A Meaningful Day (3)
Today was my last day of observation and yet it was a tough day because we were dealing with cancer patients.
I was supposed to have 3 cases. But the man who has breast cancer didn’t feel comfortable to be observed. Hence, I only experienced two.
The first case was a 41-year old African-American woman who worried about her own recurrence risk for breast cancer since her mother had bilateral breast cancers when she was 67 years old. She is a registered nurse and well prepared for the meeting. She has a small family and is the only child in her family. Her father was alcoholism and died from cirrhosis. Her maternal aunt had throat cancer but now is still living. The risk for average population to have breast cancer is about 5-10%. Since her mother had bilateral breast cancer, her recurrence risk increased to 15-22%. Though this number is doubled the average risk for ordinary population, it still belongs to the low risk of having breast cancer for her. However, 20% is a threshold for close surveillance. Therefore, she was recommended to a specialist for MRI detection in order to find small lump in her breasts at very early stage. She was satisfied with the service which has lessened her anxiety of having breast cancer.
The second case of today was a young mother who is 28 years old with a two week old daughter. She was found to have cancer in her left breast. Once the MRI confirms the lump, she will decide to have a lumpectomy or a mastectomy, either of which is painful physically and emotionally. Her family history revealed that her mother had breast cancer and her aunts had stomach cancer, brain cancer and ovarian cancer. On her father side, one of her uncles had prostate cancer. She has Germany ancestors. Due to her family history, she was highly recommended to have a genetic test in order to figure out the cancer causing genes such as BRCA1/2. If the test results are positive, that would explain her breast cancer and also warn her family members and relatives and raise their awareness of close checking later in their life. If the results are negative, the lab would try to test other genes or variants. This is a typical familial cancer example, though cancer could also be caused by environmental forces. If her cancer is due to the BRCA1/2 genes, she has high risk of having ovarian cancer later in her life too because BRCA1/2 is responsible for several kinds of cancers. Usually, patients over 35-40 years old would be recommended to remove their ovaries due to the difficulties of diagnosis. However, she is only 28 years old, she will probably be treated with birth control pills, which on the other hand will increase the possibility of having breast cancer.
Medicine and medical professionals are so helpless facing those dilemmas. No matter what, close monitoring susceptible population for certain cancer, raising their awareness of recurrence risk and recommending close surveillance would be ways to prevent the incidence of cancer, lower patients’ anxiety as possible as we can.
P.S. I am not so sure whether genetic counseling is a profession in China. At least I have never heard of it. According to my observation, I think it is very important to have such profession to educate people to prevent from certain genetic disorders. Modern medicine should not only focuses on treatment but more on prevention.
