As sisters, Donata Earley and Karen Switzer share an incredible friendship — and a troubling legacy.
The family photographs that fill Switzer's dining room help tell the story.
"She had breast cancer, she had breast cancer and she had breast cancer," Switzer says, pointing to pictures of her great-grandmother, grandmother and mother. Their faces smile back in black and white.
For Switzer, 41, her family history was a constant worry.
"You always think … in the back of your mind, 'Could it be my turn next?'" she says.
So, both sisters asked their doctors for a blood test to determine whether they carry the genetic defect that raises their risk for getting breast cancer. Women without that defect have a 12 percent lifetime risk of getting the disease. For women with the mutation, the odds can range anywhere from 50 percent to 80 percent.
For Switzer and Earley, the news was expected, but painful, as both had mutations on the BRCA2 gene, one of a number of genes linked to breast cancer.
They were then faced with the painful choice to consider having a mastectomy to avoid breast cancer.
Switzer, with just her family history and an elevated risk of getting cancer — the married mother of a 6-year-old daughter and 4-year-old son — chose to have a double mastectomy and breast reconstruction.
"My objective, really, was I wanted to get this before it ever got me," says Switzer. "I wanted to be part of my husband's and children's lives for a long time to come. "
Earley, a 45-year-old single mother to a 20-year-old son, thought that someday she would do the same.
She had just started a new job and planned to wait a year before surgery.
But six months later, she found a lump. It was breast cancer.
"I'm embarrassed to say I waited as long as I did," she says. "I'm embarrassed to admit I did have a choice. I was in the know and still decided to hold off."
The availability of the blood test, marketed by Myriad Genetics, and a recent advertising campaign to promote it, have raised concerns about whether the ads create undue anxiety about a diagnosis that may never come.
"Ideally, the genetic test gives you control over the future, but learning that you have the mutation at the moment only helps you to know what might happen down the road," says Dr. Judy Garber, director of the cancer risk and prevention program at the Dana Farber Cancer Center in Boston.
"Genetic testing is not for everyone, but when used properly, it can give women a lot of control over a difficult future," says Garber.
Specially trained oncologists and geneticists are best suited to help patients decide whether they are candidates for the screening, and what their options may be afterward.
Women who carry the defective gene can reduce their risk by taking drugs like Tamoxifen, getting more frequent screenings or by having their breasts or ovaries removed.
For Earley and Switzer, the test was crucial.
"Here's the preventive maintenance," Earley says, pointing at her sister. Then she points at herself: "Here's somebody that held off, and the bomb blew up."
Just four weeks after her final chemotherapy treatment, Earley's prognosis is good, but the fear lingers.