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Tuesday, December 1, 2009

Genetic Testing

There are probably many reasons I'm so successful teaching GSW 1100 students, some of the weakest students at BGSU, but clearly one reason is that I understand their need and ability to procrastinate.

I had my blood drawn today so that I can be tested for the "Cancer Genes" BRCA 1 and 2. This is billed as a pretty big deal, a pretty important, heavy decision. So important, that two weeks ago I was supposed to watch a dvd about it. I didn't. When I found out about the "cancer gene," it never crossed my mind that I wouldn't be tested for it. It seemed like such a no-brainer I just couldn't carve out 20 minutes to watch the dvd.

I was taken slightly by surprise today when I got my shots and the nurse suggested I "just go next door and get [my] bloods done." I wasn't expecting to have blood drawn and was clueless until she said it was for the genetic tests. Oops! I signed all the consent forms, thinking that if I hurried home and watched the dvd, I could always cancel the tests later:) Really, I didn't think it was a big deal (other than financially). After all, what's the worst that could happen? I'd be positive and uninsurable? I'm uninsurable now. At this point, I have so many pre-existing conditions, every person in my family has significant pre-existing conditions, that we are all uninsurable.

The dvd starts out talking about how serious the decision to get tested is. And I sat there for 20 minutes thinking, "If this is the most serious decision some people ever make, they need to get a life." I think I pondered birth choices more.

Simply put, 60% of women with BRCA 1 or 2 mutations will develop breast cancer as compared to about 12% of the general population. Twelve percent isn't that big of a risk, but I'd be buying lottery tickets if I thought I had 60% chance of winning anything. Breast cancer isn't a prize, though.

Among the general population, about 1.4% of women will develop ovarian cancer. Among BRCA positive women, 15-40% will develop ovarian cancer.

The BRCA gene also indicates an increased propensity for other cancers as well: cervical, uterine, melanoma, gall bladder, prostate, pancreatic, and testicular cancers.

To my way of thinking, cancer isn't like Huntington's Disease, for instance. There is no real treatment for Huntington's. Huntington's is progressive. It happens, and although the time line isn't clear, the outcome is. I can understand why people who might be at risk for degenerative, fatal diseases like Huntington's, may not want to know if they have the gene.

On the other hand, with the BRCA gene, there are specific actions that can prevent certain cancers from forming. Ovaries can be removed, for instance. Breasts can be removed. Hypothetically, had I known in my 20s that I had a 60% chance of developing breast cancer, I'd have done a lot of things differently. I'd have had my children earlier and closer together, for instance. I'd probably have stopped at age 28, regardless of how many kids I had. And then I'd have had a double mastectomy, no questions asked. If I find out next month that I'm BRCA positive, my ovaries will be gone, no questions asked. If they aren't there, there is less chance of ovarian cancer. Total hysterectomy would be my choice. Seriously. Why would I want to hang on to a potential death sentence? One time when I was talking about this, a well-intentioned friend suggested that removing my "female" bits and pieces would negatively affect my sex drive and sexual feelings.

Excuse me while I roll on the floor laughing.

Happy sex vs.'s a damn no brainer. No one is getting to experience my bits and pieces these days! Bald and bloated, vacillating between constipation and diarrhea, too tired to move, and in a fair amount of pain...I'm thinking that my happy sex days are in the past for now. To his benefit, my husband hasn't taken advantage of all the drugs I'm taking to take advantage of me:) Between the chemo brain, vicodin, ambien, codeine, and general physical degeneration, I'm the next best thing to a drunken sorority girl some nights. Even my kids know to remind me of what we've discussed after 9 pm.

If I'm BRCA positive, I'll certainly figure out a way to get at least a full hour of exercise each day for the rest of my life. I'll have justification for many more screenings. Doctors will take me more seriously. My children will know whether they should get tested or not, and make that decision early in life. They can use that knowledge to guide their lifestyle choices. They can use that knowledge to help choose a partner.

So, I'll keep you posted.

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