Last month was the first African-American History Month in which Black in Cancer has existed. The theme this year was “Black Family: Representation, Identity and Diversity”. Brought together in October 2020, Black in Cancer has become a family who encourage, support and celebrate one another. However, we are not an elitist group of intellectuals! We are passionate about mentorship, outreach, advocacy and education.

The theme for African-American History Month 2021 has caused me to pause and reflect. The Black family is a beautiful symbol of hope and strength. A few days ago we celebrated International Women’s Day 2021. I loved the theme "Choose To Challenge". These recent celebrations have caused me to think of the wonderful women that the Black family has produced.

A recently published study, which examined almost 500 African-American women with invasive breast cancer, concluded that African-American women are at an increased risk of diagnosis at a younger age and/or with triple negative breast cancer. This finding highlights the importance of talking with family members about medical history.

In brief, a family medical history is a synoptic record of the health conditions present in the close relatives of an individual. Close relatives constitute parents, grandparents, siblings, aunts, uncles and first cousins. Family medical history is a key weapon in the arsenal of your primary care clinician/general practitioner. On a practical basis, it may provide a doctor with clues that could lead to a quicker diagnosis and perhaps a more favourable outcome.

Additionally, a family medical history can help to identify if a particular medical condition; has a genetic element, is the result of exposure to an environmental hazard, or is due to lifestyle choice. The criteria set by the US Preventive Services Task Force recommends that individuals should receive genetic counselling if they have: a family history of breast, ovarian, tubal, or peritoneal cancer; have had personal experience the aforementioned cancers; or who have relatives with mutations in the genes breast cancer susceptibility genes BRCA1 or BRCA2. Following genetic counselling these individuals can be referred for genetic testing.

Patients who carry mutations in the susceptibility genes BRCA1 and BRCA2 are at a higher risk of developing breast and/or ovarian cancer. As members of the African diaspora, we don’t necessarily know the full details of our ancestry. However, studies indicate that BRCA1 mutations present in African-Americans originate from West Africa. Additionally, a study found that 12.4% of young African-American women living in Florida diagnosed with invasive breast cancer contained BRCA1/2 mutations.

As the saying goes, “prevention is better than cure”. Knowledge of being at a higher risk of a medical condition can enable people to make lifestyle changes which can help reduce the risk of developing the illness. Additionally, it can provide access to genetic counselling and testing. There is power in passing stories from one generation to another, however, this power is particularly poignant when passing down family history; it’s good to talk.

References:

1. https://asalh.org/asalh-announces-2021-black-history-theme/, accessed February 2021
2. Lovejoy LA, et al. Frequency and spectrum of mutations across 94 cancer predisposition genes in African American women with invasive breast cancer. Fam Cancer. 2020 Oct 21. doi: 10.1007/s10689-020-00213-1. Epub ahead of print. PMID: 33083949.
3. US Preventive Services Task Force, et al.. Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2019 Aug 20;322(7):652-665. doi: 10.1001/jama.2019.10987. Erratum in: JAMA. 2019 Nov 12;322(18):1830. PMID: 31429903.
4. Kuchenbaecker KB, , et al. Risks of Breast, Ovarian, and Contralateral Breast Cancer for BRCA1 and BRCA2 Mutation Carriers. JAMA. 2017 Jun 20;317(23):2402-2416. doi: 10.1001/jama.2017.7112. PMID: 28632866.
5. Ndiaye R, et al.. Evidence for an ancient BRCA1 pathogenic variant in inherited breast cancer patients from Senegal. NPJ Genom Med. 2020 Jan 31;5:8. doi: 10.1038/s41525-020-0114-7. PMID: 32025337; PMCID: PMC6994613.
6. Pal T, et al. A high frequency of BRCA mutations in young black women with breast cancer residing in Florida. Cancer. 2015 Dec 1;121(23):4173-80. doi: 10.1002/cncr.29645. Epub 2015 Aug 19. PMID: 26287763; PMCID: PMC4666784.