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Higher Incidence of Breast Cancer in the Bahamas
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Posted by:Mar 26th 2010, 01:02:50 am
The Fig Tree News TeamBREAST CANCER AWARENESS MONTH - ANEWHOPE

University of Miami researchers are probing why Bahamian women are contracting breast cancer at an early age. They’re trying to develop a simple screening test that pinpoints a genetic mutation from centuries ago.
BY FRED TASKER ftasker@MiamiHerald.com

University of Miami medical researchers say they are close to solving a medical mystery: why Bahamian women tend to get breast cancer earlier in life, and in a more aggressive form, than other women. The breakthrough is a step toward new screening tests that could identify those at risk.

‘‘We believe strongly we have found some bad genes in the Bahamas,’’ said Dr. Judith Hurley, a UM breast-cancer specialist and lead author of the Bahamas study. ‘‘And in such isolated island populations, the genes are passed on. They go round and round within extended families on small islands and stay in the population.’’

Hurley and her team have looked at 18 Bahamian families in South Florida and are launching a wider study, seeking 200 volunteers with breast cancer in Freeport, Nassau and the Out Islands.

The early study already is providing valuable information. Corlette Floyd, a Bahamian woman who lived in South Florida, learned she had the mutant gene. She died of breast cancer earlier this year, and her daughter Kimberly, 20, discovered she has the mutation and is considering a mastectomy in hopes she can prevent contracting breast cancer.

‘‘Because I’m so young, they say I have time to think it through and still decide in time,’’ she said.

Tracy Moss, of Freeport, volunteered for the latest study. She was diagnosed with breast cancer this year at 43; her mother was diagnosed at 34, her sister at 33.

‘‘I hope this study can say why this is happening,’’ said Moss, who recently met with UM researchers in Freeport. ‘‘Too many young girls in the Bahamas are getting breast cancer.’’

A Canadian medical researcher who has studied breast cancer gene mutations around the world said if the UM team can narrow breast cancer in the Bahamas to a few gene mutations, he can devise a screen to test Bahamian women for $50 each.

‘‘We could do it once, for all time. It’s genetic, so if your parents don’t have it, you won’t either,’’ said Dr. Steven Narod, director of the Familial Breast Cancer Research Unit at the University of Toronto. Those found at risk could take preventive steps — including surgically removing their breasts or ovaries and taking anti-cancer drugs such as Tamoxifen.

The UM researchers have joined the Bahamas Breast Cancer Initiative, which is trying to get women tested and set up a registry to track the number of cancer cases in the islands.

In Freeport, the Cancer Association of Grand Bahama is recruiting volunteers for the new study. ‘‘Women are very eager,’’ said association director Norma Headley. ‘‘They want information.’’

STARTED IN 2002

The UM-Bahamas studies began in 2002, after Hurley and Bahamian medical colleagues noticed that women there were being diagnosed with cancer at earlier ages than other women.

Puzzled, Hurley and Nassau’s Dr. Theodore Turnquest scanned breast-cancer patients’ charts from Princess Margaret Hospital and confirmed their suspicion — 48 percent of the patients were diagnosed before 50. In the U.S., less than one-third of patients are diagnosed that early.

‘‘In the U.S., breast cancer is for older ladies — 62 years old at diagnosis on average. That’s a big difference,’’ said Hurley, whose work is funded through the Braman Family Breast Cancer Institute at UM’s Sylvester Cancer Center.

So they launched a study of 18 Bahamian breast-cancer patients living in South Florida. In eight of them, researchers found one or more of three gene mutations that can predispose women to breast cancer.

Floyd, the Miami Gardens woman, discovered her risk through the UM study after it was found that her mother carried the mutant gene. Her mother was diagnosed at 29 and died at 47. Floyd knows she, too, carries the mutation. Her sister, Stacey, 25, does not.

‘‘I was a little depressed for a while when they told me,’’ Floyd said. ‘‘But with a lot of prayer I got through it.’’

She still faces the decision of whether to have her breasts removed. ‘‘I take it very seriously. If I decide, it will be in a timely manner.’’

Since the 1990s, scientists have known that mutations in two genes — called BRCA1 and BRCA2 — sharply increase a woman’s risk of breast and ovarian cancer. Women who have the mutations have up to an 85 percent chance of breast cancer and up to a 60 percent chance of ovarian cancer.

‘FOUNDER GENES’

Gene mutations vary widely. Across the United States, only one in 100 people has a BRCA mutation. But in Ashkenazi Jews — those of Eastern European ancestry — it’s one in 40. Three mutations found among Ashkenazi Jews are called ‘‘founder genes,’’ because they are believed to have arisen — perhaps hundreds of years ago — from a single common ancestor.

In the U.S., black women are less likely than white women to get breast cancer. But those who do get it die at an earlier age. At least 32 percent of black breast-cancer patients are diagnosed before 50; among white women, it’s 23 percent.

The Bahamas has no cancer registry, so its cancer rates are unknown. Based on the 18 Bahamian families in South Florida, Hurley said they believe they’re seeing founder-gene mutations that could go back centuries.

‘‘The mutation in the Bahamas probably came from West Africa as early as the 1500s,’’ Hurley said. ‘‘Some poor slave — male or female — had a spontaneous gene mutation in an egg or sperm cell. They happen all the time.’’

But when they happen in groups that are isolated for geographical reasons (such as the Bahamians) or cultural reasons (such as the Ashkenazi Jews) they get passed around to a greater percentage of the population.

‘‘Basically, the whole Bahamas is made up of 20 extended families — super families — that are tightly related,’’ Hurley said. ‘‘They’ve been there for centuries. A lot of them are related. You can recognize names from certain islands.’’

Her hope: If a few founder genes can be shown to be responsible for most Bahamian breast cancer, doctors can develop an inexpensive test just for those genes, rather than screening for every known gene mutation, which could cost thousands of dollars per woman.

BETTER TESTING

‘‘The benefit of finding founder genes is that you can offer more targeted testing,’’ said Talia Donenberg, a board-certified genetic counselor at Sylvester and one of the researchers who recently traveled to the Bahamas.

Kay Capron of Freeport understands. Now 41, she was diagnosed with breast cancer at 37 and was a volunteer in the first UM study. She can trace 11 family members with cancer on her father’s side. His people, the Donaldsons, came from Andros Island.

‘‘I did the gene testing and learned that the cancer was hereditary. I want to share my data so others can be informed,’’ she said.

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