Breast cancer (continued from page 3)
which can cause an eight-fold increase in breast cancer risk. About 5 to 10 percent of breast cancer patients carry a BRCA gene — 10 percent if they are Ashkenazi Jews. Women with BRCA1 or a second mutation, BRCA2, have a 60 percent chance of developing breast cancer, according to the National Cancer Institute. The risk of breast cancer is about 12 percent for the general population. About 36 percent of U.S. women with a BRCA mutation chose preventive mastectomies, a study by the Women’s College Research Institute in Toronto found. In addition to breast cancer, BRCA carriers have a 15 to 40 percent chance of developing ovarian cancer, compared to 1.4 percent for the general population, according to the National Cancer Institute. Kniss does not carry the BRCA gene. But one of her sisters died from breast cancer 10 years ago, she said. Still, that did not raise any red flags. “The only thing I remember her saying is, ‘It’s not familial; don’t worry about it,’� Kniss said. The diagnosis came as Kniss was gearing up for her campaign for City Council. Dr. Diana Guthaner, a Palo Alto radiologist, had asked Kniss to return to her office after a routine mammogram in March 2012.
“She said, ‘Liz, come in for a minute. I’m really not liking what I’m seeing,’� Kniss recalled. “How much are you not liking what you’re seeing?� Kniss asked. “I’m really not liking it at all,� she recalled Guthaner said. The first weekend after the diag-
‘I decided I could handle my disease better if I had a small support group — if it was me handling it. I knew at some level I had to conserve my energy, and I couldn’t spend it keeping a lot of people in the loop.’ —Liz Kniss, city councilwoman, Palo Alto nosis, Kniss panicked. “Does this mean I won’t see my grandkids grow up?� she said she asked herself. “I think you’re stunned initially for about a week. Then you think, ‘I hope I’ll survive.’� Kniss first underwent a lumpectomy on her left breast. Two weeks later, she returned for surgery to remove additional tissue. At the same time, she had a lumpectomy on her right breast. She did not undergo chemotherapy. After a carefully considered second opinion, she decided against radiation treatment, she said.
But whom to tell was one of the most difficult decisions to make, she said. She didn’t want to be viewed as the candidate who needs sympathy or the candidate who is sick. “That was a very hard one. I decided I could handle my disease better if I had a small support group — if it was me handling it. I knew at some level I had to conserve my energy, and I couldn’t spend it keeping a lot of people in the loop,� she said. After surgery, Kniss and her husband rented a motel room for three days where they could be anonymous. But she didn’t put her life on hold. She viewed the cancer as a distraction that she didn’t want to get in the way. “I remember thinking, ‘I have got to get done with this. May is a heavy budget month,’� she said, referring to her prior role as a Santa Clara County supervisor. Kniss said she plans to help Breast Cancer Connections with fundraising and to spread the word about the importance of screening. Most oncology organizations prefer women receive an annual mammogram beginning at age 40, said Dr. Allison Kurian, assistant professor of medicine at Stanford University and associate director of the Women’s Cancer Genetics Clinic at the Stanford Women’s Cancer Center. Other tests, such as sonograms and magnetic resonance imaging, can refine detection and are helpful for women with dense breast tissue, which can sometimes hide a tumor. On April 1, California’s so-called
Veronica Weber
Upfront
Palo Alto City Councilwoman Liz Kniss, a breast-cancer survivor, is speaking out about the importance of women getting tested for the disease. breast-density bill went into effect. Erika Bell, manager of medicalThe legislation requires medical information services. The nonprofit professionals to notify women if serves women and men with breast they have dense breasts. The bill cancer and has a research library, was introduced by former state Sen. support groups for cancer patients Joe Simitian. and families, classes, a “buddy� sysFrank delaRama, clinical nurse tem that pairs patients with cancer specialist in oncology and genom- survivors and an early screening ics at Palo Alto Medical Founda- program for uninsured patients. tion, said factors such as a family Kniss said she hopes the new history of breast or ovarian cancer, spotlight on breast cancer will have age at childbearing and lifestyle can lasting effects. be factors for getting the diseases. She reflected on how a simple Since Jolie’s announcement, local screening may be responsible for two organizations are seeing an uptick very different outcomes between sisin concern. DelaRama said women ters: Kniss is cancer-free, although who postponed physician-referred she will continue her vigilance for screenings are now calling his de- the rest of her life. Her sister was dipartment for appointments. agnosed at age 47 and died at 52. More women have inquired at “I don’t think she had mammoBreast Cancer Connections about grams. She thought she had back information related to BRCA, said trouble,� Kniss said. N
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