To celebrate Breast Cancer Awareness Month, Kathy Pratt, BSN, RN, OCN®, CBCN®, ONN-CG, a genetic patient navigator at UT Southwestern Simmons Comprehensive Cancer Center, discusses her role in reaching out to patients identified to have a greatly increased risk of developing cancer in their lifetimes. In this interview, she shares her advice in helping individuals prevent cancer, as well as her answers to her patients' common questions about breast cancer.
This interview has been conducted in partnership with the National Breast Cancer Foundation (NBCF). Recognized as one of the leading breast cancer organizations in the world, NBCF is Helping Women Now® by providing early detection, education, and support services to those affected by breast cancer. A recipient of Charity Navigator's highest 4-star rating for 14 years, NBCF provides support through their National Mammography Program, Patient Navigation, breast health education, and patient support programs. For more information, please visit https://www.nationalbreastcancer.org/
Oncology Data Advisor: Welcome, everyone, to i3 Health Oncology Data Advisor. Today we're excited to introduce Ms. Kathy Pratt.
Kathy Pratt, BSN, RN, OCN®, CBCN®, ONN-CG: Hello. I'm Kathy Pratt, and I have been an oncology nurse for 37 years. Most of that has been in breast cancer, genetic navigation, research, and cancer genetics. I work as a genetic patient navigator.
Oncology Data Advisor: Can you tell us a little bit about what you do as a genetic nurse navigator?
Ms. Pratt: Sure. Just a little background: we know that about 5% to 10% of all cancer is due to an inherited pathogenic variant or an inherited hereditary broken gene. People who have these broken genes have a greatly increased risk of developing cancer over their lifetimes. Our cancer genetics program identifies these individuals that have one of these pathogenic variants. My role as a navigator is to reach out to these patients identified through our program and make sure they're up to date on their screenings and their management guidelines, which sometimes even include preventative surgeries. Because we know that these people have such a greatly increased risk for cancer, the time to find out about this is that when we have time to prevent cancer or detect it early.
I also reach out to their family members, with their permission, to encourage what we call cascade testing. This is genetic testing for their family members to find out if they also carry that pathogenic variant, because we know if an individual has a pathogenic variant, their immediate family members—their parents, siblings, and children—each have a 50% chance of also having that same pathogenic variant. Again, this would give us the opportunity to prevent and/or early detect any cancer.
Oncology Data Advisor: If I might ask, what is the average age of your patients?
Ms. Pratt: Oh boy. It can be people in their thirties, forties, fifties, sixties. Most of these hereditary cancers occur in people younger in age, say in their thirties or forties. That is one of the landmarks of one of these hereditary cancers, that they're diagnosed generally at younger ages than those cancers diagnosed in the general public.
Oncology Data Advisor: Is there any role for nutrition and exercise in preventing cancer in these patients?
Ms. Pratt: Absolutely. We know that with breast cancer, weight gain during adult life and/or excess body weight can increase a woman's risk for postmenopausal breast cancer, and weight loss may help lower this risk. Keeping a body weight in healthy range is important, as is to avoid weight gain in adult life. Then just to talk a bit about physical activity: we know that physical activity, especially moderate-to-vigorous physical activity, can reduce the risk for postmenopausal breast cancer and may also lower the risk for premenopausal breast cancer. In addition to moderate and intense physical activity, we also need to limit our sedentary behavior, which we're really good at doing: watching TV, sitting in front of the computer, that kind of thing. Then as far as nutrition, we all need to follow a healthy diet pattern at all ages. This includes eating a wide range of nutrients and food that matters, not just empty calories.
We also talk about eating the colors of the rainbow. Tomatoes are red. Squash can be yellow or green. Spinach is green. These all provide a variety of nutrients for our body. We also need to incorporate whole grains into our diet, but these are for cancer prevention in general. Then in addition, we need to limit or omit red or processed meats, sugar-sweetened beverages, and anything with refined grains. Again, we want to encourage whole grains. Then just to touch on alcohol—it's best to not drink alcohol at all, because alcohol use increases the risk for both premenopausal and postmenopausal women. But if someone does choose to drink, the recommendation is no more than one alcoholic beverage per day for women and no more than two per day for men. Then the last thing, just touching on this whole topic, is that none of us should be smoking.
Oncology Data Advisor: There is really a lot that we can do as individuals to help prevent cancer. Do you have any tips or tools that you give to people?
