Vast Differences Found Between BRCA1 ER Positive and ER Negative Breast Cancers

We recently came across this data that we want to share with each of you:

BRCA1 germline mutations are one of the main causes of hereditary early-onset breast and ovarian cancer. Recent analysis of BRCA1 mutations conducted by researchers from the Institute of Cancer Research in London, provide additional insight regarding estrogen receptor status of the breast tumor. When a woman has a genetic confirmation of a positive BRCA1 mutation there is a difference between a diagnosis of an ER positive or an ER negative tumor. In more than 80% of cases, tumors arising in BRCA1 germline mutation carriers are estrogen receptor ER negative; however, up to 15% are ER positive.

Researchers reported a summary of the following characteristics found in the study:

Characteristic BRCA1/ER Negative BRCA1/ER Positive
Age  participants 54 52
Sex Female Female
Histological grade 3 2
Mitoses/10 HPF 81 15
ER Negative Positive
PR Negative Negative
HER2 Negative Negative
BRCA1 mutation c.124delA/p.Ile42TyrfsX8 c.4485-?_4986 + ?del/p.Ser1496CysfsX14
Somatic BRCA1 wild-type allele* Loss Loss
TP53 mutation c.927_928delTA c.951C > T
Molecular subtype Basal-like Luminal B
Tumor cell content GAP* (H&E) 71% (70%) 42% (60%)

This study confirms for Breast Health Navigators that a diagnosis of breast cancer, even when we have a confirmation that the tumor is BRCA1 positive, may vary in characteristics of the tumor.

The Journal of Pathology (2012); Pathological Society of Great Britain and Ireland

Nurse Navigators Ease the Journey of Uncertainty

Cancer transforms a person’s life from one of general well-being and confidence to one of enormous anxiety and uncertainty about the future. A pervasive sense of uncertainty characterizes the journey more than anything else.”  Dr. Jimmie Holland

Shocked, helpless, numb, confused, hopeless and seeking direction as to what she needs to do next describes the patient after hearing she has a breast cancer diagnosis. The patient, who most often is feeling physically well, has just heard words that will forever change her life. The diagnosis has just given her an entrance ticket into the world of cancer treatment—a world of unknowns, a scary place filled with many physical and emotional challenges. These challenges create a mental journey that is characterized by an evasive feeling of uncertainty.

Uncertainty is described in the dictionary as: doubt, unpredictability, indeterminacy and indefiniteness. After a cancer diagnosis, most patients feel that their body has betrayed them. Can they dare trust their own body again, or will it betray them again?  This is combined with the uncertainty of treatments. “What is the best treatment?  Will treatment work?  How can I get answers to my questions?  How long will this last? Will my cancer come back? Does anybody care about what happens to me?”

It is at this time of uncertainty that the Cancer Navigator comes into the patient’s life to help them deal with their overwhelming sense of uncertainty. As a trained Cancer Navigator, you can step into their world of fears and act as an anchor to hold on to. You come to their emotional rescue as a knowledgeable person who will navigate them through the unknowns of cancer treatment. You are a trained guide. You know the general direction of their treatment path. You know the various stops along the journey of treatment—surgery, chemotherapy and radiation therapy—and what they require. The overwhelming good news for the patient is that you are committed for the entire journey.

In a sense, you are like a GPS helping to map out their predicted journey. Like a GPS, if they get off course, you are there to help them find their way back or to find a suitable detour that will still get them to their destination. Just as a GPS serves as a sense of direction and safety when we are on a trip, we serve as a prepared guide for their cancer journey ready to offer directions without demands.

As a Navigator, your very presence and commitment for the journey reduces a patient’s uncertainty to a manageable level. You calm their emotional anxiety and reduce their fears with your navigation skills. Your presence is as valuable as any medical intervention to their recovery.