The First Real Prevention Option for the Breast Cancers That Have Had None

The Long-Awaited Milestone in Personalized Preventative Care

My niece is eighteen. My daughter is nineteen. According to Dr. Sacha Howell, the mutations that eventually lead to breast cancer are, at this moment, beginning to appear in their bodies. Some of the women in my family carry BRCA1 — a mutation that runs through us like a thread. Even the women in my family who don’t carry it still carry the one-in-eight lifetime risk that comes with being a woman in the United States.

Here is what Dr. Sacha Howell told me at the Rise Up conference in San Francisco that I want every person with a daughter, niece, sister, wife, or female friend to know: the first genetic abnormalities that eventually lead to breast cancer appear in late adolescence. Not when the tumor shows up on a mammogram. Not in her thirties, when she finds the lump. In her teens. Quietly. Invisibly. Driven by the hormones that flood a young woman’s body every month from the time she gets her first period.

The cancer we diagnose at forty has, in a real sense, been twenty years in the making.

That changes what prevention has to mean. Prevention isn’t a middle-aged woman’s problem. It’s a life-course problem. And until very recently, the medicine for it has been stuck.