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A doctor's story
Dr. Marina Jacobson, scheduled to speak at the fifth annual Steps for Survival program on Oct. 7, plans to share a very personal story.
At the event – held for the Breast Care Center at Englewood Hospital – the board-certified ob/gyn and Tenafly resident plans to talk about her recently discovered family history of breast cancer and how it has affected her as a physician and a woman.
According to the Englewood doctor, when the U.S. Preventive Services Task Force announced its recommendations for new guidelines in breast health in late 2009, she reacted the way most of her colleagues did – “with equal parts disbelief and outrage.”
Said Jacobson, “The guidelines – which recommended that women start mammograms at age 50, instead of age 40; that mammograms be done every two years, instead of every year and also suggested that self-breast examinations are no longer needed – ran counter to the real-life experiences of thousands of patients and physicians, including me.”
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Dr. Marina Jacobson |
Jacobson said she is passionate in her belief that, in the majority of cases, patients simply don’t know their own family medical history.
“Incredibly, my grandmother’s sister had a mastectomy in her early 30s but we never knew why and, to this day and despite her own brush with breast cancer, my mother insists that her aunt did not have breast cancer.”
In February 2010, Jacobson’s mother was diagnosed with Stage IV breast cancer.
“I was shocked,” she recalled. “I asked myself, how could my own mother slip through the cracks?” Her mother had had annual mammograms until two years ago. She decided at that point that she did not need to do this since she felt the mammograms were painful and, she thought, she had no family history of breast cancer.
A few months later, Jacobson’s 42-year-old cousin – who had never had a mammogram because she was “too busy” and had “no family history” – finally got one, showing a tumor.
At that point, said Jacobson, “my world was shattered.”
Her cousin was scheduled for a mastectomy with a breast surgeon in Manhattan – a step Jacobson felt was premature. Her cousin had not yet been tested for BRCA 1 or BRCA2 genes, which predispose one to breast cancer, nor had the tumor been tested for estrogen and progesterone receptors.
In addition, she had met only with a breast surgeon, not with an oncologist. Jacobson stepped in to help, first testing her cousin for the BRCA mutations, as this could alter the treatment plan, and then referring her to a group of physicians – including a breast surgeon, plastic and reconstructive surgeon, and a medical oncologist – with a multi-disciplinary approach.
As it happened, her cousin’s genetic test results were positive for the BRCA 2 mutation.
“This was the first time that I had seen a positive result, and I had to break the news to my own cousin,” she said, adding that this dramatically changed the surgery plans.
“This takes time and skill,” said Jacobson, “and navigating the medical insurance system greatly complicates the process.” Her cousin’s new surgeon recommended a double mastectomy, as her chance of having breast cancer in her other breast was significantly higher over the next five years. Jacobson also learned that her cousin might need to have her ovaries removed, as BRCA mutations also carry an associated increased lifetime risk of developing ovarian cancer.
Jacobson said her mother’s tumor was found to be estrogen receptor positive, making her a candidate for a medication that blocks these receptors from interacting with estrogen. After five months of this therapy, the primary tumor regressed significantly.
“I’ve learned the hard way that no one is safe from breast cancer. We all must be vigilant and push the insurance companies and government for support in early detection,” said Jacobson.
“What the government task force failed to consider is that many people do not really know their family history.”
Jacobson feels strongly that every woman should have the opportunity to have a mammogram annually, starting at age 40. She is also puzzled by the task force recommendation that self-examinations are no longer needed.
“From my experience in my practice, most breast cancers I have diagnosed started with a patient reporting that they ‘feel a lump,'” said Jacobson, the mother of three daughters, who will continue to actively encourage self-examination for her patients.
“The past six months have altered me as a physician and a woman,” said Jacobson. “Now early detection and keeping my patients informed are deeply rooted in the type of care I provide.”
For more information about Steps for Survival, call Todd Brooks at Englewood Hospital, (201) 894-3000.
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