What happens when three gynecologists are diagnosed with BRCA-positive breast cancer? The “Mutant and Proud! The Power of Knowledge for Cancer Prevention: Stories from 3 BRCA-Positive Gynecologists” session at the 2021 ACOG Annual Clinical and Scientific Meeting shares their experience.
OB-GYNs are accustomed to helping patients overcome a variety of health threats and conditions, but what happens when the clinician becomes the patient? That’s the exact question the “Mutant and Proud! The Power of Knowledge for Cancer Prevention: Stories from 3 BRCA-Positive Gynecologists” session explored at the 2021 ACOG Annual Clinical and Scientific Meeting.
Here are the stories of three BRCA-positive gynecologists and how the lessons learned from their own diagnoses impacted their approach to caring for others.
Meet Michelle, Kimberly, & Erin
Dr. Michelle Jacobson is an OB-GYN and menopause specialist at the Women’s College in Mount Sinai Hospital in Toronto, Canada, and she was 25 years old when she learned she was a BRCA gene carrier.
At first, she thought surveillance seemed like a reasonable decision since she was single at the time, but after getting married and having a daughter, Dr. Jacobsen realized it wasn’t wise to wait for a second child since she didn’t want a cancer diagnosis to impact her health, longevity, and the family she already had.
So Dr. Jacobsen underwent a preventive mastectomy, and now at 36 years old, she has a second child and a very low risk of breast cancer.
The second panelist Dr. Kimberly Hunt serves as the OB-GYN Department Chair at the TriStar Summit Medical Center in Nashville, Tennessee. Interestingly, Dr. Hunt began by explaining that cancer is not in her family history. In fact, it wasn’t until her aunt experienced a breast cancer recurrence and found out she was a BRCA gene carrier in her 60s that Dr. Hunt was tested—only to find out she too was a carrier.
Like Dr. Jacobsen, Dr. Hunt underwent a preventive mastectomy, and while it’s a relief that everything is benign, she noted that it was an emotional rollercoaster getting through the diagnosis amid the COVID-19 pandemic.
Lastly, Dr. Erin Keyser is the Program Director for the Department of OB-GYN at the Brook Army Medical Center in San Antonio, Texas. Dr. Keyser admitted her story was a little different in that it was her husband who first noticed a lump. At first, she just thought it was from breastfeeding, but after an ultrasound, mammogram, and biopsy, she was diagnosed with breast cancer.
Since her mother is of Ashkenazi Jewish descent, she was then tested for the BRCA gene, which she had, oddly enough, from her father’s side.
According to Dr. Keyser, getting the BRCA diagnosis after the breast cancer diagnosis felt like a second kick in the gut, and after undergoing chemotherapy, a mastectomy, and adjuvant therapy, Dr. Keyser proceeded with having her ovaries removed.
How the NCCN Guidelines Have Evolved
Based on their experiences, Drs. Jacobsen, Hunt, and Keyser all agreed that it’s important for OB-GYNs to expand their thinking on whether patients should be referred for genetic counseling and testing.
Fortunately, the National Comprehensive Cancer Network Guidelines have evolved over the years to include a deeper dive into family history. Previously, the guidelines primarily focused on first-degree relatives or personal histories of breast and ovarian cancer.
The three panelists also noted that the type of testing that gets done depends on the family history or personal history, which is why it’s so important to spend time with patients to learn more about their history.
How Their Experience Changed Their Approach
Dr. Hunt recalled that being a patient was a very humbling experience and that there was an immense amount of pressure to make the right decisions. She also noted that the complications she experienced took a toll on her emotions and self-esteem due to the appearance of her skin and how difficult simple tasks such as washing her hair became after the procedure.
But despite all of the challenges, Dr. Hunt implored OB-GYNs to take a good family history since the earlier BRCA is found, the more OB-GYNs can make a difference for a patient and their family.
Drs. Rosenberg and Keyser both mentioned a positive aspect to their diagnosis as it led them to identify a healthcare niche they were passionate about, but even then, Dr. Rosenberg said that while it’s good that breast cancer screening is out there, diagnosis is not the same as prevention.
And speaking from her own experience, Dr. Keyser stressed the importance of OB-GYNs talking about fertility with all patients. This topic is most often addressed with patients who don’t have children, but for Dr. Keyser, the reality of not having the option to have more children weighed on her, and she wished that her doctor broached the subject with her.
Another disconnect Dr. Keyser mentioned is that hem-oncs will often direct patients to OB-GYNs while OB-GYNs will direct patients to hem-oncs, which can get very frustrating for patients. So Dr. Keyser recommended that OB-GYNs take ownership of survivorship issues to help ensure a patient’s needs are met.
Although they each had unique stories and experiences, a common theme throughout all three panelists’ takeaways was the importance of telling patients that there is power in knowledge and that by doing a thorough family history, Ob-GYNs can identify patients carrying the BRCA gene and prevent cancer before it develops.