Tag Archives : HealthFirst

Healthblog: Breast Cancer Genes – Your Questions Answered 1

Health First CMYKtI’m sure that most of you will have heard in the news over the last few weeks about Angelina Jolie undergoing a preventive double mastectomy because of her very high risk of developing breast cancer, having inherited a breast cancer gene from her mother.

One of Angelina Jolie’s aims when she went public with her story was to raise awareness about inherited breast cancers and to encourage women with a family history of breast or ovarian cancer to go to see their doctors to determine their own personal risk and to get help to make informed choices about how to manage this risk.

Her story has definitely raised public awareness – it’s got people talking and it’s got people asking questions – I’ve certainly been asked a few. I hope to be able to answer some of these questions here.

What are the breast cancer genes?

We know that some women carry a mutated gene that gives them a higher risk than normal of developing breast cancer. The genes BRCA1 (breast cancer gene 1) and BRCA2 (breast cancer gene 2) are the most common faulty genes but there are others. And it is possible to carry more than one faulty gene.

Just to explain, everyone carries the BRCA 1 and the BRCA 2 genes. They’re from a group of genes called ‘tumour suppressor genes’. These genes are there to help keep breast cells growing normally and to repair any damage to breast cells. It’s when the genes have mutations (or faults) in them that they don’t work properly and that the risk of developing breast cancer increases.

Just because you carry a faulty/mutated gene doesn’t mean that you’ll definitely develop breast cancer, but your risk is increased. And, the actual risk can be different for each woman. Angelina Jolie carries the BRCA 1 faulty gene and, on average, women who carry this faulty gene have a 65% risk of developing breast cancer. For Angelina Jolie, her doctors estimated that her risk of breast cancer was 87%. It’s a bit complicated but researchers think that other mutations (other faults) in pieces of genetic material, on top of the faulty breast cancer gene, can make the risk of breast cancer even higher in some women.

Some other important things to say are that if breast cancer does develop because of a faulty gene, then it tends to develop at a younger age. And, it’s also more likely to develop in both breasts rather than just one breast.

What’s the link with ovarian cancer?

Women who have a faulty BRCA 1 or BRCA 2 gene also have an increased risk of developing ovarian cancer. These genes are also involved in controlling the normal growth and repair of the cells in the ovaries – so again, if there is a mutation (a fault) in the gene, then this control can be lost. And, in the same women, the risk of colon, pancreatic, thyroid and melanoma skin cancer is also increased.

Men and the breast cancer genes

We know that men who carry the faulty BRCA 2 gene have an 80 times higher than average chance of developing breast cancer. This means that by the time they’re 80, the chance of them developing breast cancer is about 8%. Remember – breast cancer in men is less common than breast cancer in women.

If they carry the faulty BRCA 1 gene, then this actually increases the man’s risk of prostate cancer – they’re 7 times more likely to develop prostate cancer than men who don’t carry the faulty gene.

1+in+8+women_breastcancerIs breast cancer always due to faulty genes?

Breast cancer is one of the most common cancers in the world. A woman’s lifetime risk of developing breast cancer is around 1 in 8.

Most breast cancers, however, are not due to genetics – they don’t develop because of the woman carrying faulty genes. Genetics are involved in only around 1 in 20 women with breast cancer.

“Lifestyle” factors for breast cancer include:

  • Increasing age – most breast cancers occur in women over the age of 50. For every 10 years of increasing age, the chances of developing breast cancer roughly doubles.
  • Being overweight – especially if you’ve already gone through the menopause.
  • A lack of regular physical activity in your life.
  • Regularly drinking alcohol over the recommended limits.
  • Not having children, or having your first child when you’re over the age of 30.
  • Not breastfeeding (every month of breastfeeding lowers risk in the mother) or not having BEEN breastfed (every month of breastfeeding or human milk consumption lowers risk in the BABY).  To read more on this topic, visit the page Breast Cancer and Breastfeeding.
  • Taking hormones – it’s a bit complicated but your risk of breast cancer may be slightly increased if you take the combined oral contraceptive pill over the age of 35 (that’s the pill containing both oestrogen and progesterone). And there’s also a slightly increased risk of breast cancer if you take hormone replacement therapy. Combined HRT (HRT containing oestrogen and progesterone) carries a higher risk than oestrogen-only HRT. And the risk increases the longer you’ve been taking the HRT. When you haven’t taken HRT for five years, then your risk of breast cancer drops to that of a woman who has never taken HRT.