Ms. Pratt: Well, I struggle with it personally, and so every day is a new day. I encourage people that any movement is better than just sitting down. We talk about parking further at a grocery store so that it increases your steps, or taking the stairs instead of the elevators when you can. Think about your choices when you're eating. Would a candy bar do me as much good as eating an apple, for example? Even drinking some orange juice is not as good as actually having the orange itself. So it's just about choices on a daily basis. We encourage people to make more choices in the healthy column than in the not healthy column, but nobody's perfect. It's just about your daily effort and starting over with each choice that comes to you.
Oncology Data Advisor: What are some of the questions you commonly encounter from patients with breast cancer, and how do you counsel them?
Ms. Pratt: Well, one of the main questions I always get is, "Why did I get breast cancer? Nobody in my family has breast cancer". The big takeaway is that 85% of women with breast cancer do not have a family history. So 85% do not have a family history. We know that with the hereditary cancer, about 5% to 10% of cancers are hereditary. If someone has a family history of breast, ovarian, or prostate cancer, they are at increased risk for developing breast cancer. Some of this may be due to the genetics, this inherited pathogenic variant. Some of it may be due to shared lifestyle factors or other family traits.
Another question is, "What stage is my breast cancer?". There's staging and there's grading. Oftentimes, the patient might confuse those. Grading tells us how normal or abnormal those breast cancer cells look under the microscope to normal tissue. Then staging tells us the extent of the disease throughout the body. That's the TNM system. T is for what size is the tumor, N is for lymph node status, and M is for metastasis, which means that the disease has spread outside the primary cancer site. We take where the person falls into each of those three categories, and that determines their overall stage.
Another question that comes up is, "Will I need to have my breast removed? Do I need to have a mastectomy?" This is not always the case. It depends on the tumor size, the location, the breast size; it's a supply and demand issue. Is the lady eligible to get radiation therapy? If someone does have a partial mastectomy or lumpectomy, then they have to have radiation therapy to the breast, as well. But we know that overall survival is the same if someone has had a partial mastectomy followed by radiation, or if they've had a mastectomy. The overall survival is exactly the same.
The last question is people think they automatically will need chemotherapy, and this is not always the case either. When we talk about treatment for breast cancer, there's local treatment, which is surgery and/or breast radiation, and then there's systemic therapy, which goes all through the body. That includes chemotherapy, endocrine therapy, etc. What a woman has done surgically to the breast, whether it's a partial mastectomy or mastectomy, has no impact on what systemic therapy or chemotherapy or endocrine therapy she might need. Everything is an individual decision based on that particular woman's cancer.
Oncology Data Advisor: Well, that's interesting. Now there are also even more options sometimes with the role of biomarkers. So there are some targeted therapies for breast cancer that can be given so patients can escape the general systemic chemotherapy, correct?
Ms. Pratt: Absolutely. Some women only need what we call endocrine therapy, which is a form of targeted therapy. It's standard procedure to do these biomarkers on a woman's tumor. Two of these biomarkers are hormone receptors. We look at estrogen receptor and progesterone receptor, or ER and PR. Most women's cancers are dependent on these hormones, one of these hormones at least, to grow. Part of our targeted therapy is to impact the availability of these hormones to get to any breast cancer cells. That's what we call hormonal or endocrine therapy. There's also a protein on the cell, which about 25% to 30% of women's tumors have, called HER2. This is a protein that can help the cells to grow and divide. Again, if a woman's tumor expresses this protein, then we can administer targeted therapy, such as a drug called trastuzumab, to target those cells specifically. Again, it's very customized treatment for people.
Oncology Data Advisor: Well, that's great to know. Thank you so much. This has been fantastic. Do you have anything else that you'd like to add?
Ms. Pratt: Again, most breast cancers occur in women with no family history. The two main risk factors are being female and getting older. Again, that affects all of us females. Men can get breast cancer. About one in a hundred cases occur in men. Again, about 5% to 10% of all cancer is due to these inherited genetic mutations. By having the chance to find out that someone has one of these mutations with these strong family histories, then we can prevent or detect early these cancers.
Oncology Data Advisor: Well, thanks so much. This is such interesting information.
Ms. Pratt: Well, thank you for the opportunity. I really appreciate it.
About Kathy PrattKathy Pratt, BSN, RN, OCN®, CBCN®, ONN-CG is a genetic patient navigator at the University of Texas Southwestern Simmons Comprehensive Cancer Center. She has been involved in oncology nursing for 37 years and is experienced with breast cancer, cancer genetics, patient navigation, genetic navigation, and research. She is the incoming president for the Dallas Chapter of the Oncology Nursing Society (ONS), a member of the Academy of Oncology Nurse & Patient Navigators (AONN+), and a member of the AONN+ Genetics and Genomics Committee.