Katie Jantzi (née Yelenic) was just 9 years old, and her sister Megan Yelenic, 5, when their mother died 18 years ago of metastatic breast cancer.
Katie remembers birthday parties, shopping trips, and most of all, listening to oldies and doo-wop music in her mother’s car.
“I loved riding with her,” she said, reminiscing about school drop-offs and drives to summer camp in downtown Pittsburgh where her mother worked in the state parole office. “There are certain songs, like Butterfly Kisses by Bob Carlisle and George Thorogood’s Bad to the Bone, which I listened to in her car all the time.”
In her 20s, Katie would find herself buying CDs and attending live concerts, like Frankie Valli (twice), which drew a much-older crowd.
Her sister Megan’s memories of their mother, in contrast, were limited to what she saw in videos and heard from Katie and their dad. Her mother didn’t influence Megan’s taste in music, but losing her helped shape her career goals.
“With my mom, my grandmother and my aunt (her father’s brother’s wife) having all passed from cancer, I knew I wanted to do something in healthcare and I was always interested in science,” said Megan, a second-year pharmacy school student who volunteers with the Wake County Health Department in North Carolina.
Raising awareness about breast cancer through various charity walks through the years was something Katie, the extrovert, and Megan, the introvert, had in common. That family tradition started by their mother, then carried on by the two sisters, became even more personal for them when they realized, as teenagers, they might get breast cancer, too.
One look at their family history — their mother’s death from breast cancer at 36, their maternal grandmother’s death from breast cancer and that grandmother’s sister’s death from ovarian cancer — was enough for their gynecologist to recommend genetic testing.
“I knew that it was inevitable that I was going to get breast cancer,” said Katie. “So, when I heard about the option to get genetic testing, there was no question that’s what we’d do.”
One after the other — Katie at 20 then Megan at 19 — discovered they each carried a mutation in the BRCA1 gene, which put their lifetime risk of getting breast cancer at a whopping 80 percent and their lifetime risk of ovarian cancer at substantial risk as well — 40 to 60 percent.
A Brave Face
After a four-year period of investigating options to reduce her cancer risk, Katie decided to undergo a bilateral (double) mastectomy followed by breast reconstructive surgery with breast surgical oncologist Rachel Greenup, MD, MPH, at Duke Cancer Center, and Duke plastic surgeon Scott Hollenbeck, MD.
While it’s rare for women in their 20s to have risk-reducing bilateral mastectomies, the youngest breast cancer diagnosis in a family is an important consideration when counseling women about the timing of preventive surgery. Surveillance (mammograms, ultrasounds and/or MRI) is recommended starting 10 years before the first diagnosis of the youngest family member. The Yelenic sisters’ mother was 31 years old at diagnosis.
“There’s a profound medical benefit to bilateral mastectomies in young women with BRCA mutations,” explained Greenup. “It’s approximately 95 percent effective at reducing a woman’s lifetime breast cancer risk.”
Greenup also spoke to Katie about possibly having her ovaries and fallopian tubes removed (a risk-reducing bilateral salpingo-oophorectomy) once she was done bearing children — optimally between the ages of 35 and 40 — to prevent ovarian cancer; the NCCN guideline for women who carry a mutation in the BRCA1 gene, regardless of a known family history of ovarian cancer.
“When I first talked with Dr. Greenup I had just broken up with my boyfriend and I thought “Do I really have to do all this?”” Katie said, remembering how vulnerable she felt. “I was just 23. I was so sad.”
Last December, Megan, 23, had her bilateral mastectomy, then this year, breast reconstructive surgery, with the same Duke care team as Katie. She said she never had any real doubts about her decision. Her sister Katie had blazed the trail.
“For a split second the day before my surgery last December, I thought, “Wait, wait, wait, is this really going to happen?”” said Megan. “But the decision made itself. After seeing Katie go through it, it was a no-brainer.”
It’s now been four years since Katie had surgery and two years since she got married. This next phase of her life, she said, will, hopefully, include one or two biological children of her own.
For Katie, who’s considering having her ovaries and fallopian tubes removed in her 30s to prevent ovarian cancer, that clock is ticking.
“I’m not panicked about it yet, but my husband and I are aware of the timeline,” said Katie, 28, who experienced a miscarriage last year.
Megan acknowledges she’ll eventually “need to plan for kids” as well, especially since she wants a big family like the blended family of eight she grew up in when her father remarried.
When the sisters reach their 30s, they may also need to consider hysterectomies. According to new NCCN guidelines, BRCA 1 mutation carriers have a slightly increased risk for serous uterine cancer and may benefit from hysterectomy along with the risk-reducing removal of the ovaries and fallopian tubes.
Carolyn Menendez, MD, Duke Cancer Institute’s new program leader for Hereditary Cancer Counseling in Wake County, counsels patients to thoughtfully move forward with genetic testing” only if it will help in their decision making and planning.”
“The critical determinant is whether or not the patient can view the information as data that they can use to be proactive in their surveillance and risk reducing strategies, or if they will view it as a tragedy,” she said.
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Those who are at increased risk for breast cancer or who want to discuss their breast cancer risk, may schedule an appointment with the Duke Breast Risk Assessment Clinic. Duke breast experts perform breast cancer risk assessment for women who may be at an increased risk for breast cancer due to a genetic mutation, family history of breast cancer, or individual risk factors. Risk assessments can identify women who may benefit from additional breast cancer screening and potentially diagnose breast cancer earlier. Proper risk assessment can also identify women who may benefit from certain prevention strategies, such as prophylactic surgery or risk-reducing medications.
CIRCLE PHOTO: Sisters Katie Jantzi and Megan Yelenic, both of Raleigh, North Carolna, are thankful for each other's support. (photo by Colin Huth)