Facing BRCA With Your Young Daughters
When a mother sees an article titled “Are the Kids All Right?” she is likely to read on eagerly to see what sage advice the article could provide to help her fulfill her maternal mission of keeping her child safe. We have all seen articles like this in the popular media. Usually the topics include bicycle safety, internet safety, or warning your child of “stranger danger”. As mothers, we feel a certain sense of security when we implement the tips in the article such as buying our child a securely fitting bike helmet, installing filtering software on our family computers, or teaching our child never to talk to strangers.
The story “Are the Kids All Right?” by CBS news reporter Mary Brophy Marcus addressed a far more complicated topic. The article describes a study in the issue of the journal Pediatrics that examines the emotional well-being of school-age girls with a family history of breast cancer or known genetic risk. Specifically, the study looked at girls aged 6-13 years with a family history of breast cancer or familial BRCA1/2 mutation (BCFH+ group) as compared to a group of girls without family history or familial BRCA 1/2 mutation (BCFH- group). Clearly, the “take home” tips from this study are far more complex, intricate, and situation dependent than the tips we glean from the typical parenting article. At the same time, with the expansion and increased accessibility of genetic testing, having empirically based knowledge of how familial BRCA 1/2 mutations impact the emotional health of young girls is vital.
The main findings of the study are quite intuitive and logical. First, general emotional well- being did not differ between BCFH+ girls and BCFH- girls. Second, BCFH+ girls reported more anxiety about their risk for breast cancer than girls without family breast cancer history or known genetic risk.
It seems to me that the findings of this study speak to the resiliency of this population of young girls. It is normal and expected that a girl with a family history of breast cancer or known genetic risk will have greater anxiety about her own personal risk. However, the anxiety about breast cancer remained its own entity. It did not infiltrate into the general emotional well-being of the girls studied. This may speak to an adaptive capacity of young girls to compartmentalize anxiety in a way that adults only wish they could achieve.
The third main finding of the study allows us to infer how anxiety can be lowered in young girls with family history or known genetic risk. The study found that girls’ anxiety about breast cancer was associated with higher anxiety of their mothers. What follows from this, is that lowering a mother’s anxiety about breast cancer will help improve a young girl’s ability to cope with family history or genetic risk.
So, how does a mother lower her anxiety about breast cancer, family history, or genetic risk so that she could take care of her emotional well-being and be a strong role model for her daughter as well? Strong coping skills are the best arsenal in fighting anxiety. In most instances, we do not have the power to change the circumstances that we are in. A woman cannot change the fact that she has a family history of breast cancer. What every woman can change, however, is how she thinks about the fact that the family history is present. Children often look to their parents for cues on how to think about information that they are unsure how to interpret. Mothers need not hide their anxiety; children appreciate emotional honesty. A daughter will feel that her anxiety is validated if she observes that her mother shares some of those same emotions. Seeing her mother exhibit coping mechanisms is even more reassuring and helpful. Some important ways to model coping include the following:
- Break challenges into small, manageable pieces: Show your daughter how to do this by modeling through your own actions. For example, instead of conveying a message of “I need a complete solution to the issue of genetic risk in my family ASAP”, show your daughter how coming up with a plan for the next step is more realistic, reassuring and helpful. For example, “I am going to set up an appointment to consult with a known specialist in the area ASAP.”
- Avoid the urge to catastrophize: Catastrophizing is defined as having the irrational belief that something is far worse than it actually is. Catastrophic thinking is a type of cognitive distortion (distorted way of thinking) that can lead to negative emotional states such as anxiety and depression. An example of catastrophic thinking in the case of known genetic risk for breast cancer would be “I am definitely going to get breast cancer at a young age. When I do, my family will not be able to function and life for everyone will be a nightmare.” While familial history of breast cancer can certainly make one think this way at times, catching yourself when you have such thoughts will be helpful to you and your daughter. When you become mindfully aware of your own catastrophic thinking, you can then consider other possible outcomes and more adaptive thoughts. For example, a less catastrophic thought would be, “If I am diagnosed with breast cancer in the future, it will be a challenge. But we do have great social support. My family will be okay as I get treated.”
The study in Pediatrics further explains that it is vital to recognize and address a young girl’s distress about breast cancer risk because any persistent distress in adolescence is linked with negative health behaviors such as smoking, alcohol and drug use. What follows from this concern are some other helpful directions for mothers or health professionals to employ when addressing their child’s distress.
- Incorporate positive and empowering health messages when discussing breast cancer familial risk: Explaining to a young girl that she can channel her concern to fuel healthy behaviors accomplishes two important goals. First, on a psychological level, being able to exert some control over a health issue is reassuring. Second, from the physiological perspective, reducing negative health behaviors and increasing positive health behaviors is clearly beneficial. Having ideas about fitness activities and nutrition on hand when you speak to your daughter is helpful. Brainstorm with your child about ways that fitness and nutrition can be fun for her.
- Convey the message that knowledge is power: While ignorance can be bliss at times, this is not the case when it comes to health issues. Knowledge can be both frightening and powerful at the same time. If we allow power to have more value in the “knowledge = power + fear” equation, we can then emphasize to ourselves and our families that with knowledge we can have the power to make changes, investigate possibilities, and feel hopeful. The net result is that the fear factor in this equation decreases in value.
This important study refers to BCFH+ young girls with the unique term of “pre-vivors.” “Pre” is a prefix that connotes before. This term suggests to me that no matter what challenges the future holds for these young women, they will be survivors. By incorporating some of the coping and health communication tips mentioned above, we are giving our young girls some of the tools they need to be pro-active survivors in their quest to live physically and emotionally healthy lives.
Parents should consult with a medical and/or mental health professional regarding when and how to speak with their child about this issue. Sharsheret is also available to address these issues with you.