Cancer in the third generation

News

When Anita Wanngren was told she had breast cancer, her mother and grandmother had already died of the same condition. Soon she was having conversations with relatives she had not seen for years in order to pass on the bad news.

When Anita Wanngren was fifty-three, she found a lump in her breast. According to the radiologist, who had not considered Anita's family history to be at all special, the mammogram from just six months before had not shown any traces of cancer.

"As a hard-working and professional woman, I of course went by myself to the Breast Centre, where all the investigations were performed that same day. It was fine, but I wasn't prepared for getting the results back so quickly.

The lump was cancer and it had spread to the lymph glands." Although Anita had thought herself prepared, the news came as a shock. After the weekend, when her thoughtful family members had gone back to their jobs and schools, the anxiety and thoughts of death flooded in.

"If I could wish anything from the health system, it's that they are there at times like this."

Instead it was a priest who saw her and listened to her.

Family investigation

A family investigation of Anita's cancer was started, but fortunately neither of her two sons had inherited her BRCA2 gene.

Anita Wanngren, who has a mutated BRCA2 gene, has undergone treatment for breast cancer. She is also a patient representative both at Karolinska and regionally.
She underwent surgery, received treatment and is now healthy, but she still attends check-ups due to a high risk of another cancer occurring. Anita Wanngren was advised to have her ovaries and fallopian tubes removed, which she accepted, but she has decided to keep her breasts.

"I don't tolerate antibiotics, and so any surgery involves some consideration. Every procedure is a risk," she says.

Anita also understood that she needed to call up her relatives to inform them that they were at risk of developing the same type of cancer. She had not seen some of them for years. She was given a letter to send to her relatives that would make it easier for them to have their own investigation.

"You don't have to get in touch with people and let them know, but it is something the health service encourages. It was difficult, of course. My relatives reacted really differently," she says.

Genetic cause

Familial cancer is more common than you might think, but there is inconsistency in the level of knowledge within the Swedish health system. About ten percent of all cancers have a genetic cause. Of this ten percent, the cause is known only in one in ten cases. In the other cases, the family pattern indicates the hereditary nature of the cancer, while the underlying genetics remains unknown.

"So there's room for improvement and a need for more research," says Svetlana Bajalica Lagercrantz, a specialist in breast cancer and genetics, and one of the driving forces behind a new outpatient department that she hopes will represent an important knowledge base.

Anyone who carries genes associated with familial cancer is faced with a number of difficult decisions about their own body," says Svetlana Bajalica Lagercrantz, a specialist in breast cancer and genetics.

Here, specialists in areas including colon cancer, malignant melanoma and breast cancer, as well as pioneers in the field of genetics, can gather to give advice and initiate investigations of entire families.

"We have to put familial cancer on the map. It is by no means certain that all doctors who treat cancer see a link with the family history," says Svetlana.

She is able to offer her patients guidance, genetic screening and extended monitoring. Unfortunately current preventive treatment is often drastic, involving the removal of organs.

"But in many cases we can provide a chance of detecting cancer in time. A study is currently ongoing involving full-body screening for rare forms of familial cancer where, previously, only ordinary check-ups were available.

Text: Catarina Thepper, photo: Stefan Bohlin, Oscar Segerström

Indicators for familial cancer

  • Several close relatives with the same type of tumour.
  • Cancer at an unusually young age.
  • The same patient having multiple primary tumours; tumours that are independent of each other.