Discovering Your Cancer Risk
- Actress Olivia Munn, 43, revealed on Instagram that she’s been diagnosed with breast cancer despite a “normal” mammogram and testing negative for the BRCA gene mutation, which elevates your risk for breast and ovarian cancer. At the request of her OBGYN, Munn underwent a Breast Cancer Risk Assessment, which led to the discovery of her cancer after additional screening.
- Breast Cancer Risk Assessment is a “statistical model that allows healthcare professionals to calculate the probability of a woman developing breast cancer throughout their lifetime,” Dr. Ruth Oratz, breast medical oncologist at NYU Langone, tells SurvivorNet. It assesses a woman’s age, family history with breast cancer when she first had a menstrual period, and her reproductive history to determine her risk of breast cancer.
- Munn underwent a double mastectomy, which removed both breasts and eliminated the cancer. If a woman opts to have reconstructive surgery after the mastectomy, surgeons either use an implant or take tissue from elsewhere on the body.
- Munn wanted to get through the “hardest parts” of her cancer journey before sharing her diagnosis publicly. Some people battling a disease or cancer are open to sharing their experiences as much as they can, while others prefer to keep it to themselves. SurvivorNet experts say both approaches and everything in between are valid.
Actress Olivia Munn, 43, says she’s been diagnosed with breast cancer in a social media post noting her cancer was discovered despite a “normal” mammogram and testing negative for the BRCA gene mutation, which elevates your cancer risk.
At the suggestion of her OBGYN, the “X-Men” actress underwent a Breast Cancer Risk Assessment, which helps determine a woman’s probability of getting breast cancer. Her results called for additional screening, which revealed she had an aggressive form of cancer in both of her breasts.
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Munn is an award-winning actress known for hits like “Perfect Couples,” “The Newsroom,” “X-Men: Apocalypse,” and numerous voice acting roles. However, the last year has been a rollercoaster for the mother of one.
The Breast Cancer Risk Assessment she credits for catching her breast cancer is a “statistical model that allows healthcare professionals to calculate the probability of a woman developing breast cancer over the course of their lifetime,” Dr. Ruth Oratz, breast medical oncologist, NYU Langone Health’s Perlmutter Cancer Center; clinical professor of medicine, NYU Grossman School of Medicine tells SurvivorNet.
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Last February, she wanted to be proactive about her health and underwent genetic testing.
Genetic tests can be as simple as a simple saliva swab or blood sample. The results help your care team determine if you have a specific mutation that puts you at higher risk for cancer. The results help doctors tailor your treatment and are helpful for breast cancer patients.
“I tested negative for all (different cancer genes), including BRCA,” Munn said.
The BRCA1 and BRCA2 gene mutations are among the most important genes to look for in breast cancer. Together, they are responsible for about half of all hereditary breast cancers. These genes prevent cells from dividing haphazardly and uncontrollably in a person without mutations. Mutations prevent these genes from doing their job and can allow unchecked growth of breast, ovarian, and other tissues.
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However, two months after undergoing genetic testing, Munn was diagnosed with Luminal B breast cancer in both of her breasts.
According to research in “Breast Cancer,” luminal B tumors are of a “higher grade” and tend to have a worse prognosis. This type of breast cancer is estrogen-positive (ER), meaning it is fueled by the hormone estrogen. It can also be progestogen (PR) negative, meaning it is not fueled by progestogen. This type of breast also tends to have a higher expression of the Ki67 protein, making it grow quickly. Hormonal therapy and chemotherapy are often used to treat this type of cancer.
Luminal is one of several types and is distinguished by its molecular makeup. Other types of breast cancer types include:
- Luminal A breast cancer
- Luminal B breast cancer
- Luminal B-like breast cancer
- HER2-enriched breast cancer
- Triple-negative or basal-like breast cancer
Each type has a specific, individualized molecular structure. The different types of the molecular structure of breast cancer may inform the treatment path.
Understanding Your Breast Cancer Risk
The Breast Cancer Risk Assessment examined Munn’s age, family history with breast cancer when she first had a menstrual period, and her reproductive history to determine her risk of breast cancer.
Dr. Oratz says if the Breast Cancer Risk Assessment finds that a woman is at higher risk of getting breast cancer, she should expect further testing and screening. However, if a woman is positive for the BRCA gene mutation, a Breast Cancer Risk Assessment “is not really accurate.”
“Having information empowers patients. It is very important for people to be aware of the health risks, their family history, and their own personal medical conditions. All of these things can affect the risk of developing cancer,” Dr. Oratz tells SurvivorNet.
“I’m lucky. We caught it with enough time, and I had options. I want the same for any woman who might have to face this one day. Ask your doctor to calculate your Breast Cancer Risk Assessment Score. Dr. Aliabadi (Munn’s OBGYN) says that if the number is greater than 20%, you need annual mammograms and breast MRIs starting at age 30,” Munn said.
Munn’s Breast Cancer Risk Assessment score was at 37%, which led to her undergoing an MRI, ultrasound, and a biopsy, which confirmed her breast cancer.
Munn’s Breast Cancer Treatment Includes a 10-hour Surgery.
