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Attending a genetic counseling appointment is not on the agenda of the average college student, but for Brooke Stewart, it was the most important item on her calendar. With a family history of breast cancer, she knew that her risk was higher than most, and that the key to the battle is to know what you’re facing.

Brooke’s mother Alycia was on her side. Alycia’s father tested positive for a BRCA1 mutation, and after Alycia battled breast cancer twice, she fully supported her daughter’s choice to get tested. Brooke herself was confident despite her fear. “It didn’t really scare me that much. My friends at school will say, ‘I don’t want to get tested – I don’t want to live in fear.’ But I tell them the opposite. I want to know, because then I can take action sooner than when it’s too late.”

genetic testing storyWhen it comes to genetic testing and the BRCA1 and BRCA2 genes, there are plenty of misconceptions. Tiana Pallister, Licensed Certified Genetic Counselor, is always quick to address them. “Everyone has the BRCA1 and BRCA2 genes. They’re what we call tumor suppressors and, in a very simplistic sense, they help suppress uncontrolled cell growth and act as built-in defenders against cancer.  If someone is born with a genetic mutation in one of those genes, causing it not to work correctly, their bodies are left with fewer defenses against cancer, and they have a genetic condition called Hereditary Breast and Ovarian Cancer syndrome (HBOC). Both males and females with HBOC have an increased chance to develop cancer, and the condition can be passed on from both males and females.”  Tiana also clearly outlines what risks are present, “HBOC significantly increases the chances of developing a variety of cancers; including breast cancer (in males and females), as well as ovarian cancer, pancreatic cancer, prostate cancer, and a slightly elevated risk of melanoma (which is a skin cancer).”

Though the risks of this condition are intimidating, information from a genetic test can provide the opportunity to take proactive measures, which can be life-saving. Even for those who already have a diagnosis or history of cancer, genetic testing can still impact their healthcare decisions, such as what treatments they may be eligible for.

Brooke first attended a pre-test session with a genetic counselor where she reviewed her family history and received a blood draw, and within two weeks she had her answer. She tested positive for a mutation in the BRCA1 gene, a result consistent with a diagnosis of HBOC. However, she wouldn’t face the risks alone.

During her debrief session, the genetic counselor connected Brooke to all kinds of resources and programs for preventive care. “Now that she’s been tested, they’ve set her up on everything,” Alycia explained, “She does genetic counseling. She meets with a nutritionist twice a year. They taught her how to do self-exams every couple of months. They set her up for success.”

Brooke reacted to the news with courage. “It was scary, but knowing that I have so many resources made me a little less scared. Knowing that I have it and that I’m doing what I can to prevent it – that’s the best thing I can do.” She has already made some lifestyle choices that will benefit her, such as changing her campus housing so that she can have her own kitchen in which to cook healthy meals. She has also committed to exercising and taking advantage of the offered screening measures, such as mammograms, in the years to come.

For those like Brooke who have an increased risk of developing cancer, it is also very important to be followed closely by a provider. Dr. Carrie Thompson, board certified Nurse Practitioner, runs a high-risk breast cancer screening and surveillance clinic at Logan Health. “The ultimate goal of this type of clinic is to prevent cancer or to detect it at an early stage,” she says, “In this clinic, patients undergo a breast exam every six months. During visits, we also spend time reviewing their physical symptoms and any other concerns they may have. We order and review breast imaging, and we also set up breast biopsies when needed. If appropriate, we offer some patients risk-reducing medications.” Patients at the high-risk clinic receive lifelong access to streamlined and comprehensive care, since the clinic works closely with the Logan Health Breast Center and the breast radiology department.

With this high-level monitoring, patients like Brooke can choose which risk-reducing measures they are comfortable with. “Person-centered care,” Carrie says, “that’s what the surveillance is all about.”

As she decides her own preventive measures, Brooke now advocates for genetic screening and is taking opportunities to help the breast cancer community.  Coincidentally, she has also come full circle to her family’s story. For a school project, she collaborated with the Kalispell initiative Save a Sister, an organization that Brooke’s grandmother Susan helped start during Alycia’s cancer journey. Save a Sister has helped launch and sustain the high risk screening program at Logan Health, with a mission to improve women’s access to screening mammography. They also educate the community and promote breast cancer awareness and prevention through outreach activities across Montana. Brooke’s project involved creating a marketing communications plan for the program, and her ideas have helped Save a Sister find new ways to reach women about cancer screening measures.

From school projects to campus conversations, Brooke is now sharing her story to help others find strength. After facing her fears, she encourages others to do the same: “Be brave and go get tested!”