Researching, Filming & Drawing Cancer

The Chicago Tribune has published several interesting stories on breast cancer this week — none of them about the color pink. First up is a front-page story on a new DNA test that may reveal a woman’s “odds” of developing breast cancer. Judy Peres writes:

The test doesn’t check for mutations in the rare BRCA genes that dramatically increase cancer odds –which is often recommended for families with a lot of breast or ovarian cancer. Rather, it looks for more common genetic variations that its developers say occur more frequently in breast cancer patients than in healthy women. The producers of such tests argue they help identify people more likely to get a disease and allow them to take action to reduce their risk. But experts say finding an association between genetic variations, or polymorphisms, and breast cancer is only the first of many steps needed to show that those variations can predict risk in healthy women. Risk prediction tests based on DNA analysis are the newest development in a rapidly growing field. Genetic screenings — many available over the Internet — range from tests for genes known to cause specific diseases to pseudoscientific products that claim to tell consumers which nutritional supplements will keep them healthy. Critics say some companies are exploiting consumers’ anxiety to sell them expensive tests they don’t need — products that cater to the “worried well” who can afford to pay.

The OncoVue breast cancer risk test was supposed to go on the market last spring — at a cost $647 per test — was delayed by the FDA which is now allowing the test to be sold at a discounted price of $397 to 12,000 women taking part in a study. The test, which uses DNA from a woman’s cheek cells, looks for genetic variations called SNPs (single nucleotide polymorphism) and then adds in other potential risk factors, like age and family history of breast cancer. A computer crunches the data and produces a risk number “displayed as an absolute percentage and also in comparison to the average risk of women in her age group,” writes Peres. Dr. Kathy Albain, director of the breast research program at Loyola University Medical Center, told the Trib: “An individualized ‘risk profile’ based on common polymorphisms is extremely premature … It is likely that this information will either give women a false sense of security or else increase anxiety needlessly.” Craig Shimasaki, CEO of InterGenetics, which manufactures OncoVue, said data showing the validity of the OncoVue test has been gathered but has not yet been published. The Trib also published that same day a story about a 24-year-old woman with a family history of breast cancer who learned she inherited the genetic mutation that put her at increased risk and therefore chose to have a double mastectomy. Women who test positive for the BRCA mutation “have the power of information but face difficult decisions,” writes Bonnie Miller Rubin. “They are at much higher risk for breast cancer — between 56 and 87 percent will get the disease during their lifetime, according to the current issue of Journal of Clinical Oncology — and tend to develop a more lethal form at a younger age.” Worried over her odds, Lindsay Avner chose surgery.

“I took away the ticking time bomb,” said Avner, one of the youngest patients at New York’s Memorial Sloan-Kettering Cancer Center to elect to remove two healthy breasts. A decade after it became possible to test for mutations in the BRCA1 and BRCA2 genes, experts remain divided on what to do with a positive result. Is mastectomy a pre-emptive strike that reduces risk and anxiety? Or a premature overreaction with permanent consequences? “There’s no question that these women are pioneers — and heroes,” said Dr. Patrick Borgen, Avner’s surgeon.

The story also notes that a documentary called “In the Family” is slated to be released next fall about this first generation of women who have access to genetic information about their risk of breast cancer. Filmmaker Joanna Rudnick, who tested positive for the gene mutatation when she was 27, told the Trib, “How an individual woman experiences it is influenced by her family, her history, her place in life and her values.” At FORCE: Facing Our Risk Of Cancer Empowered, Rudnick discusses going public with her story. Finally, the Trib reprinted from Newsday an abbreviated version of Stephanie Zacharek’s review of “Cancer Vixen: A True Story,” a memoir documenting cartoonist Marisa Acocella Marchetto’s 11-month-long battle with and triumph over breast cancer.

Marchetto’s drawings aren’t exactly detailed, and they sometimes look a little rushed. But their casualness suggests an immediacy that suits the material. Marchetto details even the most frightening aspects of cancer with wry humor: When a doctor aspirates her tumor to “see if the cells are angry,” she draws them – with the legends “possible cancer cells, an artist’s rendition” and “magnified 3 gazillion times” – as perverse, irate smiley-faces, sticking their tongues out at her. (Each face also has one long arm growing out of it, at the end of which is a hand with the middle finger extended.)