And I’m sure that there are other risk factors involved that we don’t yet know about – or that we may never know about.

If I carry a faulty breast cancer gene, what’s my risk of passing it on to my children?

If you remember, you inherit half your genes from your mother and half your genes from your father. So, if you carry a mutated/faulty breast cancer gene, there’s a 50:50 chance that you’ll pass it on to each child that you have. This means that if one of your family members has a mutated/faulty breast cancer gene, all of the family members will not necessarily have inherited it.

And, just to say, that both men and women can carry the breast cancer gene and so can pass it on to their children.

I have someone in my family who has had breast cancer. How do I know if it was due to a faulty gene?

Breast cancer is common. So people will often have someone in their family who has been diagnosed with the disease. But, if there is a history of breast cancer in the family, it won’t usually be because of faulty breast cancer genes being passed on through the generations. Most of the time, the breast cancer in the family will have occurred by chance, perhaps under the influence of some other breast cancer risk factors that we’ve talked about.

The risk of breast cancer in your family having been caused by a faulty gene (being a true hereditary breast cancer) becomes greater if:

  • You have blood relatives (mother, grandmothers, sisters, aunts) on either your mother’s side of the family or your father’s side of the family who developed breast cancer before the age of 50.
  • There is a history of both breast and ovarian cancer in the family, particularly if these cancers occurred in one person.
  • Any woman in your family has developed breast cancer in both breasts.
  • A man in your family has had breast cancer.
  • You are from a certain ethnic background – for example the Ashkenazi Jewish community.
  • You have a number of relatives who have had breast cancer. The more relatives that are affected in your family, the greater the chance that genetics are involved.

The bottom line is, if you are worried that breast cancer may run in your family, go and talk to your doctor. Try to map out a family tree before you go and mark on it the relatives who have had breast cancer. Your doctor will be able to discuss your risk with you. They may refer you on to see a specialist for genetic counselling and assessment.

If a woman is found to carry a faulty breast cancer gene, what will happen?

Remember, it’s still not certain that you will develop breast cancer if you carry the faulty gene. You can look at other risk factors for breast cancer as well and try to minimise those – like the lifestyle risk factors that we talked about: try to maintain a healthy weight and eat a healthy diet, try to do plenty of physical activity, don’t drink too much alcohol and don’t smoke.

But also more frequent screening for breast cancer is usually advised – you can develop a screening plan with your doctor – we’re talking about breast examinations, mammograms and other scans like MRI scans starting at a much earlier age, and happening more regularly than would be usual for breast cancer screening.

Various hormonal therapies may also be considered and they may help to reduce the risk of developing certain breast cancers in some women who carry the faulty breast cancer gene.

And then, there is the option of ‘protective – or prophylactic – surgery’ like Angelina Jolie has had. Basically removing the healthy breasts (the breast tissue) and so removing the risk of cancer developing to a large extent. We know that prophylactic breast surgery (a bilateral mastectomy) can reduce a woman’s risk of developing breast cancer by about 97%. The surgery can’t remove every single cell of breast tissue so that’s why it’s not a 100% reduction in risk.

Surgery to remove the ovaries may also be discussed because of the risk of developing ovarian cancer. In Angelina Jolie’s case, she says that she started with the breast surgery because her risk of developing breast cancer was higher (87% compared to 50% for ovarian cancer) and also because the breast surgery is more complex.

