Using Family Loss to Sing Awareness of LFS for Mo and Kerry

 

My name is Kathy Higgins. I have lost 4 family members to LFS.

 

lfs-bio-minus-photos-just-pics

KERRY

Kerry was first diagnosed with cancer at the age of 12, an osteosarcoma in her thigh. She received chemo and had multiple operations on her leg. Kerry also had several small cancer issues over the years, skin spots on her face and back. She was not diagnosed with LFS at the time because the year was 1995, and LFS was just being discussed.

KerryShe was 30 years old when she passed away in 2014. She had a recurrence of breast cancer from 2005. Without the LFS diagnosis, her breast cancer would not have been detected due to her young age. She had a double mastectomy in 2006 when precancerous cells were detected in her breast. Kerry knew there was a 93% chance those cells could turn into cancer. About 1% of breast tissue was left after the surgery and that is where the cancer started to grow, fueled by pregnancy hormones. Many LFS breast cancers are hormone driven cancers. Kerry was the mother of 2 little girls, ages 3 and 5. She had a loving husband of 8 years.

MO

Maureen.In 2002, our second daughter Maureen who was 18 years old at the time, developed a stage 4 adrenocortical carcinoma before we even knew she was sick. At this time, doctors decided it was time to look further into our family history. Maureen had surgery and chemo, but did not respond well to chemo. We lost her within 4 months.

 

FINDING LFS

Upon researching our family history, we discovered my husband’s dad passed away at age 37 in 1966 from a brain tumor. In 1993, my husband’s sister died at age 32 after battling 3 different cancers, Breast cancer, cervical cancer and leukemia over 2 years. Now LFS was discussed as a possibility and Kerry was tested and positive for Li-Fraumeni Syndrome. My husband also tested positve, but not until 2015, until then we presumed he was positive since Kerry was.

My husband Jim did not present with his first cancer until the fall of 2014 with a sarcoma in his arm. The sarcoma was treated with radiation prior to surgery in 2015. All went well until another sarcoma was discovered in his thigh in May 2015. The sarcoma was removed with no recommended follow up treatment by Dana Farber Cancer Institute. We are scheduled to go back to DFCI in November for follow up and to check for new cancers.

MAKING A DIFFERENCE

As a wife and mother, I was beside myself with grief and terrified my husband was going to suffer the same fate as Kerry, Maureen, his dad and sister. I felt so helpless to stop this disease. I decided to become an advocate for LFS awareness and raise money for research. I want to be able to help identify other families that have the same mindset we had, in that we were just an unlucky cancer family. That changed when our LFS diagnosis was found. LFS Awareness is key to survival. Many doctors do not know about LFS and are missing key signs in families that could be affected with this mutation. My goal is to travel to all of the doctors and medical facilities in my surrounding area and try to educate them about LFS. Then they can help LFS families stay healthy. Currently we have to travel 6 hours one way just to meet with a doctor that is familiar with LFS and can help us follow a healthy protocol to screen LFS patients for early signs of cancer. In this day and age, this is just not acceptable. So, in September 2016, I travelled to California to attend a rare patient advocacy training conference, so I can be a better, more effective advocate for awareness and fundraising for the LFS community.
I can never bring back my daughters, father-in-law or sister in law, but if I can even identify one family that could be saved from the heartache our family has endured, it will be worth it.

MO SONGS FOR KERRY

Mo songs for Kerry Hiigins fam

I started an organization called Mo Songs for Kerry.org with a couple of my girls’ friends and family. Every year we host a large fundraiser in upstate New York. Our 4th Annual event will be July 29, 2017. We use this event to raise awareness for LFS but also to raise money for research. Local news stations helped us do this for our past event, we had 4 different stories run in the local TV market. We are very grateful for the support our local media has given ups and the awareness of LFS. A portion of the proceeds also go to a local hospital run guest home that caters to families with loved ones in the hospital and patients who are going through long outpatient treatments.

Li-Fraumeni Syndrome is a very difficult thing to live with. You are always waiting for the other shoe to drop and you feel like the boy who cried wolf if you go in for every lump, bump or pain as if it is cancer returning. It makes living a normal life more difficult but at the same time you learn to appreciate every day you are given. If you are diligent with screenings, you can live a normal life.

LIVING LFS

We can not let living with LFS cause us to not live life to the fullest. WE will do our best to live and honor our girls and their memory by living life as healthy and happy as we can. We know this is how they would have wanted it. Kerry lived with LFS for 10 years and got married, started a business and had 2 beautiful healthy non mutant little girls. She carried firewood into her house 3 short days before she died and was entertaining all the people in her hospital room mere hours before she passed away. She lived life to the fullest even with the tremendous burden on her mind. I am very proud to be the mother to these two special ladies and I hope to make them proud with my efforts to make a difference. I will be a warrior beside my husband and do everything I can to help him be screened carefully and get treated right away if any signs of cancer appear.

I am very grateful for the LivingLFS.org website and support group where we can connect with other families going through similar problems. We are all stronger if we support one another and share our trials and tribulations as well as our joys of negative test results and positive treatment outcomes. Before discovering this website we did not know a single LFS family. Hugs and Prayers to all of you out there dealing with LFS. We are stronger together!


