Brian Middleton: Welcome back, Jacksonville. Happy Saturday to you all. It’s a little wet outside, but we’re so glad you’re joining us today for the conversation with Dr. Ali Kasraeian. I’m not Danielle Lee. I’m Brian Middleton, filling in for Danielle.
Dr. Kasraeian, thanks for letting me fill in this weekend.
Dr. Kasraeian: It’s always a pleasure having you.
Brian Middleton: How are you doing today?
Dr. Kasraeian: I’m doing great. Today, we actually had an amazing morning. We had our second annual Zero Prostate Cancer run. Our practice, Kasraeian Urology, is partnered with Zero Prostate Cancer, an organization devoted to their goal of ending prostate cancer, a tall order that they have devoted themselves to. It was our second run. We did the first run last year in December. This year, we had more than 400 runners. We more than doubled … Actually, we had about 250 or so runners last year, so we increased the amount of runners that we had this year.
We raised more than, I think, $61,000 or so. We still have funds, I think, coming in, from what I hear. I really want to thank Lori Batts. She’s the executive director of our clinic and our practice, for really making that happen. And our staff, everyone in our office that works so hard, so diligently. All of our sponsors. It wasn’t just a sponsorship. They were really integrated and involved. They met weekly and monthly over the past year to make this happen. All the survivors and their families and everyone came out to run, it was just a wonderful morning. Thank you for everyone who made that happen.
For my family and my dad and everyone in my family. Without my dad, the practice wouldn’t be here. He’s been doing this since 1986. To everybody who brought the practice here and making our practice be there, so thanks, dad, for letting me do all this stuff that I do, and for allowing all of us to do the things that we do. It was a great morning, and hopefully gives a little bit back to our community and raises awareness for prostate cancer in the last day of prostate cancer awareness month. I don’t know if there are 30 days or 31 days. Yeah tomorrow is October, so tomorrow begins breast cancer awareness month.
It’s a great back-to-back month for screening and awareness for a cancer that is very important to men and people who love men. September is prostate cancer and October is breast cancer awareness month. Today, we’re going to talk about an issue that is profoundly important and ever more important as we learn more and more about one of the most important factors, I think, to the future of cancer, both in terms of diagnosis, understanding, and as we learn more, potentially the treatment and personalization of how we manage cancers. The genetics of cancer.
To help us understand the history of our cancers and the heritage of our cancers and the tale of our cancers and the futures of cancers of those ahead of us is Alex Meyer. She’s an oncologenetic specialist of Ambry Genetics, a company that’s devoted to genetic testing. She’s calling in from California. She’s going to enlighten us with what I think is a very important for not only patients who are dealing with cancer, but the family of those who love them. Also, people that may not even know that they have cancer, but clinicians and physicians that deal with cancer that may not know these things exists. I think it hopefully will be a very enlightening discussion.
Alex, thank you for joining us.
Alex Meyer: Thank you for having me! Very happy to be here.
Dr. Kasraeian: Let me ask you, as we start this discussion, when you look at the discussion of genetic counseling, from both a discussion with physicians and discussion with patients, what is the most surprising thing for you as, obviously, someone who is devoted to the importance of genetics to application, to disease and cancer? The fact that it’s not used more often.
Alex Meyer: I think probably the most surprising thing, and I had this surprise when I first started my career as a genetic counselor and unfortunately, I continue to be surprised about it to this day, is how few people are aware that men can carry hereditary mutations. When you’re looking at a family history of cancer or any disease, really, that may have a genetic component, the paternal family history, your father’s family history, is just as important to look at as your mother’s. I spend a lot of time trying to overturn that concept that people have in their heads, that it’s really only mom’s family history that you need to think about.
Dr. Kasraeian: Where do you think that comes from? As far as I know, it takes a 50/50 contribution from both sides of the fence to create a fertilization process in the embryo.
Alex Meyer: Right. Right, and you’re 100% right. Not only that, but the cancer genes that we test for, they don’t exist on the x chromosome or the y chromosome. They exist on the chromosomes that males and females share. I think this misconception comes largely from that the fact that for the longest time, the only cancers that people really thought about being hereditary or genetic were breast and ovarian cancer. I think that’s partly due to the fact that the BRCA1 and BRCA2 genes are the most commonly known hereditary cancer susceptibility genes out there. They’re the ones that most people have heard of, partly because of Angelina Jolie and her experience having a BRCA1 mutation. It’s the kind of thing that doctors always have asked or been concerned about a family of breast cancer, but that seems to be the only cancer they’ve ever been concerned about there being a family history for.
I think the only other cancer that kind of has resonated or has rung a bell in physician’s minds, or I should say a good percentage of physicians, not all, of course, is colon cancer, which can obviously occur in men or women. However, I still find, even with my colon cancer patients, I would get referrals more often for women with a personal or family history of colon cancer than compared to men. I’m not sure where that disconnect came from, but I think a large part of it, we can lay at the feet of breast cancer and clinicians really only being concerned about hereditary components of breast cancer.
Dr. Kasraeian: I’ll tell you, that speaks volumes to the power of the advocacy and awareness of breast cancer awareness campaigns. They do an amazing job over the past two to three decades of raising awareness for breast cancer. Other cancers have not done as good a job. Right now, one out of eight men are said to get prostate cancer in their lifetime. It used to one out of seven. It used to be one out of six. I think the disparity in that number moving towards one out of eight is just because of the US Preventative Services Task Force recommendations against screening in 2012 that were doing less screening. Even still, I think the breast cancer world does a better job, and so the dollars that they got in terms of research allowed for that. The awareness allowed for more people to understand and be more aware of breast cancer, as far as some of the other cancers.
Just for the audience, 5-10% of prostate cancers are hereditary. The BRCA2 gene is an associated hereditary risk factor for prostate cancer, which, you know, BRCA2 is also associated with breast cancer.
Alex Meyer: Right, right. Like you say, the BRCA2 gene is one of the more common breast cancer genes. It is thought of as a breast cancer gene, or a breast and ovarian cancer gene. Very rarely are people aware that it does increase risk for prostate cancer significantly. I think there is something to the fact that the breast cancer community has done an amazing job with advocacy. I think they also have the advantage of mammograms being available as an effective screening tool. They’ve gotten the word out about mammograms. We haven’t had the same advocacy push or visibility placed on prostate cancer screening. When it does get visibility or attention, it’s usually negative attention and how it leads to over diagnosis and that sort of thing.
Certainly, it’s wonderful that the breast cancer has made the strides that it has, but we’d like to see that happen for other cancers as well. Certainly those associated with hereditary cancer susceptibility, like the BRCA prostate cancer association, we want to make that particularly visible.
Dr. Kasraeian: Let me ask you. Who should be aware of and look at the concept of genetic testing from both a patient standpoint or a, “I’m a general person, just kind of floating around, kind of curious about my cancer risk?” Or a clinician standpoint. Should all of us go and give blood and look at our genetic signatures and be concerned about this?
Alex Meyer: Well, there’s certainly some in the genetics community who would advocate that for basically general population-