Margaret Blume is relishing the luxury of complaining about the tendonitis in her elbows and the arthritis in her knees. Her purportedly deadly late-stage ovarian cancer, found during an exploratory ultrasound, has simply “disappeared.”
Blume, 59, is the longest survivor of a groundbreaking two-and-a-half-year study led by Seattle medical oncologist Dr. Saul Rivkin. Rivkin has been ovarian cancer’s archenemy ever since it claimed his wife’s life in 1993. Through the Marsha Rivkin Center for Ovarian Cancer Research, Rivkin has treated 54 late-stage ovarian cancer patients with chemotherapy and the drug olaparib.
“Almost half of them have died already,” Rivkin says. “If you really want to save lives, you have to get out ahead of it in time and prevent it from happening.”
If the cancer is caught early enough, as two women in Rivkin’s Ovarian Cancer Early Detection Program found out, there is a good chance that debilitating chemotherapy treatments will not be necessary after surgery. Rivkin removed one healthy patient’s uterus, tubes, and ovaries. “She was tired of being screened twice a year, and had a prophylactic surgery,” he says. “We found the cancer at surgery.”
Another patient in the early detection group discovered her cancer after a routine ultrasound screening. “She was stage one also,” Rivkin says, “and required surgery and no chemotherapy. She is doing well now.”
Blume and her mother had both breasts removed due to breast cancer. Her mother died of peritoneal cancer. Blume’s sister had breast cancer, and her maternal grandfather and two great-aunts died of cancer.
“Dr. Rivkin saved my life,” Blume says. “I feel like I have a future.”
A wife and a mother of one adult son, Blume has the BRCA 2 gene mutation, one of three BRCA defects strongly associated with breast and ovarian cancers in Ashkenazi Jewish women. Blume’s mother and three of Blume’s male and female siblings tested positive for the BRCA 2 mutation.
“These cancers are highly linked,” says Wendy Law, Ph.D., director of scientific programs at the Rivkin Center. “If a woman has BRCA 1 or 2 in her family, or if she has had breast cancer herself, that puts her in a higher risk category.”
According to Law, one in 40 Ashkenazi Jews has a BRCA genetic defect, compared to one in 345 in the general population. Both men and women with a BRCA mutation can pass it on to their children, giving them a 50 percent chance of inheriting it.
“The most current thinking is that if you have a BRCA 1 mutation you have up to a 65 percent chance of breast cancer and a 35 to 40 percent chance of ovarian cancer if you do no intervention to decrease that risk,” says Dr. Julie Gralow, a medical oncologist at Seattle Cancer Care Alliance. “For BRCA 2, the breast cancer risk is maybe 45 percent and the ovarian cancer risk is probably 10 to 15 percent.”
BRCA mutations may also put Jewish men at a greater risk of developing prostate cancer. “Prostate cancer is increased with both of these mutations, although not generally at a younger age,” Gralow says. One out of two men in the general population is at risk for prostate cancer. That’s slightly higher for Ashkenazi Jewish men with a BRCA mutation, she says. Prostate cancer is the most common cancer in men, and like ovarian cancer, it is typically slow growing and symptom-free in its early years.
Two screening tests done in a routine office visit, the CA125 blood test and a transvaginal ultrasound, have a high degree of accuracy for detecting ovarian cancer in nearly 80 percent of the diagnosed cases. For men, a rectal exam and a prostate-specific antigen (PSA) test measure the level of this prostate-generated substance in the blood. Men should also track changes in urination, Gralow adds.
All women should perform monthly breast self-checks, schedule annual exams, and, after age 40, get regular mammograms. At-risk women may increase the odds of detecting cancer early by getting extra mammograms and MRIs, and may prevent it by going through with prophylactic surgery.
Two cutting-edge genetic therapies (preimplantation genetic diagnosis and microarray analysis) are available from in-vitro fertilization clinics that can eliminate virtually all cancer-inducing BRCA mutations from embryos, reducing the risk of transmitting the potentially deadly mutation to less than 1 percent.
The best defense is to know your risk factors. “Know your family history, and look for signs and symptoms,” Law says. “I think we’re just at the forefront of making people more aware of this cancer and how to be more proactive about it.”
Intervention Is the Best Medicine
Tips for early detection and lowering breast cancer risk from local experts Dr. Anne McTiernan, Dr. Julie Gralow, and Dr. Constance Lehman.
Know Your Risk
Tell your doctor if you have family members who have had breast cancer, especially a mother or sister. Some women at high risk may be recommended for an annual MRI. For more information about genetic counseling, visit cdc.gov/genomics/resources, nsgc.org, or jewishgenetics.org.
If you’re over 40, get mammograms. Detecting breast cancer early offers the best chance for good results.
Keep a healthy weight, include physical activity in your daily routine, minimize alcohol intake, and don’t smoke.
New moms should breast-feed for as long as possible. Breast-feeding for at least a year reduces breast cancer risk for the mother.
High-risk women may consider taking an estrogen-blocking drug such as tamoxifen, raloxifene, and aromatase inhibitors.
Avoid hormone replacement therapy, which increases risk for breast cancer. If you must take hormones, avoid those that contain progesterone and limit their use to less than