Ireen Muthoni wants to be tested to see if she has a cancer-causing gene in her body. Her fears — she may have inherited a mutation in the gene called BRCA1 or BRCA2 which increases her chances of having both breast and ovarian cancer.
“I think my father’s family has some genetic mutation; three of his brothers have had different types of cancer,” she says.
Fathers, as well as mothers, can pass the defective genes that cause breast and ovarian cancer on to their daughters. Males who have breast or prostate cancers can pass the faulty genes to their daughters and they are likely to get breast cancer, said Dr Frederick Chite, an oncologist and haematologist in an earlier interview.
Five to 10 per cent of breast cancer cases are caused by mutations in the BRCA 1 or BRCA 2 genes and studies show that women with these inherited abnormalities may get cancer at an early age. “But we cannot line up everyone for gene testing. Breast cancer ideally is an age disease and if someone gets it in the early 20s or 30s, there must be an abnormality. We expect breast cancers to occur in older women,” Dr Chite said.
Other factors that determine if someone should be tested for the defective genes include where multiple family members get breast and prostate cancers, if a patient gets cancer on both breasts and where a male gets breast cancer.
Genetic testing is important in the prevention, diagnosis, and treatment, especially now that the high cost of cancer treatment is taking a toll on Kenyan households and medical insurers such as National Hospital Insurance Fund are paying millions of shillings in treating diseases at advanced stages.
Gene testing helps guide the type of treatment that a person receives, saving one from trial-and-error drugs. For instance, if one is found to have inherited a defective gene, she may opt to have her breasts removed or have the second breast removed if one breast already has cancer. This would reduce the high cost of treating advanced cancer or recurrences.
Testing of BRAC 1 and BRAC 2 gene at Pathologists Lancet Kenya costs Sh166,999 and the test results take two months to come out.
“We have to be realistic, if you want to fight a disease, do you wait for the numbers to go up then you fight it?” said Dr Chite.
If someone has BRAC 1 and BRAC 2 gene, there are high chances that she will develop ovarian cancer. In this case, ovary removal is recommended because ovarian cancer is deadly and sneaks up on someone with non-specific symptoms.
But women unwilling to remove their ovaries and breasts should be put on the high-risk list and go for yearly ultrasounds and other tests to avoid being caught unawares.
However, ovary and breast removal would be challenging for young girls and women who want to bear children.
Dr Wanjiru Ndegwa-Njuguna, a specialist at Footsteps To Fertility Centre, says egg or ovary preservation is the only option for young girls and women who are undergoing cancer treatments including chemotherapy and radiotherapy, which are toxic to the ovaries.
Chemotherapy and radiotherapy can cause infertility among men and women by killing sperms and ovaries as well as triggering menopause. Also, women with hormone-receptor-positive cancer, meaning a tumour growth that is fed by oestrogen typically take tamoxifen drugs, which can also cause loss of menstruation but this does not mean that they are infertile.
Dr Ndegwa-Njuguna says the fertility preservation options depend on the age of the woman and stage of cancer.
“Unfortunately most stage 2, 3 and 4 cancers require immediate treatment and won’t allow time for an intervention. But for children who are undergoing treatment, we may want to remove part of the ovary surgically and freeze it with the hope of repositioning it later.
“For women past puberty, we have the option of giving them medication to produce many eggs and surgically remove them for freezing. For women and girls undergoing radiation, we may do surgery to lift the ovaries above the pelvic area to avoid radiation. This is called ovarian transposition and radiation shading,” she says.
Eggs can be frozen for many years. A two-year-old was the youngest patient globally whose immature eggs were preserved to give her the chance of being a mother one day. However, it is recommended that the expiry period of storage is 10 years.
At Footsteps To Fertility Centre, the procedure for freezing as many eggs as they can harvest, costs about Sh450,000, says Dr Ndegwa-Njuguna.
However, as more young girls and women get cancer and require to preserve their ability to procreate, there are many myths surrounding egg and ovary freezing.
“People assume that it doesn’t happen in Kenya and others think that freezing eggs does not guarantee pregnancy, yet it does give hope to a lot of women who would otherwise not have the option of having a child,” she says.
Kenyans also think that the babies born from frozen eggs have an increased risk of congenital abnormalities. “More than 5,000 babies worldwide have been born from frozen eggs. There has been extensive research done and none has shown any increase, above the normal, in abnormalities in these babies,’’ the fertility expert says.