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Jan 10, 2021
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You can’t crush genes with your finger. Can cancer be outsmarted?

There are families in which one and the same oncological disease takes away generation after generation in its prime. Previously, science did not know why this is happening and how to protect against it. Much has become clearer today. This means that people with “bad genetics” have hope.

Our experts:

Oncologist, Head of the Department of Chemotherapy, N.N. N.N.Blokhina of the Ministry of Health of Russia, Doctor of Medical Sciences, Professor Elena Artamonova.

Deputy Director General for Science of the Federal State Budgetary Institution of the National Medical Research Center of Radiology of the Ministry of Health of Russia, Doctor of Medical Sciences, Professor Boris Alekseev.

There is no single answer to the question of why cancer occurs. And although the mechanism of the disease is always the same (the accumulation of breakdowns in the DNA of cells), the reasons are different.

Can’t you escape fate?

Major risk factor age. Since the process of accumulating mutations in cells usually occurs gradually and lasts for decades, older people are more likely to get cancer. However, many points can accelerate the development of the disease. First of all, this is smoking, alcohol abuse, obesity, physical inactivity, stress. Those types of malignant tumors that arise due to age or under the influence of adverse factors are classified as sporadic (that is, accidental) cancer. It is this form of the disease that develops most often in more than 90% of cases. Sporadic cancer is not inherited. And a healthy lifestyle helps to reduce the risk of its development.

But in 5-10% of cases, the cause of cancer is a certain heredity. Having received certain “defective” genes from their closest relatives, people become hostages of their genetics. And then the same type of cancer inevitably haunts all generations of one family. Moreover, genetic cancer flows more aggressively than sporadic, and manifests itself at a younger age. Genes cannot be changed (at least not yet). So what do you do? Just wait for this terrible clockwork, inherent in its own nature, to work? Of course not!

Thanks Angelina

Not everything is known about the role of heredity in oncology. But already a lot. Science made a huge contribution to this process, and became a popularizer of a new approach to the prevention of hereditary cancers. Angelina Jolie… The mother of the actress died of a genetically determined disease. Having discovered in her genes that almost certainly guarantee the development of a tumor of the reproductive system in the future, the Hollywood star decided on the preventive removal of the mammary glands and ovaries. And not only did the operation, but also openly told about it, which became an important medical precedent that opened a new one in the fight against cancer. Since then, the genes BRCA1 and BRCA2 are popularly called by the name of Angelina Jolie.

Changes in the BRCA1 and BRCA2 genes primarily increase the risk of cancer of the reproductive organs. In women, it is ovarian and breast cancer (however, breast cancer can also occur in the stronger sex, although very rarely). Men who inherit these genes have an increased risk of prostate cancer (PCa). And recently it was found that these mutations also increase the risk of developing pancreatic cancer.

I see nothing, I hear nothing

To find out if there are mutations in the BRCA1 and BRCA2 genes, today it is possible in many laboratories, simply by taking a blood test. However, not all people from those families to which the cancer has firmly clung to its claw consider it necessary. Moreover, often people carefully hide information about the presence of defective genes from all relatives and friends, and even sometimes mothers hide this fact from their daughters.

Such false bashfulness can go sideways. Because the danger of genetic cancer in that it occurs much earlier than it is customary to start worrying. For example, if the maximum risk of sporadic breast cancer occurs after the age of 50, and therefore mammographic screening is performed starting at 40, then even a young girl may develop genetic breast cancer. Therefore, with such heredity, it is necessary to turn to a geneticist as early as possible in order to develop an individual examination plan. For example, for the prevention of genetic breast cancer, it is necessary to conduct MRI of the mammary glands from the age of 25 or even earlier.

Genetic and familial cancer are not the same thing. Sometimes in the same family, certain tumors can occur, although there are no mutations in the genes of relatives. Probably, in this case, other factors are triggered: common bad habits for the whole family, for example, or infection with the same viruses.

When it comes to childbirth, ovarian cancer is especially dangerous. The geneticist will help calculate the risk by year, which will help the woman make the right decision about family planning.

The same goes for hereditary prostate cancer (PCa). The presence of first-degree relatives (father, brother) with such a disease increases a man’s risk of contracting prostate cancer by 1.5 times, and if there are two or more such relatives, then the risk increases by 5 times. As a rule, with hereditary PCa, mutations in the BRCA2 gene are found in the blood of patients, which the sons inherit from their parents and can then pass on to future generations. And if a still healthy man is a carrier of a mutant gene, then screening for prostate cancer (that is, passing a blood test for PSA prostate-specific antigen) he should start not at 50, like everyone else, but already at 40.

Strategy the most aggressive

Sporadic and genetic cancers are also treated in different ways, so research on mutations in genes is necessary not only for prevention, but also for those who have already become ill. Indeed, the scheme and volume of treatment depends on the results of the analyzes. With appropriate genetics, the treatment will be more aggressive. For example, in breast cancer, today there is a general trend towards organ-preserving surgeries, but with genetic breast cancer this is out of the question. Moreover, having found a tumor in one mammary gland, the other is preventively removed by performing a bilateral mastectomy, since there is a risk that cancer cells will “move”.

The presence of a mutation in the BRCA1 and BRCA2 genes in ovarian cancer also an indication for the complete removal of these organs, even at an early stage of the disease. Treatment for genetic PCa is also very aggressive. The prostate gland is removed completely, along with the regional lymph nodes. And then “rays” and hormonal therapy (and, after immunohistochemical analysis, possibly targeted therapy) are also prescribed.

Breast cancer (BC) ranks first in terms of morbidity and mortality among all cancers in women. Among male cancers, prostate tumors (PC) are in second place in terms of prevalence and third in mortality. Unfortunately, all these diseases are often detected late. Almost every third patient with breast cancer and every fifth patient with PCa is diagnosed at the terminal stage. In 60% of cases, ovarian cancer is also detected when it is too late to talk about a complete cure, so every fifth woman with such a diagnosis dies within a year.

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