Genetics are built compounds, making us fascinating scientific jigsaw puzzles. As we function day-to-day applying sunscreen on our ‘Mum’s nose’, trying to wear flattering clothes for the stocky build that we got from ‘Dad’s side’ and taming those curls that great-aunt Marilyn also had, our DNA contributes to our overall identity.
However, genetics isn’t always about appearances and character traits. Many people are dealt a difficult hand, with a medical illnesses passed down along with other characteristics like blue eyes or blonde hair.
Bree Wakefield, 31, has the BRCA2 gene from her father’s side.
BRCA2, along with its sister, BRCA1 is the most well-known gene linked to breast cancer risk. People like Wakefield who have this genetic mutation, have up to a 65 per cent risk of developing breast cancer, where the average Australian woman has a risk of 10 to 12 per cent.
While less than one per cent of the population actually have the BRCA1/2 gene mutation, these individuals make up a significant portion of breast cancer patients. At least five per cent of people with breast cancer are people who carry the same genetic mutation as Wakefield.
Being a BRCA2 carrier, Wakefield has had to deal with being high-risk to illness and also seen many of her family members battle the trauma of cancer. Despite this, she tries to keep a positive outlook and feels empowered by the discovery of her genetic status, provided by the science of genetic testing.
Last year, just after her 31st birthday, Wakefield made the difficult decision to have her breasts surgically removed; a way to prevent the breast cancer diagnosis she saw her grandmother, great-aunt and her aunty all experience before her.
“I owe my BRCA2-positive diagnosis to my aunty who had genetic testing due to our significant family history of cancer,” Bree says.
"From early on I had no doubts that I would have a mastectomy. I felt that I could use the knowledge of being a BRCA2 carrier to alter my destiny and prevent my family and I from going through cancer and all its hurdles and heartache.”
“I was initially shocked when I had my diagnosis not long after, which revealed I was also carrying the gene mutation. But from early on I had no doubts that I would have a mastectomy. I felt that I could use the knowledge of being a BRCA2 carrier to alter my destiny and prevent my family and I from going through cancer and all its hurdles and heartache.”
Even though having mastectomy and reconstruction (breast implants or using own body tissue) is common for many women aware of their gene mutation, Wakefield admits that taking charge of her medical fate was not easy.
“Changing my body was a big deal for me. I was really concerned with how my ‘new’ boobs would look, which seems quite vain given the circumstance, but a reality for many women” she says.
“I was also really concerned about how long my recovery would be. I’m a mum of three young kids and very involved in community projects such as School of the Air and distance education. As a lively person used to activities that demand energy, I didn’t have time to sit out from my busy life.”
Wakefield lives on a property that farms sheep and wheat just 75 km North-East of Mildura, Victoria. Her inability to access services is a problem facing many women living in rural and regional areas who struggle with the consequence of preventative cancer surgery.
The price of inheriting a BRCA gene mutation is high. Sue Jones, Programs Manager of Pink Hope, a health organisation providing support to women at risk of breast cancer, says that mastectomy surgery has many costs beyond medical expenses.
“Even if women go through the public health system where no payment is exchanged there are other costs associated with the invasive surgery,” Jones says. “These include, not being able to work and needing extra help or services in the home such as, house work, childcare, food preparation and travel and driving.”
While women in Australia are fortunate to go through a healthcare system where treatment can be funded under initiatives like Medicare, BRCA 1/2 carriers compromise their comfort by having to go on long waiting lists and are unable choose their own medical team for such sensitive surgery.
Some patients can use their private health cover to remedy this. However, if their chosen medical team charges over the ‘scheduled fee’ (a fee set by government rebates and private health insurers), patients are left paying a hefty gap between their health care allocation and the cost of surgery. In some cases, this can leave women "out of pocket $20K", says Jones.
Wakefield says that with all the positivity that comes with having a preventative mastectomy, many people don’t realise the strain on carrier’s emotions.
“My surgery was major and my recovery was long, but I was able to dodge cancer, unlike some of my friends who were battling the disease which occurred from sporadic causes,”
“My surgery was major and my recovery was long, but I was able to dodge cancer, unlike some of my friends who were battling the disease which occurred from sporadic causes,” she says.
“I feel very fortunate in that I was able to avoid cancer before it became a reality. This is why I’ve since been passionate about spreading the word and creating awareness of inherited breast cancer genes. I hope that through discussing my story with others, we’ll see more people get tested to change their medical destiny.”
While Wakefield has reduced her own breast cancer risk and is adapting to life with 'new boobs', she now faces another challenge as a parent who has quite possibly passed on the BRCA2 gene to her daughter.
“It wasn’t until I went through my preventative mastectomy that I realised the enormity that I have likely passed on to my children,”
“It wasn’t until I went through my preventative mastectomy that I realised the enormity that I have likely passed on to my children,” she says.
“Not only am I worried that my children may inherit the BRCA2 gene, but I’m also saddened for our ongoing generations.
“My daughter, Alice is only 4 so her understanding of our family medical history goes as far as, ‘I had to get new boobs, as my old ones might have made me sick’.
“But as she grows, I intend on being very open about her high risk of breast cancer. Hopefully I can stand as a positive role model for her and demonstrate that being a BRCA2 carrier is not a curse. However, I hope that when Alice is older and has been tested, there will be a less drastic and invasive way to decrease her breast cancer risk.”
Wakefield was diagnosed with the BRCA2 gene when she was a 25-year-old newlywed and first time parent. Five years later, after researching her genetics and preventing her biological fate she continues her rewarding and demanding life as a mother.
She looks at her old breasts as having done their job, as she says she is eternally grateful for the experience of breastfeeding her children. While the biology of Wakefield’s natural breasts may have given her children a genetic mutation, they also facilitated a tie that she reflects on fondly - the ability to nurture her children in their first stages of life.