Each oncology checkup, I examine lab results. Because kidney function appears to have declined since treatment for breast cancer, I wonder what to blame: chemo or contrast dyes? Equally likely, I imagine, genes and natural aging are responsible.
Recently I studied the glomerular filtration rates (GFR) and wished I could choose the higher score for non-African Americans. For GFR, two numbers appear for "African Americans" and "non-African Americans." I have diverse roots reaching across the world, including parts of the African continent, although I am mostly white. But what part of me is not? If only medical concerns could be mapped, organ by organ, I mused. Where would my kidneys fall?
Such musing is not unfounded. Breasts can be mapped, in a sense, with certain mutations clustering in ethnic groups. Although my own clinical medical tests did not reveal common BRCA mutations associated with increased risk for breast cancer, despite a range of relevant ancestors, there are other genetic mutations that cluster.
Researchers thus continue to learn more about how to prevent and how to treat cancers. Some studies, for example, have shown that African American women with breast cancer can experience a higher mortality rate. Last year, sharing research to understand why, the Journal of American Medicine Oncology published a study called, "Comparison of Breast Cancer Molecular Features and Survival by African and European Ancestry in The Cancer Genome Atlas."
All of us should try to collect stories about roots, including reports of cancer and other health issues (such as kidney disease) across generations. While we do not get to pick our genes, or know precisely which ones are affecting us at any given time, it is helpful to be informed about how ancestry plays into risks and health care decisions. For people who do not have access to trends within birth families, genetic testing can help to sort things out.
While we are more than the sum of our genes, genetic information is still useful. It is also essential to remember that although some cancer-predisposing genes or related factors are present at birth, other genetic mutations can occur as we live our lives. Because nurture and nature are intertwined, a genetic predisposition does not mean that cancer is inevitable. Environmental factors are part of the bigger picture of genetic mutations, according to the American Cancer Society, and responsible for most cancers.
Whatever our ancestries, being mindful of both nature and nurture can inspire us to seek answers on how to survive and to thrive. It fascinates me to think about genetic challenges and how I can address them. While I was not successful at tricking breast cancer genes, I have not thrown in the towel. I like to think that a gene for resilience, which seems to have been handed down by some relatives somewhere in the mix, is helping me to survive. In addition, I keep exploring healthy habits to cajole nurture into balancing nature. I know that my kidneys, blood, remaining breast and other bodily functions appreciate that.