Going for A Walk

I took a walk this morning.  Later on, I’m going to a vinyasa yoga class.


I don’t work out because I want to reduce my breast cancer risk.  Until a few weeks ago I hadn’t really thought of exercise in those terms, to be honest.  But recent studies support that potential effect.


Three and a half years ago I learned that I have a BRCA2 mutation and thus a 45% or greater chance of breast cancer in my lifetime.  With medical support, I decided (as do the majority of BRCA+ women) to do high-risk surveillance rather than a preventive mastectomy.  Because of good screening tools and treatments for breast cancer, such enhanced surveillance gives a similar survival rate as does prophylactic mastectomy.


But with that 45% (or more) figure in my mind, it seemed to me that any lifestyle or environmental impacts on my risk were dwarfed in comparison to the inherited risk that my body naturally harbored.


Close surveillance, with mammogram/ ultrasound and breast MRI six months apart, could at best accelerate the detection of any cancer that might arise.  The risk level remained.   (I wasn’t ready then to consider chemoprevention, taking a drug like Tamoxifen to potentially reduce the odds of getting breast cancer, but have since started a five-year course of that medication).


I was  very aware however that though exercise hadn’t prevented my mother from getting either breast or ovarian cancer, her pre-illness fitness level made her much better able to cope with both diseases, especially the latter.


Mom’s ovarian cancer treatment four years ago started with a major abdominal surgery and she was in the hospital for quite some time, getting her lung capacity and strength back.   She went into the operation in good physical shape – she and my dad take daily walks and she hikes with a group of friends once a week.  If she hadn’t been so strong initially, I cannot imagine how much harder her post-surgical experience would have been.


Since that time, I do think about my mother as I get on the elliptical machine or walk the Lady Bird Lake trail.  I exercise at least partially with the goal of being in the best possible shape to cope with whatever illness (or emotional upset or other life challenge) may be in my future.  My Mom was a good role model there, as she is in so many ways.


But it seems I may be reducing my breast cancer risk as well.


A large American Cancer Society research study recently found that women who walked for at least 7 hours per week (generally 1 hour per day) had a 14% lower risk of developing breast cancer than those who walked less than 3 hours per week.


Not only that, but the group of women who worked out longer and more strenuously – 10 hours per week of vigorous exercise – saw an even greater reduction, with a breast cancer risk 25% lower than the least active group.


And another study coming from the University of Minnesota suggests a potential mechanism through which exercise might be impacting breast cancer incidence, through changing the ratio of estrogen metabolites.


Curious to read more?  see http://cebp.aacrjournals.org/content/22/10/1906.short




These were studies drawn from the general population, not specifically of women with BRCA mutations.  There is no guarantee that the same results would apply to our specialized tribe.


But I appreciate the idea that my walks, and my yoga and gym time, may be reducing my breast cancer risk.  It’s not why I do it, but as a potential side benefit it isn’t bad at all…


And yes, I’m going for a walk again, tomorrow.








Help Wanted

Learning that I carry a BRCA mutation, and thus subsequently am at high risk for both breast and ovarian cancer, brought a maelstrom of emotional baggage along with it.  Shock and confusion, in the early days.  Being me, I plunged into research, tying to learn everything I could about this topic.  Books, websites, materials from the genetic counselor…  That in turn resulted in emotional and mental overload.  I often fell into the dreaded downward Google spiral, overwhelmed by too much information flowing over me to properly process what I read.   Turning off the computer, the statistics and questions still ricocheted through my exhausted brain.


Looking back from my perspective now, three years later, what helped me get through that challenging time?  Other than the obvious (and very important) support of family and friends, that is.

First, talking with a genetic counselor was crucial and saved me from myself.  When I needed a respite from my over-active mind, I focused on their words and advice.

The genetics counselors said that for me – then 47– surgery to remove my ovaries and fallopian tubes (BSO) was the immediate priority.  So, focus on getting that organized and the rest could come with time.   Having just accompanied my mother on her wrenching ovarian cancer journey, seeing first hand the rigors of her treatment and recovery, they didn’t have to say much to convince me.

For my breast cancer risk, I had choices.  Either a prophylactic bilateral mastectomy (PBM) or a high-risk screening program.  Both were medically valid.  Both had pros and cons.  (More about the details of this decision to follow in a later post.)  I decided to do enhanced surveillance (breast MRI in June and mammogram/ultrasound in December.)  The genetics team also mentioned the possibility of chemoprevention, with tamoxifen or a similar drug, but I put that to the side for the time being.

Secondly, the genetics team referred me to two tremendous sources of support – a therapist who had experience working with BRCA issues, and FORCE (the national non-profit that supports individuals and families affected by hereditary breast and ovarian cancer.)

I met weekly with the therapist over about a five-month period.  I’d never had any therapy previously – perhaps I could have benefitted from it at times, but had never actually made it happen.  My experience was so positive that I would not hesitate to access similar help in the future when I feel the need.  Getting professional help and taking the time to process all the issues that come with a BRCA+ test result was tremendously empowering.

And last but not least, FORCE…  The website at http://www.facingourrisk.org/ provided a wealth of information.   To this day I refer to it often.  There are message boards where people share their questions and stories and support one another (though in the early days I found I could only dip my toe into those waters – if I went too far or too long it was overwhelming for me).  There are local FORCE support groups.  I signed up to get emails from the San Francisco Bay Area group, though with our relocation to Austin I never ended up connecting with them in person.  Several years later I attended the FORCE national conference with my husband, where I learned an incredible amount about state-of–the-art research results as well as connecting with many women facing similar issues.

Several years later into my BRCA journey, I discovered Facebook groups where I have found virtual – but very real – support.   I am grateful for groups like BRCA Sisterhood, Previvors, Beyond the Pink Moon, Learn About HBOC, and BRCA Advanced 101 & 102.


Now, three years and three months after getting the paperwork stating that I carry a “deleterious BRCA mutation,” I am far from the constant state of mental and emotional overload that I once inhabited.  Concerns and issues still arise, certainly, and this aspect of our genetic heritage will continue to affect me and my family into the future.   But I have made it through the initial days of wondering how – and whether – I could cope.

I know many women are out there, walking a similar path.  But sometimes the voices of those doing high-risk breast surveillance get lost in the shuffle, overshadowed by the complicated issues presented by the PBM option.  And sometimes the key issue of ovarian cancer risk is forgotten by the media, in discussions of this “breast cancer gene.”   So now I hope to provide the same support and informational help to others that I have benefitted from, in this land of “Elevated Risk.”