“The Bold Type” and that gene

I get a lot of TV show recommendations from my patients these days. I try to watch as many shows as are recommended with some reference to genetics. This series will focus on the BRCA1 and BRCA2 genes, or more colloquially, ‘that gene’. This is part two of a multipart series and will contain spoilers.

My recent guilty pleasure show is The Bold Type, which follows three millenial women who work at Scarlet- a global women’s magazine à la Cosmopolitan Magazine (upon which the show is based). During the episode about breast health, the characters are discussing story ideas. It is a quick fire round of ideas that could be turned into a full story, bringing about the following conversation:

Alex: I met a female doctor who thought with the right family history, women should be offered genetic testing for mutations in the BRCA genes to women in their 20s.

Jane: That’s way too young!

Jacqueline: Why do you think that?

Alex: Well actually a lot of people do. She’s taken a lot of flak for giving a preventative double mastectomy to a woman in her 20s.

Jane: In her 20s? That’s so irresponsible.

Jacqueline: Is it? I think we need to find out.

What we find out as the story unfolds is that our young heroine Jane has a family history of early-onset breast cancer in her mother. This story will obviously affect her very differently than  our other female leads who have no family history or personal experience with cancer. 

Let’s break down the different parts of the episode and put into context what someone may experience in the real world.

Reviewing the facts with the “BRCA doctor” goes by quickly. The doctor reviews the facts in much the same way the characters are used to throwing out story ideas: quick, dirty, and to the point with no time wasted on fluff pieces or commentary. While the BRCA doctor does a nice job with the facts, I agree with Jane’s assessment that she is very aggressive.  Here are the facts presented in the show:

  • If one of your parents has a BRCA mutation, then you have a 50% chance of having it ✅
  • If you test positive for a BRCA mutation (as a woman), then your lifetime chance of breast cancer jumps from 13% to 80% ✅ [The numbers change slightly depending on your source, but close enough for a checkmark!] 
  • The chance of getting breast cancer in your 20s is low ✅
  • Prevention is always better than cancer. ✅ [ Perhaps cliché, but ✅✅]
  • Family history of breast cancer in your mother at 32 makes you an excellent candidate for testing ✅
  • Results in one week? 👎 Typically 2-3 weeks, but one week is possible for urgent situations

While I think it’s great for everyone to be offered the testing, there is grace in acknowledging or recognizing that not everyone wants to know or not everyone is ready for that information right now. It’s okay to take some time and think about this decision. Jane is clearly upset by the conversation, so I may have taken a different approach. There is room for many different tactics in this world. I’m glad that there are aggressive types out there because as it demonstrated in the show, being aggressive starts the conversation about genetic testing. If Jane hadn’t become upset about the aggressive tactics of this BRCA doctor, there would have been no story. Sure, she stays upset for a while. This is not just about the information she’s processing, it also involves memories and feelings and non-logical information.  She’s still grappling with how all of this information fits in with her memories of her mother struggling with breast cancer, with how breast cancer stole her mother from her while she was still a little girl, and with how she may now be faced with the knowledge that she could suffer through the same cancer diagnosis as her mother. 

I am one of those people who wants all of the information. I want to know all of the nitty gritty little facts. In my experience, many people who make it to a genetic counseling appointment also want the facts. But not everyone. Just like no two people are the same, no two genetic counseling appointments are the same. Even the character Jane- who generally is interested in learning everything and she’s explained in the past that’s why she became a journalist- is anxious and upset with all of the information being presented to her during her appointment. The doctor even states that she doesn’t believe every woman in her 20s should have the test, yet should at least be offered the test. Some people thrive on information, while others get more power from other avenues, such as knowing something like an increased risk of getting breast cancer is a possibility and moving on. They live their lives knowing it could be there, and choose to move forward anyway.

For Jane, she just wanted support and understanding. She needed her friends to be there with support instead of opinions. Everyone has their own opinions about this topic. Friendly encouragement can sometimes toe the line with feeling cajoled into getting the testing done. I’ve heard complaints that family members forced people to meet with me, tried everything they could to get the patient to not see me, told the patient that it’s okay to see me as long as they don’t get the test, or as long as they don’t get the surgery. Genetic counselors will meet with you wherever you are, mentally or physically. They will do their best to provide you with support, whatever your support structure looks like (or doesn’t). By the end of the episode, Jane goes back to see the doctor to get the test done with her full support team in tow. Then she shares her story to help others. I hope this story serves the same goal.

Questions about that BRCA gene and whether you should have a test for it? Schedule with one of our certified genetic counselors here https://geneticsupportfoundation.org/appointments

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