Genetic liklihoods drive screenings for breast cancer

Breast cancer is the second- most common cancer among women in the United States, according to the Centers for Disease Control and Prevention. One in eight women will develop breast cancer, which claims the lives of an estimated 43,600 women each year.

In September 2019, then-18-year-old Kelsey Knutson of Virginia decided to get screened. That might seem young, but Knutson knew it was time, due to her family history.

"My mom had breast cancer and my grandma had both breast and ovarian cancer," said Knutson. "It turns out there is a genetic mutation that runs in my family that puts me at high risk."

Knutson's older sister, Kaitlin, had been tested for the mutation a few years earlier. When it was confirmed that Kaitlin had it, Kelsey knew she was likely to as well. Her test came back positive.

The BRCA1 mutation is a cancer gene that is often inherited.

"People with the BRCA1 mutations have hereditary breast cancer, which places them at a higher-than-average risk for developing breast cancer as well as ovarian cancer," said Carolyn Olson, an advanced practice registered nurse in Essentia Health's breast health program. "On average, a woman carries a 12.5-percent lifetime risk of developing breast cancer."

The mutation doesn't mean Knutson has cancer, but at just 20 years old she has an 83-percent lifetime risk of developing breast cancer.

"I was in shock at first. I just thought this meant I was going to get breast cancer one day and lose all my hair," Knutson said.

Knutson immediately scheduled follow-up appointments with her providers at Essentia to determine the best path forward and how to reduce her chances of developing breast cancer.

They recommended a healthy diet, regular exercise and limiting alcohol intake.

"I think a lot of people would think this is a death sentence," Knutson said. "For me, it's really opened my eyes and helped me take control of my health care. It's also an eye-opener that has helped me really enjoy living in the present and focus on things that I enjoy."

For women at average risk, annual mammograms and clinical breast exams should start at age 40, according to the National Comprehensive Cancer Network.

"We also recommend breast self-awareness at any age, maintaining a healthy lifestyle of moderate exercise, keeping your body mass index below 25, smoking cessation and minimal alcohol intake," Olson said. "For persons that are high-risk, which is someone with a greater than 20-percent lifetime risk of developing breast cancer, depending on their age and other factors, they should have (an exam) every six months, an annual mammogram and an annual breast MRI."

For now, Knutson gets yearly breast exams and does self-examinations regularly. Upon turning 25, she will undergo yearly MRIs to monitor for cancerous growths and start her mammograms at 30.

"I would recommend taking care of your breast health to anyone," Knutson said. "It's better to keep an eye on things and catch them early than to wait for them to progress and potentially be more difficult to treat."

Because of advancements in treatment, the survival rate is much higher for breast cancer patients than it once was, especially if detected early.

"According to the American Cancer Society, on average, early detection of a Stage 1 breast cancer has a 99-percent five-year relative survival rate," Olson said.

"If you do have this mutation, don't be scared and make rash decisions," Knutson said. "Just take the necessary precautions, do routine screening and stay in touch with your doctor. Live life normally and freely. Yes, I was scared at first, but you can't go through life that way. It will only set you back."

Knutson is a junior at the University of North Dakota in Grand Forks. She is majoring in pre-med biology and hopes one day to attend medical school with an emphasis on genetics - a decision driven in part by her own family history.

"I wasn't interested in genetics until I found out I had this mutation," Knutson said. "It drives me to learn more about all genetic diseases and hopefully be able to help more people in the future."

When she's not at school, Knutson can be found hunting, snowmobiling or spending time with her large and tightknit family - things she enjoys now more than ever before.

"People feel sorry for me for having this mutation, but I don't think of it that way. It's allowed me to live a little bit more and push me in what I want to do in life and driven me to want to help people in my career when I'm done with college," Knutson said.

Signs and symptoms to look for include changes in the size or shape of the breast, lumps, a change in skin texture and more.

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Making screenings easier

Minnesota's U.S. Senate delegation of Amy Klobuchar and Tina Smith were among a group of legislators that introduced legislation recently to promote the use of preventive health care services, like physicals, mammograms and other cancer screenings, and routine examinations.

Studies have found that more than one in three adults reported delaying or forgoing health care because of coronavirus-related concerns. Other statistics show that the odds that a woman received a breast cancer screening were 20 percent lower in 2020 compared to 2019, and during the early months of the pandemic, health screenings for children decreased in frequency by 40 percent.

"Following my breast cancer diagnosis earlier this year, this issue is personal to me," Klobuchar said. "While I was fortunate to have caught the cancer at an early stage, that is not the case for many. As a result of delays in care due to the pandemic, doctors continue to see patients who have developed more serious conditions that could have been caught earlier."

The Preventive Care Awareness Act would:

• Award grants to states, territories, localities, and Tribal organizations to increase appropriate utilization and decrease disparities in preventive care services;

• Establish a task force to develop recommendations addressing preventive care access during the coronavirus pandemic and future public health emergencies; and

• Direct Health and Human Services to undertake a coordinated, focused public health education campaign to enhance access to preventive services.