Genetic Testing Program Patient
Upon learning she carried the genetic mutation for breast and ovarian cancer, Britt Wanek cried for 10 minutes. She then decided to have a double mastectomy and reconstructive breast surgery.
Wanek, 32, connected with Alexian Brothers Health System’s (ABHS’s) genetic testing program after breast cancer took her mother at 54 and ovarian cancer killed Wanek’s aunt at 45. Other relatives also had died from cancer.
“I just wanted to be proactive, because I’m a fighter,” she says. “I didn’t want to let cancer invade me. I wanted to do something about it. I wanted the testing done so I would have the knowledge.”
A doctor suggested genetic testing to Wanek after she had a grapefruit-size fibroid tumor removed from her uterus when she was 27. Because of her family history of cancer, “I was scared,” she says. “He really wanted to know if I had the (genetic mutation).”
Wanek contacted Tinamarie Bauman, R.N., M.S.N., A.P.N.G., Manager of High Risk/Genetics and a Certified Breast Health Specialist at ABHN, which has offered predictive genetic tests for cancer since 2001.
“The program is pretty unique in our area,” says Bauman, one of two advanced practice nurses credentialed in genetics in Illinois and one of 28 such experts in the nation.
Genetic testing involves taking a sample of blood or tissue to learn more about a person’s genes. From June 2009 to June 2010, ABHS provided predictive genetic tests for 394 patients and provided genetic counseling for a total of 516 patients. These numbers have remained consistent for several years, Bauman says.
“We test for any cancer considered hereditary,” she says. “If people feel like they have a personal or strong family history of cancer, we first do an assessment in which they talk to us and we draw out their family history, including the ages people were diagnosed and the cancers involved. If our assessment shows that there is a hereditary cancer syndrome, we test for that syndrome.”
In Wanek’s case, there clearly was such a syndrome. Plus, she is of Eastern European Ashkenazi Jewish descent, and it’s estimated that one in every 40 Ashkenazi Jews carries the genetic mutation for breast and ovarian cancer, compared with one in every 300 to 400 people in the general population.
After Bauman told Wanek she had tested positive, “I felt like my world was coming to an end,” Wanek says. Collecting herself after crying, she asked, “What are my options? What do I have to do? What are my odds?”
Bauman explained that people who test positive for the genetic mutation have up to an 87 percent chance of developing breast cancer and up to a 44 percent chance of developing ovarian cancer.
In explaining possible preventive treatments, Bauman told Wanek that she could take tamoxifen, a medication used to treat and to prevent breast cancer. She also could have frequent mammograms and MRIs. Concerned about possible side effects of these treatments during her child-bearing years, Wanek rejected both options.
A third option, Bauman explained, was to have a double mastectomy and reconstructive breast surgery. This option reduces the chances of developing breast cancer by more than 90 percent, Bauman says.
“I started asking questions about that,” Wanek says. “I felt that was the only option. Tina said, `It’s a big decision to make,’ and I said, `I don’t need to make a decision. That’s what I want.’ ’’
She asked Bauman to recommend the appropriate doctors, and she referred Wanek to an ABHS surgeon for the double mastectomy and to another ABHS doctor who specializes in breast reconstruction. She met with both doctors and decided to move ahead promptly. “Everyone said I should talk to a million people,” Wanek says. “But I talked to (the two ABHS doctors), we bonded, and I didn’t talk to anyone else.”
ABHS offers counseling for women who are considering preventive surgery, but Wanek was certain in her choice. “All I thought was that I wanted to have kids, and I wanted to be there for their wedding,” she says. “I didn’t want to die at 50.”
Wanek did seek counseling at ABHS to help her through some difficult times in the months between her surgery and the completion of her breast reconstruction. “It was hard to deal with the way I looked,” she says.
Today, though, Wanek says she “couldn’t be happier” with the results. Positive and upbeat, she praises her breast reconstruction specialist: “He did the most amazing job.” At his request, she sometimes counsels and advises other patients considering a similar choice. Wanek also praises her surgeon, Bauman and the ABHS nursing staff. “Everybody was so awesome,” she says. “I was treated really well.”
Since undergoing her aggressive preventive treatment, Wanek has married, and she and her husband are expecting their first child in January 2011. She works about 30 hours a week as a payroll and human resources specialist, runs regularly and is taking a spinning class.
Wanek says she is “really glad” she acted decisively to minimize her chances of developing breast cancer. “It was harder than I expected it to be, but it was worth it,” she says. She plans to take the same approach to minimize her chances of developing ovarian cancer. Six months after giving birth, she will have a total hysterectomy, she says, adding that her two surgeries will reduce her overall chance of getting cancer to 5 percent to 8 percent.
“A lot of people don’t get the hysterectomy part,” she says. “They say, `Why wouldn’t you want another baby?’ But my husband and I feel this baby is our miracle. We would rather just love this baby and know that I will be alive and healthy.”
Wanek knows there’s a 50 percent chance she will pass on her genetic mutation to her child, but her instincts tell her “this baby doesn’t have this gene,” she says. “I feel like it’s done. I just feel like this baby is OK.”
She strongly recommends predictive genetic testing for other women facing circumstances similar to hers, “because then you have the knowledge,” she says. “If you have the knowledge, you can make changes in your life. Knowledge is power – the power to make changes for the better and to live.”