What have you inherited from your parents?


Angelina Jolie announced on March 24, 2015 that she has had her ovaries and fallopian tubes removed over fears of cancer, following her double mastectomy two years ago. - AFP

One of the most prominent liberal ministers of the early 20th century, Harry Emerson Fosdick, once said: “Life consists not simply in what heredity and environment do to us but in what we make out of what they do to us”.

Indeed, in the 21st century modern medicine, it is totally possible to detect what one has inherited from one’s parents, and what they can do to us.

I don't usually have the indulgence of watching a movie, but recently had an opportunity to be captivated by the Oscar winning portrayal of Julianne Moore in the movie “Still Alice”.

I was saddened by the cruelty of a rare hereditary Alzheimer’s disease, robbing the Alice of the memory of her past which she desperately tried to hold on to.

I was even more painfully upset by the fact that the patient was apologising to the children for carrying the genes that may affect 50% of the next generation. Did she even have to express regrets for the brutality of the defective genes that is beyond her control?

The tragedy of hereditary diseases really reminded me of another actor, Angelina Jolie, who rejected the fate of bad genes.

In 2013, Jolie underwent prophylactic double mastectomy, after learning she had 87% risk of developing breast cancer due to defective BRCA1 gene.

She inherited the BRCA mutation from her mother, who suffered from breast cancer, but died of ovarian cancer.

Jolie’s grandmother also died from breast cancer. In March 2015, after detecting the raising of tumor markers, Jolie underwent another preventive operation, as the calculated risk of her developing ovarian cancer due to the same genetic anomaly was 50%. 

Jolie detailed her experienced in The New York Times, describing her informed health choices to undergo these preventive operations as proactive measure for the sake of her children.

Although in Jolie’s opinion, knowledge is power, one still cannot deny the fact that knowledge is also a “burden” passed on to the next generation.

Having read many accounts of the courage and empowerment of Angelina Jolie, I asked myself two pertinent questions: “Is the quest for what bad genes one inherited from the parents a pathological fear of death or merely a sensible preservation of life?”

One of the pioneering American psychologist and educator, G. Stanley Hall, had the incredible foresight of stating: “The man of the future may, and even must, do things impossible in the past and acquire new motor variation not given by hereditary.”

In fact, we have even reached the possibility of identifying what is undesirable that we inherited from the parents, we can change the course of such misfortune. On that note, let’s answer a question of what you may inherit from your parents on this special day of Mother’s Day.


Dear Dr. G,

I am Simon and I have a dilemma that I hope you can help me to resolve. I am 54 and have relatives with strong family history of breast cancers.

My mother, sister and aunt all had the diagnosis of breast cancer treated in the local university hospitals. They are all doing extremely well and the specialists had pointed out we may have family history of breast cancer genes, BRCA mutations.

The doctors had asked my other family members to have the tests. Apparently, even the men have to have the tests as this may cause prostate cancer.

Frankly, I am worried. I am not sure I am ready to know my risk of getting prostate cancer. What will happen when I know my risk?

Is there such a thing as preventive surgery for prostate cancer? If so, what are the consequences?

Regards,

Simon.



BRCA1 and BRCA2 are normal genes in human that help to stop cells becoming cancerous, by producing proteins that fix our DNA. 

The mutations of BRCA genes can occur in both men and women, increasing the risk of breast cancers in both genders and ovarian cancers in women.

The association of faulty BRCA genes with prostate cancer is less well delineated. The risk of prostate cancer is 3.4 times and 8.6 times with BRCA 1 and 2 mutations, respectively.

While the risk of prostate cancer is increased with such mutations, the majority of prostate cancers are not hereditary.

Recent data also highlighted men affected by prostate cancer associated with BRCA genes are also likely to be more aggressive. As a result, men with defective BRCA genes are encouraged to have regular PSA and rectal examinations.

Early diagnosis with biopsies and radical surgeries are also recommended.

The “Jolie” influence had prompted a headline of a man with mutated BRCA gene having prophylactic radical prostatectomy. The truth was the man actually already had the biopsy-detected cancer, and therefore there were no “real” first radical prostatectomy done in men for preventive purposes.

Like the mastectomies and oophorectomies, all operative interventions carry their risks. Although, the radical removal of the cancerous prostate can be carried out with the assistance of robots, the long term possibilities of erectile functional compromise and urinary incontinence cannot be under-estimated.

One of the most famous twentieth century Christian Physicians, Paul Tournier, once said: “Acceptance of one’s like has nothing to do with resignation; it does not mean running away from the struggle. On the contrary, it means accepting it as it comes, with handicaps of heredity, of suffering, of psychological complexes and injustices.”

On that note, I would like to take this opportunity to thank my mother for everything I have inherited from her. Good genes or bad, her kindness and love have truly nurture me to the person I am today. Happy Mother’s Day, Mom!


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