There could be something unique about the genetic makeup of Bahamian women that predisposes them to cancer at an early age, researchers say. It’s why they intend to carry their study to another level to further explore an “alarming” observation.
Anecdotal information suggests that there is a high incidence of breast cancer in young women in The Bahamas, according to Dr. Judith Hurley, a breast cancer specialist at the University of Miami School of Medicine, who is working along with Bahamian physicians, Dr. Theodore Turnquest, and Dr. John Lunn to find out the ‘why’.
“A few years ago I was at a breast cancer conference and I ran into Dr. Lunn and I said to him, ‘Are all of your patients young? Every single one I see over here is young.’ And he said ‘Oh yes. They’re all young’,” said Dr. Hurley, who said what she was witnessing struck her as being unusual.
It was at that point that they agreed to carry out research into a disease that, in the United States, is commonly thought of as a disease of older women.
Not so in The Bahamas, the researchers have noted.
They pulled the records of 108 patients and what they found “jumped out as being abnormal.”
Their study found that in this country, 48 percent of the patients with breast cancer whose charts were reviewed were under 50 years old and 48 percent of them presented with Stage III of the disease.
“This high rate of locally advanced breast cancer in very young women points to a genetic etiology,” the doctors said in their findings.
Dr. Lunn said the initial findings were “alarming and distressing”, particularly since the disease progresses faster in younger women and they tend to have a higher mortality rate.
“Often we find that in post-menopausal women, the disease is much less aggressive,” he noted.
In the white population in the United States, more than 55 percent of patients are diagnosed with breast cancer after age 60.
But the researchers said that in black women, a smaller percentage are over 60 years old at the time of diagnosis (45 percent), and a significant proportion of black women with breast cancer are under 50 (32 percent) at the time of diagnosis. This is in sharp contrast to the proportion of breast cancer diagnosed in white women under 50 (23 percent).
The doctors said in an initial report that, “this epidemiological difference suggests a difference in causation in the women of Afro-American descent.”
“If 50 percent of the breast cancer patients in The Bahamas is under 50, you have a whole lot of lives that are being lost prematurely,” Dr. Hurley told The Journal.
One 33-year-old Bahamian woman, who asked not to be named due to the stigma she said is attached to the disease, has taken note of those findings. She was 22 years old when she found a lump in her breast while taking a shower one day.
She had Stage IV cancer.
“It was frightening and very depressing,” she recalled, “I was angry and bitter for a while. I asked ‘Why me? Why should I even go to church?’ I’m now much more spiritual and I do believe in God. The truth is that death is inevitable.”
But she said it’s inevitable for everyone and she intends to keep on living.
The mother of two, who has been cancer-free now for more than five years, traveled to the United States last year for genetic testing and learnt that she remained at “high risk” for cancer.
Her sister, who is also in her 30’s, has also been diagnosed with breast cancer.
Dr. Hurley believes that some kind of genetic abnormality among Bahamian women may be the reason why so many of them are being diagnosed at a young age. She took her research a step further, reviewing breast cancer research conducted in Africa.
“I said these are all black Bahamian women, maybe it’s something from Africa,” she told The Bahama Journal. “There’s very little published about breast cancer in Africa, but what little is published shows that it’s very rare there, but when it does occur it occurs in young women.”
One study done at the University of Nigeria showed that a large proportion of young women who had breast cancer had some kind of genetic abnormality.
Dr. Hurley found the occurrence of breast cancer in young women to be the case among Bahamian women who live in The Bahamas, but also those who live in the Miami area.
The significance of the findings if they are confirmed through further testing would be that The Bahamas would need to change its screening for breast cancer, she said.
“In The Bahamas you use American Cancer Society guidelines for screening which call for starting mammography at age 40,” Dr. Hurley pointed out.
“Well, 28 percent of the patients in The Bahamas, as near as we can tell, has cancer already so that’s not the right way to screen them. The whole issue needs to be looked at so we can find breast cancer when it’s earliest, so we can prevent breast cancer.”
The researchers are now working under the assumption that there’s a genetic predisposition that may be passed around through certain Bahamian families.
But they have not ruled out the possibility that there may be an environmental cause. However, Dr. Hurley noted that in underdeveloped African countries the breast cancer rate is low and the age is young, which may suggest that the cause is not environmental.
“We think maybe it’s genetic. When you look at places like the United States, first world industrialized countries, the average age of breast cancer is much higher, but the disease is much more prevalent,” she noted. “So that’s where the general thought is that there’s something environmental about breast cancer in first world countries [and not developing countries].”
Dr. Hurley is in the process of looking at the genetic tests of some Bahamian women to find out if there is a common trait.
“If that small number gives me some data, then I’ll try to go further with it and see,” she said.
The researchers want to determine whether there indeed are certain genetic mutations present in Bahamian women, which lead to a predisposition to developing breast cancer.
The tests for genes, known as BRCA1 and BRCA2, can determine if there are certain mutations connected to the development of breast and ovarian cancer.
“You can get that from your mother or you can get that from your father,” explained Dr. Hurley. “It doesn’t matter which parent it comes from. If it’s a gene then we can trace it back and we can test for it.”
But the test is very expensive, costing about $3,000.
“But if we can find a specific deletion or a couple deletions that are the ones that are found [in Bahamian women], the cost can be brought down to $400 or $600,” Dr. Hurley said, “which would be a very effective screening tool.”
Experts have recommended the test for women who have close relatives who have been diagnosed with breast cancer or have relatives with ovarian cancer, particularly if the cancer occurred at a relatively young age.
Dr. Lunn said if it is discovered that Bahamian women have the genetic mutation in great numbers, it would have significant implications, including whether they respond differently to drugs.
After being tested in the United States last year, the 33-year-old woman who spoke with The Bahama Journal said she found out she had the genetic mutation and her doctor advised her to have her breasts surgically removed and get a hysterectomy.
But she said she was not willing to take these “extreme” measures to reduce her risk of a re-occurrence.
“I’ve had enough of poking and probing,” she said. “The Lord has the final say.”
Dr. Lunn said mastectomies are not very popular among Bahamian women, but some of them who are high risk have had them done.
The young woman who spoke with The Journal said she believes that women in The Bahamas should be screened long before 40, and she hopes that would be the outcome of the ongoing research.
Local doctors involved in the research have applied to the Government of The Bahamas seeking permission to get approval from patients to use their personal data for ongoing studies.
Dr. Hurley and the other researchers have not yet done any research into breast cancer into other women in Caribbean countries.
By: Candia Dames, The Bahama Journal
