In the Family

POV | DIR. JOANNA RUDNICK

Joanna Rudnick's story, as told in her unblinking new documentary, In the Family, is an intensely personal one. As the Chicago filmmaker found in making her film, it is a story shared — in their own individual ways — by thousands of other women and even a few men. Joanna, whose family has a history of breast and ovarian cancer, took advantage of breakthroughs in genetic research and tested for the recently isolated BRCA genetic mutation. Those with BRCA mutations have up to an 85 to 90 percent lifetime chance of developing breast cancer, and up to a 50 to 60 percent lifetime chance of developing ovarian cancer. At age 27, Joanna tested positive.

Such knowledge would be simply devastating if it did not also offer treatment and hope. But the only true preventive treatments are devastating in their own right — radical mastectomy (total removal and reconstruction of both breasts) and oophorectomy (removal of the ovaries, ending the chance of becoming pregnant), preferably by age 35, and certainly by age 40. Such a course would be a blow to any woman, whatever her age or circumstances. But for a young woman like Joanna, still searching for love and looking forward to marriage and children, the cure seems nearly as daunting as the looming disease.

When Joanna tested positive for the BRCA mutation, she set out to make a film about the science behind BRCA, but even more about the impact of this new medical knowledge has on women's lives. Shying away from putting her own life and emotions at the film's center, at first she searched for a young, unmarried woman like herself to be the film's primary subject. But having the BRCA mutation has become something that is often hidden, especially among younger women, because of the negative impact it can have on women's prospects for love, marriage and children. Unable to find a suitable subject, Joanna bravely stepped into the role.

The BRCA mutation runs in Joanna's family. Two great-grandmothers died from ovarian and breast cancers. Joanna's grandmother Ethel developed breast cancer at age 56; her mother, Cookie, was diagnosed with fallopian tube cancer at 44. Joanna's older sister, Lisa, a radiologist who diagnoses breast cancer and drove the process to get tested, turned up negative for the mutation. Inheritance of the genetic mutation is not a given, but there was no doubt that Joanna was a candidate for the test.

But once you know, what do you do with the information? Despite the assurances of doctors and researchers, who see the life-saving potential of genetic testing, Joanna knows her future has been turned on its head. Still in the spring of her life, she must face life-and-death choices generally reserved for old age. She must ask herself the searing question, "How much do I sacrifice to survive?"

Books

Eating Pomegrnates: A Memoir of Mothers, Daughters, and the BRCA Gene by Sarah Gabriel

After the grief of losing her mother to cancer when Sarah Gabriel was a teenager, she had learned to appreciate "the charms of simple happiness." With a career as a journalist, a home in Oxford, England, a husband, and two young daughters, she was content. But then at age forty-four, she was diagnosed with breast cancer—the result of M18T, an inherited mutation on the BRCA1 gene that had taken the lives of her mother and countless female ancestors. Eating Pomegranates is Gabriel’s candid and incredibly intimate story of being forced to acknowledge that while you can try to overcome the loss of a parent, you can never escape your genetic legacy.

Hope in the Face of Cancer: A Survival Guide for the Journey You Did Not Choose by Amy Givler

Amy Givler, M.D. a cancer survivor, shares her experience and the stories of others with the voice of encouragement, faith, and strength she so desperately needed at the point of her diagnosis. With medical knowledge and insight into the path to come, Dr. Givler is able to offer answers and hope.

Positive Results: Making the Best Decisions When You're at High Risk for Breast or Ovarian Cancer by Joi L. Morris and Ora K. Gordon

The latest options: genetic testing for breast cancer risk and surveillance, assessing risk, mastectomy and breast reconstruction techniques, ovarian cancer surveillance, surgery, managing menopause, and risks in men who carry mutations on BRCA genes.

Pretty is What Changes by Jessica Queller

A timely, affecting memoir from the front lines of medical science: When genetics can predict how we may die, how then do we decide how to live? Eleven months after her mother succumbs to cancer, Jessica Queller has herself tested for the BRCA "breast cancer" gene mutation. The results come back positive, putting her at a terrifyingly elevated risk of developing breast cancer before the age of fifty.

Previvors: Facing the Breast Cancer Gene and Making Life-Changing Decisions by Dina Roth Port

Through the incredible true stories of five young friends, as well as interviews with more than seventy top breast cancer experts, health writer Dina Roth Port addresses the universal questions of women everywhere who have watched family members suffer from the disease and wondered, "Am I next?"

The Emperor of All Maladies: A Biography of Cancer

The Emperor of All Maladies is a magnificent, profoundly humane “biography” of cancer—from its first documented appearances thousands of years ago through the epic battles in the twentieth century to cure, control, and conquer it to a radical new understanding of its essence. Physician, researcher, and award-winning science writer, Siddhartha Mukherjee examines cancer with a cellular biologist’s precision, a historian’s perspective, and a biographer’s passion. The result is an astonishingly lucid and eloquent chronicle of a disease humans have lived with—and perished from—for more than five thousand years.

Movies

NOVA: Cancer Warrior

Will Endostatin revolutionize cancer treatment?Imagine cancer as a highly manageable disease. Imagine treatment with few side effects. Imagine a revolution in medicine. Dr. Judah Folkman (Director of the Surgical Research Laboratories at Bostonís Childrenís Hospital) shares his 40-year quest for a radically new cancer treatment, including the development of the much-touted drug, Endostatin.As a young doctor, Folkman proposed that tumors cannot grow beyond the size of a pinhead without a network of blood vessels to nourish them. He also believed if the blood supply was blocked, the tumor couldnít grow to become life threatening. At first, the medical community scorned this controversial idea.Now, Dr. Folkman invites cameras into his lab for a first-person look at the groundbreaking clinical research that offers hope to cancer patients.

NPR Radio Segments

All Things Considered: Supreme Court Gene Ruling Splits Haris Over What's Natural

The U.S. Supreme Court on Thursday ruled that human genes cannot be patented, upending 30 years of patent awards granted by the U.S. Patent Office. The court's unanimous decision has enormous implications for the future of personalized medicine and in many ways is likely to shape the future of science and technology.

Tell Me More: A Mother and Daughter Confront their Breast Cancer Risk

Hollywood superstar Angelina Jolie has been in the headlines, by her own choice for a change. Genetic testing showed she was at high risk for breast cancer, so she decided to have a double mastectomy to improve her odds. She revealed her choice, and the thinking behind it, in a recent op-ed in The New York Times.

Websites

FORCE: Facing Our Risk of Cancer Empowered

National nonprofit organization devoted to hereditary breast and ovarian cancer.

In the Family

The official website of the award-winning film.

National Breast Cancer Foundation, Inc.

Official website for the National Breast Cancer Foundation.

National Cancer Institute

Resources available from the National Cancer Institute (NCI).

National Ovarian Cancer Coalition

Official website and resources from the National Ovarian Cancer Coalition.

POV: In the Family

PBS website for In the Family.