SCITUATE
When Jane McGovern learned she had breast cancer at age 46, she
wasn't that surprised. After all, she knew lots of women with
cancer. But the Scituate mother of three was shocked to learn that
she carried a gene that greatly increased her risk of not just
breast, but ovarian cancer.
"There's so much breast cancer, so I thought, 'Now it's my turn,"
said McGovern, a former aide for special needs children and co-
writer of a new comedy about cancer. "But when I found out I had the
gene, my heart stopped for a second. I had heard there was a gene
for breast cancer, but I didn't know it was linked so highly with
ovarian cancer."
Many people are unaware of this connection, but publicity is
likely to increase knowledge. Last month, the U.S. House of
Representatives designated the final week in September as National
Hereditary Breast and Ovarian Cancer Week. A new version of the
comedy, "The MOMologues," focuses on cancer and references
hereditary cancer. And the new memoir, "What We Have," by Boston
College professor Amy Boesky is the story of the effect of
hereditary cancer on her and her family.
"I hope my story helps to get the word out," said Boesky, who
spoke to a gathering of a dozen women at Buttonwood Books in
Cohasset. "A lot of people don't know about the genes, and I live in
the medical mecca of Newton and Brookline. The extent to which it is
out there in the public consciousness is unbelievably small."
The genetic mutations are called BRCA1 and BRCA2 (for Breast
Cancer 1 and Breast Cancer 2 genes) and substantially increase the
risk for breast and ovarian cancers. Discovered in 1995, these
mutations occur in tumor suppressor genes and make them work less
effectively. If a man or woman has the mutation, the child has a 50
percent chance of inheriting it. However, only about 10 percent of
cancers are hereditary.
"Most cancers are not caused by genes, but if you have the genes
they significantly increase your risk," said Dr. Laura Dominici,
breast surgical oncologist at Dana Farber/Brigham and Women's Cancer
Center and South Shore Hospital. "But you also can have the mutation
and never get cancer."
Between 40 and 80 percent of women with BRCA1 and BRCA2 will
develop breast cancer and 15 to 40 percent of women will develop
ovarian cancer, Dominici said. These cancers tend to be aggressive
and occur when women are younger than age 50.
Boesky, 51, said she grew up with the idea "have children and get
those things (ovaries) out fast," since both her grandmother and
aunt died of ovarian cancer at young ages and her mother had a
preventive hysterectomy. When her mother developed breast cancer and
died from it 17 years ago, the genes and their increased risk for
cancer were not known, Boesky said.
"We thought it was a small treatable cancer, so it was not
treated in the way an aggressive cancer would have been," she said.
Today, doctors recommend that women with BRCA1 and BRCA2 have
their ovaries removed once childbearing ends because there is no
good screening for ovarian cancer, Dominici said. For breast cancer,
doctors may recommend prophylactic removal or close monitoring with
an MRI.
"It is so personal about how individuals perceive risk," Boesky
said. "Every situation is different depending on your age,
childbearing and perception of risk. I don't think there is a neat
formula for what people feel or do."
Both McGovern and Boesky had surgeries to remove their ovaries,
uterus and breasts and to reconstruct their breasts. Boesky had her
surgeries at ages 34 and 37, before she developed cancer and after
she bore two daughters. McGovern, who has three teenage and young
adult children, had the surgeries after she developed breast cancer
last year, which now is in remission following chemotherapy and
radiation. She still has one final reconstruction surgery.
Until she began asking questions after her diagnosis, McGovern
was unaware that her grandmother and four cousins had breast cancer
and another grandmother had ovarian cancer.
"We're a classic Irish Catholic family and don't talk about these
things," said McGovern, 47, who has five siblings. "Apparently, I do
have a family history."
Knowing your family history is the first step toward preventing
cancer or finding it in its earliest stage, said Dr. Dominici. Red
flags include female relatives with pre-menopausal breast cancer and
ovarian cancer, and male relatives with breast cancer.
"If a woman has a suspicious family history, she would meet with
a genetic counselor, who would recommend whether the risk was such
that she should be tested," Domenici said. "Even though it's a
simple blood test, the decision isn't easy because there are a lot
of implications."
Interestingly, Boesky has never been tested for the genetic
mutation. She went ahead with the surgeries because she wanted to
take every step possible to protect herself from cancer, she said.
"Even if the genetic test were negative, I know there are other
BRCA mutations out there and there are some women who get
inconclusive results," she said.
With her daughters now in high school and college, Boesky has
been wrestling with whether to get tested.
"Is it better for me to have the testing, so I know whether it's
really necessary for my daughters to have it?" she asked. "I think I
would like to be tested first to take on the worry and spare them.
If I'm negative, then they don't need to worry."
Boesky shared this dilemma with the women at her book reading.
"What would you do with the knowledge that a medical condition
hung over your family?" she asked. "How much would you want to know
and when?"
For women who know they have BRCA1 or BRCA2, doctors offer more
hope than ever before.
"People search for a reason they got cancer, and in most cases we
can't answer that," Dominici said. "But in this case, we have an
answer. Since we know about these genes, we can do more screening,
prophylactic surgery, and try new trials of chemotherapy targeted to
the cancer. We're also looking to see if some medications can be
used in a preventive manner, and that is exciting."
McGovern said she feels hopeful and expresses that in monologues
she wrote for the new comedy "The MOMologues: Pink Ribbon Overdose."
Co-written with fellow cancer survivors Pam Ahl and Lisa Rafferty of
Scituate (a creator of the original "MOMologues" and "MOMologues2:
Off to School), the production will be performed as a benefit Oct.
27 at the Hard Rock Cafe in Boston.
"There's nothing funny about cancer, and yet there are funny
moments," said McGovern, who also produced the show and acted in
last year's "The Best of the MOMologues." "Breast cancer takes away
so much, but it doesn't have to take away your sense of humor. We
think laughter is therapeutic and helps you shift from feeling like
this is the end of the world to I can get through this."
Reach Jody Feinberg at jfeinberg@ledger.com.
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