Just a year ago, on February 22, 2014, Marian and Andrew Strider celebrated
their wedding. Like most couples, they began their first year of marriage
with joy and anticipation. But, during the same period, they were to face
some very difficult decisions concerning Marian’s health and their
hopes and dreams about children.
The couple knew Marian has a strong family history of cancer. Her mother
died of breast cancer, and her mother’s two sisters have both been
treated for the same disease. There was a good possibility the sisters’
cancers were genetically linked and that Marian might carry the gene mutation.
That would measurably increase her risk for ovarian, breast and colorectal cancer.
Marian decided she should seek genetic counseling to confirm the possibility.
As an engineer at Tesla Motors Inc., where she and Andrew work, she is
adept at making clear decisions based on an analysis of critical information.
Yet, Marian made her determination to have genetic testing with mixed emotions.
“For me, it was a ‘no-brainer’ to get the test, based
on what we knew about my mother and aunts,” she said. “But,
it was still not an easy choice. Many of us might prefer to remain ignorant
of the fact that we have a markedly higher risk of cancer. But, I made
peace with the idea.”
Marian and her husband thought long and hard about what the test results
would mean to her and her family. What would she do if the mutation were
found? What would it mean if there was no mutation? And, how would the
information affect other members of her family, particularly her sisters?
Once Marian and Andrew decided to move forward, they turned to Washington
Hospital’s Cancer Genetics Program, which is affiliated with the
highly respected UCSF Medical Center in San Francisco. Based on the results
of blood testing, the program provides clients with a comprehensive risk
assessment, including a complete personal and family medical history,
to assess for cancer risk and possible predisposition for carrying a cancer gene.
A wide range of cancers is considered, including breast and ovarian cancer,
colorectal cancer, adrenal cancer, and certain types of thyroid and brain
cancer. Once a month, during a full day clinic in Fremont, clients meet
with a specially trained genetic counselor from UCSF to discuss test results
and risk management strategies.
“When clients come here at a fairly young age, as Marian did, they
can often get tested before the cancer occurs, and we can help them reduce
their risk,” explained Laura Constantine, RN, nurse navigator for
the Washington Women’s Center, which works closely with the genetics program.
“We are able to meet with people, provide education and start screenings
earlier, if needed, all right here in the community. Having academic-level
services like those from UCSF here in the Tri-City Area is a great benefit
to people who live and work here,” Constantine continued.
If testing confirms the client is at higher risk for cancer, medical oncologist
Vandana Sharma, MD, PhD, the program’s medical director, works with
them and their primary care physician to identify risk management strategies
tailored to their needs.
Before her first appointment, Marian educated herself about genetics and
its role in causing cancer. When her test results came back, it was confirmed
that she does carry a genetic mutation. Together with the genetic counselor,
she and Andrew weighed the options.
“At my age, and with our plans to have a family, we decided to take
a less radical path at first,” stated Marian. “We don’t
need to rush our decisions about prevention and treatment. Technology
continues to advance, and there may be more options in the coming years.”
So, for the next few years, Marian will be monitored closely for signs
of breast and ovarian cancer through screening and exams. The couple is
also going forward with plans to have a baby. In an effort to avoid passing
the gene on to their children, they have decided to use in vitro fertilization,
so the embryo can be genetically tested.
In another five years or so, Marian expects to have her ovaries and breasts
surgically removed. This will reduce considerably her chances of getting
ovarian or breast cancer.
As Marian and Andrew prepare to celebrate their first anniversary with
a trip to Switzerland, they feel at peace with the decisions they’ve
made for themselves and their family.
“Overall, we’re very happy about the path we are taking, and
we are grateful for the expert guidance we’ve received in making
our decisions,” she concludes.
Learn more. For more information about the Washington Genetic Counseling
Program, go online to www.whhs.com/cancergenetics. To learn more about
Washington Women’s Center, visit www.whhs.com/womenscenter. To reach
Laura Constantine, RN, the Women’s Center’s nurse navigator,
call (510) 608-1356.