Dilemmas of destiny
Lila (the patient’s name has been changed) was only in her 20s when she learned that she could be at increased risk for breast cancer. A genetic test had revealed that her mother carried a mutation signaling a heightened risk for the disease. But Lila opted to live with uncertainty — and the hope it engendered — a little longer. She wouldn’t test, but she would be vigilant, opting for frequent mammograms. At age 34, Lila, now the mother of two small children, learned she had breast cancer. Personalizing her treatment would require genetic testing. This time she consented. The procedure verified the mutation and revealed another detail: Her tumor flourished with exposure to hormones. “She knew the mutation increased her risk for a second cancer, so she chose bilateral mastectomy,” says Judy Garber, a Harvard Medical School (HMS) associate professor of medicine at Dana–Farber Cancer Institute and Brigham and Women’s Hospital....