Positively Living LFS, It’s NOT a Death Sentence.

Odds are that Li-Fraumeni Syndrome is THE most devastating hereditary cancer syndrome that you have never heard of, unless of course you know one of our families or you have had the misfortune of being recommended for genetic testing for a TP53 mutation. Odds are also that if you ran across an LFS family on the street, you wouldn’t know it- but pay attention. They are the ones living life to the fullest DESPITE the risk of cancer.

Learning you have Li-Fraumeni Syndrome can be one of the most devastating diagnoses a person can hear. It is overwhelming to learn that you may have more than a 90% chance of getting cancer in your lifetime. That you could or may have passed this gene along to your children. It is tough information to process. Diagnosis unfortunately often comes on the tail end or during treatment for cancer. Often other family members have or have had cancer as well, which is one of the reasons someone might be tested. I am not talking one or two cancers, I am talking about dozens of cancers. There are strict criteria that are followed before genetic testing is recommended. There are still many doctors who are completely unaware of LFS. There are many families who fit the criteria who have never been recommended for testing who might benefit from it. Yet so many who get the diagnosis find relief in knowing that it is not a curse. It is not something they “did”. The diagnosis although daunting gives them information to make better decisions about their health. It helps them to live better. Somehow, despite the diagnosis, the risk, families with LFS persevere and choose to live the positive rather than fixate on the negative.

When a newspaper publishes a sensational article about a false positive genetic test of Li-Fraumeni Syndrome and how devastating it is to the woman who thought for 7 months she had LFS and was going to die, our community takes the shot. Although we have plenty to complain about- rare are the complaints. Our community is stocked with strong fighters who are Living LFS. When a woman sues over the false positive- which is absolutely a thing that happens- despite the misinformation given to her by her doctor- it hurts our community. It also highlights several problems. There is not enough awareness of this rare condition. There are doctors giving out incorrect information and ordering genetic tests without the proper information and follow up with appropriate specialists, like genetic counselors.  I do not know the details of the lawsuit, but I do know that the article incensed our community. Mistakes do happen and there are consequences. Sometimes the collateral damage is significant. Yes this woman had 7 months of thinking she had a cancer syndrome, which at the end of the day she does not. We are sympathetic to this emotionally as we have hundreds of families who know they have the syndrome. The damage is to our community. We struggle to get adequate screening and care because the syndrome is so rare that most physicians have no idea it exists. The damage is to the people who actually HAVE the syndrome and can not pass this off as 7 months of anguish. True strength is knowing you have this syndrome and choosing to live while constantly advocating for your own health care.

brandy-ries-mutant-elle

Thank you to Brandy Ries for expressing how it feels to be living LFS.

Li-Fraumeni Syndrome is not a death sentence. No one gets out of this great big adventure in life without dying. Li-Fraumeni Syndrome is a hereditary cancer syndrome. Some families get heart disease. Others live with diabetes or severe metabolic conditions. Our risk of getting cancer is significant. We can pass along the gene to our children. Not everyone with LFS gets cancer. We have a vibrant strong support group online of individuals who not only have LFS but are living with this syndrome. They fight for awareness, they advocate for their care and their children’s care.  They face extensive medical bills. They spend inordinate amounts of time trying to get screening covered. They do so with grace and strength and a whole lot of laughter. We affectionately refer to ourselves as mutants. We get scanned, poked, prodded, cut and joke about expendable body parts. We have members who are students and professionals and scientists and artists. We have lawyers, doctors, nurses. We have teachers and equestrians and dance instructors. We are a cross section of society and are represented in countries all over the world. We may not have huge numbers or be a public health threat, but our history and genetics are significant to the war on cancer. Over 50% of all cancers, in normal people have mutations in p53- a protein that tells cancer cells to stop. These cancers can’t be passed along- they are in cells, tumors. We unfortunately have the p53 mutation in all of our cells- so at any given time cancer could pop up in any of our parts. It is also in our germline cells- meaning we can pass it along to our children.  Through it all, we cope and carry on. There is hope in our genes. Unraveling a major mystery of cancer is in our genes. You just have to find it. Like the positive side.

We do not wish this syndrome on anyone, as you would not wish someone to be in a car accident or be accidentally injured. When one of our LFS family members tests negative, we celebrate with them. It is a time we encourage negativity. We want more people to be negative for LFS.  When members test positive, we help with resources and support needed as they adjust. It is an adjustment. Yet there is so much misinformation and confusion out there as exhibited by the recent New York Post Article entitled Doctors Gave Me a Death Sentence After Genetic Mix Up. A woman was told she had Li Fraumeni Syndrome and that her chance of getting cancer was nearly 90% and she would just keep getting cancer until she would die.  There is no need to sensationalize a syndrome like LFS. We would like to clarify a few points.

