Shawnna Latino had few concerns as she awaited the results of her biopsy for breast cancer in 2015. After all, she was a registered nurse who understood the ramifications of the disease, and she had done all the right things — regular self-examinations and never-missed yearly mammograms.
So when a mammogram detected calcifications in one of her breasts, she thought they were simple benign calcium deposits.
“When the results came back from the biopsy, I was shocked,” she said. She had tested positive for breast cancer.
The diagnosis was particularly troubling because of Shawnna’s family medical history, which is fraught with cancer. Her mother at age 70 had been diagnosed with breast cancer just eight months before her daughter’s test results.
At the same time, Shawnna’s brother was battling aggressive prostate cancer, which eventually took his life. Their maternal grandmother had died of cancer, as had the grandmother’s five sisters. A maternal aunt had died of pancreatic cancer, and her daughter, Shawnna’s cousin, was diagnosed with the same disease soon afterward.
When Shawnna consulted with her oncologist, Dr. Thomas J. Harris at Texas Oncology in Waco, he wanted to conduct genetic testing, something that is done as needed at the oncology clinic.
She thought it unlikely that she might have a gene mutation, which can indicate a high risk of breast and ovarian cancer as well as other cancers. The mutation affects only a small percentage of the population.
However, once more, Shawnna found herself with a positive test result, this time for mutation of the BRCA-2 gene.
“I never imagined it would be positive,” she said.
They then tested her mother and discovered the same genetic problem. The women found out later that Shawnna’s maternal cousin was in the same boat. “She has the exact mutation that my mom and I have,” she said.
BRCA 1 & 2 are tumor suppressor genes that prevent uncontrolled cell growth and help keep normal cells from becoming cancerous. If either is mutated, a woman will have a 40-70% risk of having breast cancer and 27-44% chance of ovarian cancer during her lifetime.
In men, such mutations can result in male breast cancer (6% risk) or prostate cancer (20%). Both genders are also at risk for melanoma and pancreatic cancer.
Just as troubling, if not more so, is the fact that people of either gender with the mutation have a 50% chance of passing it to their children, which keeps the cancer cycle going throughout generations.
“The last thing you want to do is pass it on to your child,” Shawnna said. Her biggest fear was that her daughter, Bailee Norris, may have inherited the mutation. However, genetic testing showed that Bailee had not, a great relief to her mother.
Dr. Carlos Encarnación, breast cancer and genetics specialist at Texas Oncology, said, “Cancer is a genetic disease, but it is not always inherited.”
Most cancers are sporadic, he said, caused by lifestyle choices like smoking or other unknown factors, but some develop through a mutated gene (like BRCA) inherited from either parent.
The doctors at Texas Oncology treat all types of cancer using radiation and drugs, but they also work to identify cancer risks in a timely manner.
“Our focus is early detection and prevention,” Encarnación said.
A person considered at high probability because of family history or other factors should have a risk assessment, starting with an interview and an estimation of risk. If testing is deemed necessary, a blood or saliva test can be done to see if there’s a mutation. The price of testing has gone down dramatically, and insurance often covers the cost or at least part of it.
Is genetic counseling important for much of the population?
“Absolutely,” Encarnación said. “If a patient had cancer or has family history of cancer, he or she should have a risk evaluation and maybe genetic testing.”
He suggests that people discuss this with their family doctor and be referred to a specialist if necessary. It’s important that the counseling and testing be administered by those who are specifically trained for it.
“Genetics has become an integral part of oncology, and it will keep changing over time,” he said. Researchers found the first cancer-related gene, BRCA-1, in the mid-1990s, but new genes related to various types of cancer are being identified regularly.
Reduction of cancer risk in BRCA carriers can be achieved in a couple of ways, including hormone blocker pills or preventative mastectomies.
However, he said of the mastectomy, “Not everyone with a BRCA mutation has to choose that. They may prefer an enhanced cancer surveillance program.”
Women with BRCA mutations who do not intend to have more children should “strongly consider” having their ovaries removed to lessen their chance of a deadly ovarian cancer, Encarnación said.
For Shawnna, when she learned of her breast cancer and gene mutation, the choice was clear. Though the cancer was only in one breast, she said, “I decided to have both removed and be done with it.”
After surgery for the removal and reconstruction, she went through chemo and radiation treatments, continuing to work as a nurse every day except for Wednesdays, her treatment days.
“I think that had a lot to do with my well-being,” she said.
Later that year, she had a complete hysterectomy to reduce the risk of ovarian cancer.
Because she has the BRCA mutation, she is screened each year for pancreatic cancer and also must be seen by a dermatologist once a year to check for melanoma.
In the meantime, Shawnna and her husband, dentist Chad Latino, and children Bailee, Aidan and Tristan are moving on with life by enjoying every day to the fullest. And, along with friends and business partners Scott and Michelle Irwin, they have begun a new enterprise.
The four of them will be keeping their current jobs but are planning to open a hatchet-throwing business whenever the current pandemic subsides. Stumpy’s Hatchet House, which is in a Waco historic building at 924 Austin Ave., was due to open before the coronavirus hit.
With a laugh, she says of the venture, “It was kind of a coincidental thing. ‘Sure,’ we said. ‘We all have full-time jobs. Let’s start a business!’ ”
Shawnna has a joyful attitude that is apparent. Of her cancer experiences, she said, “There were so many blessings in that journey. I never asked ‘why me?’ It was always ‘why not me?’ ”
She considers genetic testing essential.
“It’s so important to know your health history and your family history,” she said. “It can save your life. Knowledge is power, and it’s very empowering to know about yourself.”
As Shawnna found out, sharing your medical history with family is also highly important to alert others to possible inherited genetic mutations.