Regardless of any family history of breast cancer, every woman should be ‘breast aware’

As a woman, you know your body best and you are the person who is likely to notice any changes in your breasts that may indicate possible breast cancer. In particular, you need to look out for:

  • Changes in breast size or shape.
  • Changes in the texture of the breast skin like puckering or dimpling of the skin.
  • A nipple that becomes inverted (turns in on itself).
  • A lump or thickening that you can feel in the breast.
  • Redness or a rash on the skin of the breast or around the nipple.
  • Discharge from one or both nipples (unless pregnant or breastfeeding).
  • Constant pain in a breast or in one of your armpits.
  • A swelling that develops in one of your armpits or around a collarbone.

If you notice any of these changes, then don’t wait, go and get it checked out by a doctor.

And also, if you are worried about your risk of breast cancer because there is a history in your family, again, go and talk to your doctor. In Switzerland, your gynaecologist is probably the best person to talk to.  Your gynaecologist may refer you to the Breast Centre at the Hopital Universitaire de Geneve (HUG) or the Breast Centre at the Centre Hospitalier Universitaire vaudois (CHUV) where a multidisciplinary team is available including genetic specialists as needed.

The Swiss Cancer League also have also produced an information leaflet in English about breast cancer which has some useful contact details. The Federation Suisse des programmes de depistage du cancer du sein has also published a leaflet in English.

And finally, if you are a newly arrived expat or if you’ve been here for a while and just want to learn more about how things work in Switzerland from a health perspective, including where to turn in case of a cancer diagnosis, then try the HealthFirst Expat Health Seminar, listen to Health Matters on WRS, or read the Healthblogs here on MiV

To close, let’s use Angelina Jolie’s story as it was intended – as an opportunity to stimulate conversation and raise awareness about breast cancer.

Blog Originally Published 23.05.2013 by Dr Michelle Wright
Adapted for Moms-in-Vaud 23.05.2013

Have you or a loved one been touched by Breast Cancer?  How did it affect you?  How did you find support as an expatriate?   Share your story below or read other mother’s stories of cancer from our blog.

Healthblog: Beware of the marching caterpillars

I knew nothing about these creatures before moving to Switzerland. The first I learnt about them was when a friend developed a skin rash because of them.

Marching caterpillars are usually somewhere between 3 and 4 centimetres long and they’re covered with thousands and thousands of pointed hairs. There are two types: pine and oak. The pine marching caterpillars have a darker body. You can clearly see the hairs sticking out from their body and you can see a rusty colour running along their back. The oak marching caterpillars again have a darker body but this time you can see a slightly yellower colour running along their back.

They’re called ‘marching caterpillars’ because they literally move along in single file behind each other – in a procession. In fact, they’re also known as ‘processionary caterpillars‘, so you might have heard that term as well. In French, they’re called ‘chenilles processionnaires‘.

If you’re interested in their life cycle, what happens is that the Pine and Oak Processionary moths lay their eggs during the Summer months. They lay them on twigs and small branches in the tree canopy. The eggs stay there over winter (they have a protective layer to protect them from the cold weather). Then the larvae start to hatch from the eggs in the Spring. The larvae are the caterpillars.

The caterpillars are highly active during the Spring and Summer. They live in the Pine and Oak trees and form colonies, creating large nests in the trees that look a bit like cobwebs or candy floss/cotton candy. It’s when they’ve run out of the food from the tree that they’re living in that they come down from the tree, all at once, all together in a long single file, following each other head-to-tail. They’re basically on the move to find another tree to set up camp in, looking for somewhere to pupate (to go through their pupal stage so that they can transform – undergo metamorphosis – into their adult form, the moth).  So, you can often see the caterpillars marching along in their single file procession and they can cover large distances along the ground.

The caterpillars mature and develop over a period of about 9 to 12 weeks and they pupate inside their nests during the end of June/beginning of July and the adult moths emerge 1 to 2 weeks later. They lay their eggs and the life cycle is completed.

