The following is a real patient encounter from the perspective of Dr. Laura Kimbro, a physician who recently launched the Center for Women’s Health in Sonoma Country, CA. Dr. Kimbro specializes in the treatment of hormonal imbalances, vulvar conditions, and issues associated with sexual health.
Each year when pink ribbon season rolls around, and countless fundraising walks populate with crowds of people wearing brightly colored t-shirts and sun visors, we are reminded of women’s battles against cancer.
They draw attention to issues that many women understand intrinsically and know very little about breast and ovarian cancers. These are diseases that are generally first discussed at the first OBGYN check-up, right around the sweet-16th birthday.
Still, for many women, until they know someone battling cancer or become diagnosed themselves, the disease often doesn’t enter their everyday reality.
For many women, the risk of cancer floats somewhere in the back of their minds, cataloged alongside the endless lists of worries women carry around with them every day. With a vague understanding that cancer is dangerous but often detectable or even curable, the thought remains on the shelf until a diagnosis becomes personal. Until then, cancer stories like Angelina Jolie’s pre-emptive breast removal/replacement surgery may be the only reference to genetic testing widely circulated.
Despite her story’s compelling nature, it leaves the impression that only wealthy women with access to expensive health care qualify for cutting-edge technology and personalized risk evaluation. The focus of these stories is often less on genetic screening and more on the extreme measures taken to avoid developing cancer. And ultimately, these anecdotal stories can be quickly brushed aside in the face of more pressing issues like prepping for a presentation at work, helping with homework, and cooking dinner.
That is why I feel compelled to share Amy’s story.
Amy is a healthy, vibrant, and professional 23-year-old woman who lives in Alaska. When she’s not on active duty with the United States Air Force, she’s often hiking glaciers or salmon fishing. A Sonoma County native, Amy returned home this summer to visit her family, and during her time home, she experienced a mysterious pain in her breasts. She immediately began searching online for a specialist who would understand why this pain concerned her as much as it did. It wasn’t necessarily the physical pain that had her worried, but what it represented. Amy knew the women in her family had a generational history of breast cancer and understood that early detection was paramount in fighting the disease.
After finding the Center for Women’s Health through her research, Amy called my office, explained her concerns, and scheduled an appointment. When we met, Amy told me that both her grandmothers had breast cancer and her aunt was diagnosed at 24. Her story provided me a deeper understanding of the reason for her visit. The pain in her chest wasn’t just an annoyance, but an internal alarm going off that something severe could be developing. She knew that 1 in 8 women developed breast cancer in the U.S., and she prepared herself for the worst.
Breast imaging was ordered and thankfully came back normal, with her tests showing she was cancer-free. Amy then participated in a saliva-based genetic screening. The examination revealed that her genes decreased her risk of breast cancer despite her family history. However, the test did determine that Amy had a genetic risk for ovarian cancer, something she had not considered before our meeting.
Amy’s lifetime risk of ovarian cancer is more elevated than most, so we spoke on the phone about her life goals and whether or not she wanted to be a mother down the road. Because of her age and willingness to remain proactive with her health care, a recommended course of treatment will come into play after Amy has the family she someday hopes to have. Later, as Amy approaches menopause, it is recommended that she have her ovaries removed. In the meantime, I was happy to give her guidance on routine screenings regarding how to monitor any ovarian abnormality as she matures.
Amy was relieved that her breast cancer risk wasn’t as high as she first worried. With annual mammograms and other screening modalities, she could manage that risk with proper medical monitoring and attention. The information all reassured her that she could have a different fate than her grandmothers and aunt.
Amy’s story is inspiring on a few levels. She represents a new generation of proactive women in seeking the care and advice they need to make important choices for their life and wellbeing. She was brave enough to face the risks head-on and live a happy and healthy life despite those risks. Nothing can prevent her from developing breast or ovarian cancer. Still, I am confident that she is better equipped to catch a disease early if one develops down the road with her knowledge and proactive approach.
It’s important to share that information with your doctor so they can determine if genetic testing is right for you. This information is valuable as it also informs recommendations for positive lifestyle changes, evaluating the benefits versus risks of hormonal contraception, hormone therapy, and prevention screening strategies. If Amy had only been tested for the BRCA gene alone (often purchased without a physician through popular genetic tests like 23andMe and AncestryDNA), she wouldn’t have the advantage of developing a proactive and strategic medical plan for the future. When it comes to preemptive cancer screening, comprehensive professional genetic testing in conjunction with a specialist’s guidance can make all the difference.
Amy’s story exemplifies the power that knowledge and courage can have when saving lives and reducing the potential number of people with cancer.
If you would like to find out more about the Center for Women’s Health, visit the website at http://center4womenshealth.org/.