A nurse, in helping care for a young metastatic breast cancer patient, learned how genetic testing could have saved the patient’s life – and ultimately led her to get tested herself
In 2008, Tamara Hussong Milagre was working as a nurse in Lisbon, when a chance encounter with a patient led to a startling revelation.
Among her patients at the time was a 27-year-old pregnant woman named Sandra who was in the hospital to undergo a mastectomy after doctors diagnosed her with advanced triple-negative breast cancer. While caring for the young woman in the recovery room following the surgery, Milagre listened to the unborn baby’s heartbeat. She thought to herself, “What happened here? How could it come to this point, and what failed?” Sandra later had induced delivery at 32 weeks of pregnancy so that she could start her chemotherapy, but two years later, she lost her battle with cancer.
Later, Milagre learned that Sandra was genetically predisposed to breast cancer on her father’s side, with two aunts who died young of metastatic breast cancer. But her own personal risk was not considered serious enough to warrant the testing, said Milagre.
“I promised her on her death bed that this would not happen again,” Milagre said, “neither to her daughters, nor to mine.”
To make good on that promise, Milagre looked at her own history, which included a paternal grandmother and aunts that died from mBC and ovarian cancer. Upon genetic counseling, she underwent testing, which indeed proved that she carried the same BRCA1 gene mutation as her feminine forebears, which is called a germline or hereditary mutation. Moreover, she connected additional dots: a mother with breast cancer twice and a brother with a maternal mutation, as well.
“Now I understand why everybody in our family got cancer and many of them died of it,” she said. “I knew that cancer was lurking around the corner and I decided quickly to advance with the mastectomy.” She later underwent a complete hysterectomy.
These are radical surgeries in response to a probability – rather than a predictor – of cancer, Milagre explains. But regardless, the experience galvanized her onward when in 2011, she founded Evita, a Portuguese non-profit organization whose name relates to the word “avoid,” and is dedicated to supporting families affected by hereditary cancers. There are also broader implications here, she maintains, for national health care priorities.
“If we’re talking about keeping health care and its costs sustainable,” she said, “then we need to talk about prevention and early diagnosis. Hereditary cancers can be five times more expensive to treat than are sporadic cancers.”
Evita is also focused on dispelling myths about cancer prevention.
“You can still enjoy life!” she says with clear enthusiasm while noting potential side effects following surgery to induce early menopause and prevent ovarian cancer, such as hot flashes and weight gain. “Ask any late stage diagnosed woman if she would have preferred to avoid or to have known in time about her cancer….for me, it was absolutely the right decision. I can show people how not to be afraid of genetic testing because life continues and, oftentimes, very well.”