Families with cancer in their genes get clues to staying well from high-risk screening programs

DETROIT — Nancy Hearshen worries much more about her daughter's future than her own chances of getting breast or ovarian cancer.

Hearshen, 67, and her daughter, Rachel, 35, who live in Farmington Hills, Mich., carry a genetic mutation that significantly raises their risk of getting either type of cancer.

Nancy Hearshen chose to have her ovaries removed to cut the odds she'd ever develop ovarian cancer. She's weighing a double mastectomy as another safeguard.

Her daughter, a 1996 University of Michigan English literature graduate who has returned to school at Wayne State University to become a teacher, has chosen a different path. Rachel Hearshen is single and wants to have a family someday.

She undergoes tests every six months and exams several times a year to look for any early signs of cancer. She also takes the drug Tamoxifen, which has side effects including hot flashes, to discourage cells in her breasts from becoming cancerous.

"It's like everything changed from that day forward," she said of her Feb. 17, 2009, diagnosis of the gene mutation known as BRCA2. Her maternal grandmother and aunt died of cancer and most likely had the trait without knowing it; testing was largely unheard of 10 to 20 years ago.

Families like the Hearshens have new resources as they weigh difficult choices about preventive care. More hospitals are developing cancer genetics programs that offer the latest in mammography and magnetic resonance imaging (MRI) tests to find cancer early, as well as teams of surgeons, genetic counselors and doctors who help patients and their personal support teams make major decisions about the issues they face.

Some hospital systems, such as the University of Michigan, began their high-risk breast cancer programs as far back as 1994. Since then, the Breast and Ovarian Risk Evaluation Program has seen about 1,800 patients and expects more than 200 patients this year. Other programs, including the High Risk Breast Program at Beaumont Hospital in Royal Oak, Mich., opened this year. More centers are expected in the years ahead.

"In 2010, genetics is not research," said Whitney Ducaine, a certified genetic counselor at Beaumont. She's trying to spread the word about facilities that have comprehensive cancer genetics programs and their importance.