Description
A woman has just been diagnosed with breast cancer. Her doctor tells her that while cancer is a multifactorial disease, she carries the breast cancer susceptibility gene, BRCA1. One of her two identical twin 19-year-old daughters is afraid that she also may have inherited the gene (Chapter 4, Learning Objective 2, 3, 8).
What considerations would you give her daughter who is worried about inheriting the cancer gene?
What ethical issues are raised when one identical twin wants to know her genetic susceptibility to a disease and other does not?
Book: Norris: Porth’s Essentials of Pathophysiology, 5e
response for each classmate, as per step 2 Respond with at least 100 words (each) to at least two classmates’ posts.STUDENT 1: Carla zueroCancer is the leading cause of death in adults worldwide, secondly to cardiovascular disease (Norris et al,. 2020). Breast cancer can occur in both men and women, but it occurs more frequently in women especially if family member such as a mother, sister or aunt have had breast malignancy. People carrying a BRCA mutation have a lifetime risk of 80% of developing breast cancer (Norris et al,. 2020).According to the National Institute of Cancer (cancer.gov) BRCA genes are tumor suppressing genes but when they mutate, they become harmful and then the individual is susceptible to breast cancer. In this scenario the mother has developed breast cancer and her teenage daughters may have also inherited the gene. Because the mother has a BRCA1 gene mutation, there’s a 50 percent chance the daughters will also have a BRCA1mutation (Susan G. Komen, 2021). Things that need to be taking into consideration are the genetic mutation, family history, environmental risk factors and lifestyle. There are many steps that can be taken to reduce the risk of breast cancer such as enhanced screenings that involves screening at a younger age and more often, risk reducing surgery, where both breasts are removed and chemoprevention drugs to reduce the risk of cancer. Taking these steps does not guarantee that they will not get cancer.An ethical dilemma that may arise when one daughter wants to test for the gene mutation and the other does not. First both should speak to their healthcare provider or a genetic counselor. A benefit to testing is knowing for certain if an individual has the gene mutation. Testing can help in understanding the disease and the step that needs to be taken to treat it. It is possible to inherit a harmful BRCA1 gene and never develop cancer (Susan G. Komen 2021). Ultimately it is the decisions of each individual whether they test for the mutation or not. It is possible that one sister may go ahead with testing and the other does not, but it will be a difficult secret to keep if, she is positive. Because in the case of twin they have both the same set of genesTo sum up, cancer is a disease that effects the genes, and many women suffer breast cancer. Mutation of BCRA1increases the risk of breast cancer. It is important for women to have screenings. Early detection is key in treating the disease. Genetic counseling may help families better understand and make informed decisions about treatment.National Cancer Institute. (2019, November 19). BRCA gene mutations: cancer risk and genetic testing https://www.cancer.gov/about-cancer/causes-prevent…Norris, & Tuan, R. L. (2020). Porth’s essentials of pathophysiology (Fifth edition.). Wolters KluwerSusan G Komen. (2022, March 21). BRC1 and BRCA2 inherited gene mutations in women https://www.komen.org/breast-cancer/risk-factor/to…STUDENT 2: Tiffany AI would explain to the daughter that breast cancer is a multifactorial disease involving multiple interactions between the environment and genes (single and multiple genes). It can be caused by diet, exercise, smoking, etc. If she wants to go through the diagnostic measures for cancer detection she will have to make an appointment, so the process can start. During the meeting I would explain, cancers for which current screening or early detection has led to improvement in outcomes include cancers of the breast (mammography), (Norris et al, 2020). Also, during the appointment I would explain that blood must be drawn to look for the presence of the gene. I would applaud her for wanting to know if the gene is present to start with the options of making sure the cancer doesn’t start. When one twin wants to know, but the other does not. It can cause a plethora of ethical issues. The healthcare team must be really careful with this situation. The healthcare team must make sure the twin signed the proper documentation, confidentially agreement, and obtain the correct contact information for when the results are ready. Also, we as the healthcare team must respect the twin who doesn’t want to know. Her autonomy is important as well of not wanting to know and offering her information of the steps involved when she is ready. References:Norris, T. L., Tuan, R. L., & Porth, C. M. (2020). Porth’s Essentials of Pathophysiology. Wolters Kluwer.
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