So what problem can they cause for humans? The problem is that the caterpillars are covered in hairs and these hairs contain a toxin that is highly irritating to humans. The hairs can break off from the caterpillars very easily and can become airborne easily as well – they can be carried on the wind. If your skin comes into contact with the hairs, then they can cause an irritating, itchy skin rash. It’s like small, red, slightly swollen bumps on the skin. It might only last for a few hours but sometimes the skin rash can become scaly and eczema-like and last for a few weeks. If you breathe in some of the airborne hairs, then this can lead to breathing problems – wheezing, and difficulty breathing, particularly in people who already suffer from asthma. And the hairs can irritate the eyes causing an irritant conjunctivitis – irritation, itchiness and redness of the eyes.

The degree of symptoms can vary from person to person. Not everyone who comes into contact with the caterpillar hairs will develop symptoms. Some people don’t have any problems at all. They don’t react to the hairs. The most common problem is the itchy rash. Yes, it’s unpleasant but it’s not serious or life-threatening. However, if someone already has asthma and they inhale the hairs, then there is the potential to spark off an asthma attack which can be severe in some people. And I believe that a severe allergic reaction (an anaphylactic reaction) has been triggered in some people who have come into contact with the caterpillar hairs.

If you come across the caterpillars in a tree, or on the move in their procession, the first thing that I would say is that you should try to stay away from them as much as possible – avoid the area. And avoid any trees where you can see the cobweb or candy floss like nests. If you see the caterpillars on the ground, certainly don’t handle them in any way.

And keep children and pets away as well. Explain about the caterpillars to your children – teach them to stay away if they see them – they’re probably quite attractive, interesting-looking creatures to children – some of whom love picking up creepy crawlies when they’re out and about exploring.  Show them a picture so that they know what to look out for and tell them not to touch them or go near them.

If you’re worried that there is a colony in one of the trees in your garden, then you should contact your commune to get the nest removed. DO NOT try to get rid of the nest yourself. Even when the nests are empty, they can still contain large amounts of the caterpillar hair and that’s the toxic stuff. They’re full of hair because the larvae (the caterpillars) moult inside the nest, casting off their skin and their hairs, causing them to accumulate. If you try to knock down or disturb a nest, then this can make the hairs airborne and easy to inhale.

If your skin does come into contact with the caterpillars or their hairs, then you need to remove them as soon as possible. If available, to protect the skin of your hands whilst you’re doing this, put on a pair of kitchen gloves or a pair of gloves from your first aid kit.  Afterwards, like you would when practicing basic first aid, wash your hands.   I would also suggest washing the affected area of skin with copious amounts of soap and water. Any rash can be treated with antihistamines – either in cream or tablet form – you can go and discuss the rash with a local pharmacist, or of course, see your doctor if you’re worried.

What to do if you think you have inhaled some of the hairs and you develop breathing difficulties? Anyone known to have asthma already should always carry their reliever inhaler with them when they’re out-and-about. This is an inhaler containing a drug that helps to dilate up the airways and so help relieve the wheezing and breathing symptoms. So, if you have a salbutamol inhaler prescribed already, then take it. If you don’t already have an inhaler prescribed, then it depends on how severe your symptoms are. Obviously, anyone with very severe symptoms should see a doctor or they may even need to call an ambulance in extreme cases. Then, medication can be given by the doctor to help relieve the wheezing and breathing problems.

So, marching caterpillars – what they look like, why you need to stay away from them and what to do if you haven’t managed to!   Share this with your friends/family or share the podcast of the Health Matters show from WRS.

Health First CMYKt

Blog written by Dr Michelle Wright (10.05.2013) Medical Director, Health First
Adapted for the MiVblog 15.05.2013 by expatparent CH

Want to learn more about basic first aid and when to call a doctor?   Read the Healthblog’s here on MiV or try out a first aid class.