Munn underwent a double mastectomy to treat her cancer.
When a woman decides to have a mastectomy, several factors go into that decision. Among things to consider is whether to have breast-conserving surgery such as a lumpectomy. These decisions should be made alongside your doctor by openly and candidly discussing risks vs. benefits.
“A double mastectomy typically takes about two hours for the cancer part of the operation, the removing of the tissue,” Dr. Elisa Port, Chief of Breast Surgery at Mount Sinai Health System, tells SurvivorNet. “The real length, the total length of the surgery, can often depend on what type of reconstruction [a patient] has.”
WATCH: What Happens During a Double Mastectomy
Other factors that weigh into the decision to get a mastectomy are the size and features of the tumor and your family history. However, the gravity of your decision comes into full view, especially if you choose to get a mastectomy and remove both of your breasts.
Some women decide to have their breasts reconstructed and have implants put in right after the mastectomy, while others don’t have reconstruction at all.
Dr. Port added that most women opt to have some reconstruction. The length of these surgeries can vary greatly. When implants are used, the procedure can take two to three hours (so the total surgery time would be around five hours). There is also the option to take one’s own tissue (usually from the belly area) and transfer it into the breast area during reconstruction.
Power of Support
Munn is grateful she had continued support throughout her cancer journey from family and friends. She expresses added gratitude to her partner, John, who stood by her side every step of the way.
“I’m so thankful to John for the nights he spent researching what every operation and medication meant and what side effects and recovery I could expect. For being there before I went into each surgery and being there when I woke up, always placing framed photos of our little boy Malcolm so it would be the first thing I saw when I opened my eyes,” Munn said.
In a heartfelt video shared as part of Munn’s Instagram post, she is seen hugging a loved one and a photo of her family at her bedside.
A life-altering diagnosis can impact the patient and their loved ones emotionally and physically.
Research published in The Journal of the Royal Society of Medicine studied the impact of a cancer diagnosis or disease on family members. It found, “Most chronic diseases have similar effects on family members including psychological and emotional functioning, disruption of leisure activities, effect on interpersonal relationships, and financial resources.”
Feelings of “helplessness, lack of control, guilt, anger, embarrassment” are some common emotions parents, siblings, and other relatives within the household of someone battling a health condition may experience, according to researchers.
Communicating your feelings is something licensed clinical psychologist Dr. Marianna Strongin also believes is vital to helping couples dealing with a cancer diagnosis.
She adds that people faced with cancer should “surround [themselves] with individuals who care and support [them]” throughout treatment while also acknowledging their limits on what they can handle.
“Going through [cancer] treatment is a very vulnerable and emotionally exhausting experience,” Dr. Strongin wrote in a column for SurvivorNet. “Noticing what you have strength for and what is feeling like too much [is] extremely important to pay attention to as you navigate treatment.”
‘I Needed to Get Through the Hardest Parts Before Sharing’
Munn chose to wait a year before sharing her breast cancer journey publicly because she wanted to make sure she was emotionally ready.
“I’ve kept my diagnosis and the worry and the recovery and the pain medicine and the paper gowns private. I needed to catch my breath and get through some of the hardest parts before sharing,” Munn explained.
Some people battling a disease or cancer are open to sharing their experiences as much as they can, while others prefer to keep it to themselves or close loved ones. SurvivorNet experts say both approaches and everything in between, are valid.
WATCH: Sharing a Diagnosis
“Patients who have just been diagnosed with cancer sometimes wonder how they are going to handle the diagnosis of the cancer in social situations,” psychiatrist Dr. Lori Plutchik explains.
Questions like “How much information should they share and with whom should they share the information?” are things Plutchik says patients take into consideration.
Dr. Plutchik explains, “There is no one right way to handle this diagnosis. People should do what feels right to them.”
A cancer journey can last months to years, which means cancer warriors may be experiencing a lot of uncertainty until they fully understand where their health stands. This uncertainty can influence when a cancer patient is ready to share their diagnosis, Dr. Plutchik further explained.
Dr. Plutchik stresses that those close to a person going through cancer should be respectful of their wishes when it comes to disclosing their diagnosis and seeking support.
In the hours following Munn’s emotional, social media post, an army of online supporters flooded her timeline with positive and affirming messages.
“You are my hero. Your post will save so many lives. I love you so much,” Munn’s OBGYN, Dr. Thais Aliabadi, commented.
“You played a superhero on screen, but you’re a real-life hero. I pray for a complete recovery,” Instagram user Terrence Hall commented.
What To Ask Your Doctor
If you have been diagnosed with breast cancer, you may have questions about keeping your strength through treatment. Here are a few questions to help you begin the conversation with your doctor:
- What treatment will I be receiving?
- What side effects are associated with this treatment?
- Are there steps I can take daily to help minimize these side effects?
- What physical activity routine do you recommend for me during treatment?
- Do you have recommendations for someone who doesn’t particularly enjoy exercise?
- Can you recommend a dietician who can help me with healthy eating tips and weight maintenance?
- I’ve been having trouble sleeping. Do you have any treatment recommendations?
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