HYANNIS – When two sisters found out they shared the BRCA 2 genetic mutation for cancer, their first thoughts were for their young children. Then they courageously decided to have their breasts, ovaries and fallopian tubes removed at Cape Cod Hospital, where genetic testing for high-risk patients is helping women and men beat cancer before it starts.
“When Dr. (Kathryn) Dalton told me that I had the BRCA 2 genetic mutation, my whole world flipped over,” said Kirsten Wickson of Brewster. “My first thought was for my six-year-old daughter Emily. I didn’t want her to grow up without me.”
Kirsten immediately encouraged her sister to be tested at Cape Cod Hospital’s High Risk Breast Clinic.
“We both have children, and when my sister found out she was also BRCA 2 positive, we decided to have the surgery because we intend to be there for our children as they grow up,” she said.
Kirsten’s sister (who asked not to be named in this story), has an 8-year-old daughter and 6-year-old son. She said her children are the reason she decided to prophylactically remove as much “at-risk” tissue as possible to reduce her risk of getting cancer in the future.
“I need to believe that by the time my daughter is old enough to have to worry about this, science will have come a long way and she won’t be faced with this decision. I have a couple decades to hope for good things for her,” she said.
Memories of their father’s long struggle with multiple sclerosis (MS) contributed to the sisters’ decision.
“Our father passed away in 2015 with MS, which he bravely fought for 23 years. I was his caregiver and watched him endure the disease,” said Kirsten. “My sister and I knew beyond a doubt that if someone had told him he could have had his legs surgically removed and avoided all those years of illness, he would have done it without hesitation. We were guided by his example. We went into surgery with no doubts.”
This is the first time Kathryn Dalton, DO, FACS, director of breast services for Cape Cod Healthcare, has performed surgeries on sisters since opening the High Risk Breast Clinic within the hospital’s Cuda Women’s Health Center in 2015. However, Dr. Dalton expects to see more cases of family members pursuing their care with her. She sees many local family members at the high risk clinic, and more people are coming from off-Cape to receive their care at Cape Cod Hospital.
“Relatives need to be tested,” she said. “If a man or woman has the gene mutation, siblings need to be checked. We test first-degree relatives, and if they are positive, we keep testing second and third generations until we get negative results.”
To date, about 90 patients tested at the clinic have been found to have a genetic mutation for cancer and one-third have elected to have preventive surgery, she said.
“People are coming here from off-Cape because patients are telling their friends and family that they have a very good experience with us,” said Dr. Dalton.
She performs the bilateral prophylactic mastectomy (removes both breasts), and plastic surgeon Michael Loffredo, MD, immediately performs reconstructive surgery.
High Risk Breast Center Offers Genetic Counseling
Dr. Dalton explained that the High Risk Breast Clinic offers on-site genetic counseling, testing and comprehensive breast cancer risk evaluation. High risk determination is based on family history of breast and ovarian cancer and personal factors, such as age of first live birth, timing of menarche and menopause, hormone replacement therapy and many other factors. Most breast cancers are sporadic; approximately five to 10 percent are a result of a genetic predisposition, such as the BRCA 1 or 2 genes.
“Patients who inherit the BRCA 1 or 2 gene mutations have up to an 87 percent lifetime risk of developing breast cancer and up to a 63 percent risk of developing ovarian cancer,” said Dr. Dalton. “There are also other genes, less known by the public, that can cause breast and ovarian cancer. Patients who are identified as high risk for a genetic mutation can meet with a high risk specialist and be tested that day at our center.”
Test results typically come back in about a month, Kirsten said.
“Dr. Dalton gave me my results personally. She was surprised because my family history hadn’t suggested I would have the genetic mutation. I remember how understanding she was. She said this was traumatic news for my husband and me, but that she deals with this all the time. We were confident in her ability, and Dr. Dalton made our options clear,” she said.
Her sister said she also chose to be proactive.
“I decided I’d rather control the situation than have it control me. I decided to have the surgery now and be done with it rather than wait and maybe get cancer. I hated the idea of going back for tests again and again, year after year, just waiting to find out if we had cancer yet. After I made the decision, I was at peace with it,” she said.
Both sisters said it’s a huge relief to have the surgery behind them. Neither is looking back with doubts or regrets. Instead, they are upbeat and anticipating a healthy future.
“I want to share this story in case even one person is helped,” said Kirsten. “Even if you have a rock-solid family history, find out if you should be tested. Go to a doctor and genetic counselor who are qualified and do this all the time.
“I’m sore, but I’m fine,” she concludes. “It hurts, but I’ve had kidney stones and gone through childbirth. This is much easier! If you’ve gone through labor, you can handle having your ovaries removed and a double mastectomy. I am glad I did this.”
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