LFS is not a Death Sentence. It is a Life Sentence. Knowing you have the TP53 mutation that causes LFS is vital to making preventative screening, treatment and health decisions. We are sensitive to radiation. This is a huge consideration in cancer treatments. Many chemotherapies are also cytotoxic and do not work as well with mutant p53. These are pieces of information needed for appropriate care and can change the effectiveness of treatment and quality of life. Knowing our status helps us make decisions day to day to help us stay healthy and give our bodies a chance to hold off cancer.

False Positives are a real thing. According to Merriam-Webster, a  false positive is defined as:  relating to or being a test result or an individual that is erroneously classified in a positive category (as of diagnosis) because of imperfect testing methods or procedures <a false–positive pregnancy test> <… one must bear in mind the cost of needless medical procedures generated by the huge number of false-positive mammograms …—David Plotkin, The Atlantic Monthly, June 1996>. A false positive means a person was told they have a disease or condition when they do not. The test result is actually positive, it could result from a contaminated sample, a mixed up sample, or clerical error. There are safeguards in place and ways to avoid this. The chance of getting a false positive is estimated to be less than 1%. That tells me the companies are very good at what they do- I wish I had less than a 1% error rate on any given task. It tells me false positives do not happen often, but they can happen.

According to a paper by Jhaveri et al, about the benefit and burden of cancer screening in LFS- regardless of family history, certain types of breast tumors and age at diagnosis are strong indicators for testing for TP53 mutations.

If mutations in BRCA 1/2 and/or Lynch syndrome-associated genes have been considered and not found, screening for Li-Fraumeni syndrome may be appropriate. Table 2 lists guidelines regarding whom to test specifically for Li-Fraumeni syndrome. In general, the Classic and Chompret criteria can help identify families at risk for germline p53 mutation, though it is important to remember that negative results do not rule out a diagnosis of Li-Fraumeni syndrome if the personal or family history is suggestive of the syndrome [2,10]. While most guidelines generally suggest testing for TP53 mutations in families with classic tumor types (sarcoma, breast, adrenocortical carcinoma, and brain tumors) and with cancer onset < age 45, an important independent testing criteria for clinicians to recognize is that all women with early-onset breast cancer (age of diagnosis < 35), regardless of family history, should also be considered for TP53 mutation testing, particularly if the breast tumor is Her2-positive.

Translation- there are many mutations that are linked to LFS. Some are not known. A negative test does not mean you do not have LFS. There is a condition called LFS-like- all the criteria are met, yet the genetic test is negative.  A strong family history is an important indicator of risk. A young woman with no family history and breast cancer is a candidate for genetic testing for LFS. Especially if her breast cancer is Her2 positive. Sometimes genetics gets ahead of our understanding. We have a lot to learn about what causes cancer and LFS. Until we have more information- it is important to meet with qualified professionals if you have a significant family history of cancer and are concerned. Genetic counselors are excellent resources.

New York Post Article- Doctors Gave Me Death Sentence After Genetic Mix-Up:Suit

It is true that there is not a lot of accessible information out there about LFS. Living LFS and other organizations are working to change that. We are happy to answer questions- our collective experience with LFS professionally and personally is extensive. Families with LFS spend a lot of time educating doctors and professionals on their condition. We learn to be our own best advocates. We do this day in and day out. It becomes part of our normal. It is a shadow that follows us, but we work hard to keep the light in front of us and move towards that.  We have many passionate professionals who have dedicated their life’s work to helping our families get the screening and care we need as well as the research to support what is best for our community. They do not do it for financial gain- they do it for our incredible families.

So before we vilify a group, a genetic testing company, we need to get our facts straight. What is the real issue here? The issue is not that one woman had a false positive. The issue is that the information given, although bluntly true- was not the entire picture or an accurate representation of the syndrome. The issue is that in the decades that this syndrome has been known- it still is not on the radar of many medical professionals meaning there are families out there at risk that haven’t been identified. There are families not getting the best information or being referred to the appropriate professionals to help them cope with the risk and emotional impact of this syndrome because it is rare. There are now families who were given positive tests who will demand retesting because of this statistical anomaly. There might be families who won’t get tested because they will not trust the results, because of this article. The issue is after decades- despite valiant efforts of multiple institutions around the world- there is no one screening regimen for LFS families that is a standard of care. The issue is LFS families struggle to get the care they need to live because the syndrome is so rare. Yes the syndrome can BE DEVASTATING but it doesn’t have to BE. THAT is the ISSUE.

So while we fight cancer and advocate and support each other. While we try to change these issues for our children, we continue to live LFS.  Please join us by spreading awareness, not misinformation. Get to know our families. Read some of our blogs, follow us on Facebook, Twitter, or Instagram. Give our special families a shout out so we know you support us and living LFS.

 

Resources:

New York Post Article- Doctors Gave Me Death Sentence After Genetic Mix-Up:Suit

“False–positive.” Merriam-Webster.com. Merriam-Webster, n.d. Web. 18 Sept. 2016.

Jhaveri AP, Bale A, Lovick N, et al. The Benefit and Burden of Cancer Screening in Li-Fraumeni Syndrome: A Case Report. The Yale Journal of Biology and Medicine. 2015;88(2):181-185.