BRCA2 & Breast Cancer Risk

 

The following article features in Issue One of the ST BREAST magazine.

After her Mum was diagnosed with ovarian cancer in early 2019, 35-year-old communications executive and mother of three Nina Bosco underwent genetic testing. Similar to her mum, her test came back positive for the BRCA 2 gene, dramatically increasing her own risk of developing breast or ovarian cancer. For Nina, it was a ‘nobrainer’ to undergo a double mastectomy as an initial step to mitigate the risk of developing cancer due to the BRCA2 gene mutation. In a few years, she will also have her ovaries removed. She says in the months leading up to her surgery and throughout her long recovery, her employer – the National Australia Bank – was “fantastic”, allowing her to work flexibly as required.

“I have always been loyal to my employer and the NAB brand, but it has definitely gone up another level after this arduous experience and the wonderful support I received from my colleagues and senior executives within the bank.”

“This all started in December last year. We went out to lunch and my Mum could not finish her food. She felt full really quickly and she was bloated. The bloating specifically had been going on for a little while, but she had put it down to menopause. I pushed her for a pelvic ultrasound, which is when we made the unlikely discovery.

One of her ovarian tumours was 23-centimetres– it was enormous! A second tumour was six centimetres. She has had chemotherapy – a combination of intra-peritoneal and intravenous - and has no disease any more. She is continuing on therapy for the next few years to try and keep her cancer in  remission.She has been an absolute hero. Even her team of oncologists think she is such a trooper.

Genetic testing was recommended for my Mum straight away - the day after surgery in fact, when they removed all of the visible cancer.

The alarm bells went off because Mum’s aunt in Greece has ovarian cancer, another aunt had developed and died of breast cancer in 1983, my grandmother had colon cancer and Mum’s brother had prostate cancer. So four out of four siblings, with three exhibiting the “typical” pathway of a  BRCA2 mutation – breast, ovary and prostate for men.

Even before I knew I carried the BRCA2 gene, I had always been very vigilant with my breasts. My GP would call it hyper-vigilant. Not only regular breast ultrasounds, but six-monthly clinical examinations and also a mammogram for the first time at 34. I always had this deep feeling. While breastfeeding my son Lucas almost 9 years ago, I even met my now amazing breast surgeon Elaine – she assured me the lumpiness while feeding was completely normal.

Once I was tested and the result was positive it really was a nobrainer. I just thought, ‘they are definitely coming out’.

For me, my breasts have done an amazing job feeding three wonderful children, including twins. I was fortunate that my husband and I completed our family in our twenties.

Mum feels awful, but truly she has saved me. For ovarian cancer management, the best way to mitigate risk is to remove the ovaries and fallopian tubes. For BRCA2 this should occur well before the age of 50 when the risk escalates dramatically; for me, this will happen by age 45. Until then, I have to stay on the contraceptive pill to suppress ovulation, because halting that process every month is protective.

Work

My Mum and Dad do a lot of caring for my three sons alongside my in-laws, so life became a bit chaotic juggling work and kids after she was diagnosed.

I’m very lucky to live super close to my parents and next door to my parents-in-law, so we worked out a new rhythm with the diagnosis.

My employer, the National Australia Bank, has been fantastic. I’ve worked at NAB for 12 years, and they’ve seen me through a wedding, and three babies – including a tough twin pregnancy!

Since everything happened, I have worked flexibly and worked a lot from home. It is fantastic that in this day and age you can manage to keep working through these sorts of life events. It keeps your mind off the hard stuff and keeps you mentally busy.

And at the end of the day, we are all adults and there are so many ways to work remotely and stay on top of things. So long as the work gets done, that is what counts.

It might be different if I worked for a small company but NAB is a big employer and they have progressive and innovative workplace policies that are really designed to look after their people. This sort of flexibility is not just for health matters; it’s time to look after elderly parents or even taking time for mental health.

It’s just nice to know they have your back during the tough times.

 

The Future

As for my three boys - Lucas, Christian and Alexander - they will be tested for the BRCA2 gene at 18, when they are old enough to deal with what it means for them. They have a 50:50 chance of carrying the gene, so it’s essentially like flipping a coin.

Should they test positive for BRCA2, they are at an increased risk of male breast cancer, prostate cancer as well as melanoma and pancreatic cancer (which is similar for women who carry the gene). I know there will be more screening and trials and ways to look after people like us, particularly when it comes to pancreatic cancer, so I try not to dwell on that too much as the research is still so new.

It’s actually quite comforting having a gene that has been so extensively researched and continues to be. So many people have strong family histories of cancer, and their gene mutation has still not been discovered.

BRCA2 isn’t the end of the world; it just means being more vigilant about your health, not fearing doctors, and really taking care of yourself.

Nina

*Nina has since had a successful prophylactic double mastectomy with reconstruction, and all breast tissue was deemed benign. She is now recovering  at home after the six-hour surgery, and looks forward to returning to NAB in full health later this year.