancy. We have several genetic tests for cancer, but there are many more waiting to be discovered.
  • A careful pedigree (your family history chart) can often provide information about risk which would not be found on genetic testing. 
  • There are many emotional factors and other issues surrounding genetic testing. A genetic counselor can help you wade through these issues before you are given a readout that may be hard to understand. 

Genetic testing is becoming much more affordable, but should not be done without some thought or care.

Options for Women (and Men) With a Family History of Breast Cancer

There are many options if you find that you are at an increased risk for developing cancer. Simply taking a look at your diet and exercise and making sure you know the possible symptoms are a good start.

Earlier or more detailed screening may be recommended. For example,  a report published in the journal Canadian Family Physician states that women who, upon looking at medical history, have a 20 to 25 percent lifetime chance of developing breast cancer should receive a  breast MRI in addition to a mammogram for screening.

If you have an increased risk, however, it's important to find a physician who can help you navigate those gray waters.

Who Can Help You Come Up With a Plan?

If you appear to have an increased risk for cancer, your genetic counselor may have a recommendation on who you should see, but if not, we have a few tips.

It would be wonderful if there were guidelines and if primary care physicians knew exactly who should have increased screening and when. Unfortunately, by the time you have researched your risk, you may know as much or more than many physicians. Medicine has become so complex that no one physician can know everything. Even a breast cancer specialist may be more familiar with the latest clinical trials for treatment than in what to do for those at an increased risk. So how can you find someone to help you?

Breast cancer organizations provide one excellent source. These organizations provide support for many women who would otherwise fall through the cracks. Many of these organizations do an excellent job of answering the multitude of questions related to a specific disease.

A surprising, but often successful place to learn the latest news is to become involved in cancer-related social media. Physicians and researchers who are interested in the genetics of breast cancer play on a level field with patients, caregivers, and advocates on Twitter. If you don't have a Twitter account, it only takes a minute to sign up. A few tips are in order so you don't get lost in cyberspace. Use hashtags. The hashtag #BCSM stands for "breast cancer social media" and can help you find people who are most active online, including physicians.

You may wish to use other hashtags as well such as #breastcancer and #cancergenetics. Take some time to get the feel of the landscape, follow those who are researching answers to the questions you are asking, and go ahead and tweet your questions, for example, "Who is interested in the genetics of breast cancer or family history of breast cancer?" 

What If Your Family Doesn't Want This Conversation?

Though learning about your family history of cancer can be important, not every family will welcome this conversation. Many families will not want to go down this road for a number of reasons, and it's important to respect these family members. Thank them for considering your request. There are still plenty of ways in which you can lower your risk of breast cancer.

After Dinner: Spread the Conversation

What does every mother want? Healthy and happiness for her children. What do children want for their mothers? Her health and happiness. A conversation about your family history of cancer is a gift you can give each other.

As a final note, while we've talked about Mother's day and women with breast cancer, we must point out that men get breast cancer, too. And unlike the one in three women who will develop cancer in their lifetime, it will be one in two men. Perhaps you can begin planning your Father's day family conversation before you leave the table.

Sources:

American Cancer Society. Cancer Family Syndromes. Updated 03/15/17. https://www.cancer.org/cancer/cancer-causes/genetics/family-cancer-syndromes.html

American Society of Clinical Oncology. Cancer.net. Collecting Your Family History. Updated 02/16. http://www.cancer.net/navigating-cancer-care/cancer-basics/genetics/collecting-your-cancer-family-history

Heald, B., Marguard, J., and P. Funchain. Strategies for Clinical Implementation of Screening for Hereditary Cancer Syndromes. Seminars in Oncology. 2016. 43(5):609-614>.

Love, Susan M., Elizabeth Love, and Karen Lindsey. Dr. Susan Love's breast book. Boston, MA: Da Capo Lifelong, 2015. Print.

Shekar, S., Duffy, D., Youl, P. et al. A Population-Based Study of Australian Twins with Melanoma Suggests a Strong Genetic Contribution to Liability. Journal of Investigational Dermatology. 2009. 129(9):2211-9.

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