Part 1 Question: Are the BRCA1 and BRCA2 genes reliable predictors of cancer and if so, should the person take the steps necessary to reduce their risk, such as a double mastectomy? Why/why not? Student responses: Rachel Nelms 1.​ Objectives: Nucleotides are the individual monomers of nucleic acid. These molecules are relatively complex, consisting of a nitrogenous base plus a sugar-phosphate “backbone.” There are four basic types of nucleotide, adenine (A), guanine (G), cytosine (C), and thymine (T). A nucleoside consists of a nitrogenous base, which is covalently attached to a sugar (ribose or deoxyribose) without the phosphate group. A nucleotide consists of a nitrogenous base, a sugar (ribose or deoxyribose), and one to three phosphate groups. Step 1: Respond to the following: Are the BRCA1 and BRCA2 genes reliable predictors of cancer and if so, should the person take the steps necessary to reduce their risk, such as a double mastectomy? Why/why not? Yes, according to the National Cancer Institute, "A woman’s lifetime risk of developing breast and/or ovarian cancer is markedly increased if she inherits a harmful variant in BRCA1​ or ​BRCA2​, but the degree of increase varies depending on the mutation" (NCI, 2020). Yes, I absolutely think that if this is the case for anyone, they should take every step necessary to reduce their risk. According to the Mayo Clinic staff, "Women who have already had breast cancer and also have a family history of the disease, prophylactic mastectomy can reduce the risk of developing cancer in the other breast by 90 to 95 percent" (Clinic, 2021). If this is true, then I am not sure why anyone would pass up this opportunity. I would certainly do whatever it takes to make sure that I am reducing my cancer risk of any form. I have a daughter who is only two years old, so if I found out that I had any form of cancer or any disease or illness that I knew could kill me, then I would be doing everything in my power to fight to continue my life with my daughter for as long as possible. Resources: Clinic, M. (2021, January 8). ​What to know about surgery to lower breast cancer risk​. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/mastectomy/in-depth/prophylactic-mastect omy/art-20047221. NCI. (2020). ​BRCA Gene Mutations: Cancer Risk and Genetic Testing Fact Sheet.​ https://www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet#whatare-brca1-and-brca2. Shae Sibole 2.​ DNA and RNA are the types of nucleic acid found in our cells. Their primary structures constitute linear polymers composed of monomers called nucleotides. DNA and RNA consists of four different nucleotide.All nucleotides have a common structure: a ​phosphate​ group linked by a phosphoester bond to a ​pentose​ (a five-carbon sugar molecule) that in turn is linked to an organic ​base.​ All nucleotides have a common structure: a ​phosphate​ group linked by a phosphoester bond to a ​pentose​ (a five-carbon sugar molecule) that in turn is linked to an organic "base​". The nitrogen bases adenine and guanine are purine in structure and form a glycosidic bond between their 9 nitrogen and the 1' -OH group of the deoxyribose. Cytosine, thymine and uracil are pyrimidines, hence the glycosidic bonds forms between their 1 nitrogen and the 1' -OH of the deoxyribose. For both the purine and pyrimidine bases, the phosphate group forms a bond with the deoxyribose sugar through an ester bond between one of its negatively charged oxygen groups and the 5' -OH of the sugar. According to Campbell (2018), "The polarity in DNA and RNA is derived from the oxygen and nitrogen atoms in the backbone". Nucleic acids are formed when nucleotides come together through phosphodiester linkages between the 5' and 3' carbon atoms. The linear sequence of nucleotides linked by phosphodiester bonds constitutes the primary structure of nucleic acids. It is the linear sequence of nucleotides that make up the primary structure of DNA or RNA. Sequences are presented from the 5' to 3'. Secondary structure is the set of interactions between bases, i.e., which parts of strands are bound to each other. In DNA double helix, the two strands of DNA are held together by hydrogen bonds. The nucleotides on one strand base pairs with the nucleotide on the other strand. The secondary structure is responsible for the shape -that the nucleic acid assumes. Polynucleotides can twist and fold into three-dimensional conformations stabilized by noncovalent bonds; in this respect, they are similar to polypeptides. Although the primary structures of DNA and RNA are generally similar, their conformations are quite different. Unlike RNA, which commonly exists as a single polynucleotide chain, or strand, DNA contains two intertwined polynucleotide strands. This structural difference is critical to the different functions of the two types of nucleic acids. BRCA1 and BRCA2 are two examples of genes that raise cancer risk if they become altered as they are tumor suppressing genes. Having a mutant BRCA gene greatly increases a woman's chance of developing breast cancer and ovarian cancer. This was the reason Angelina Jolie had preventative breast cancer surgery, followed by ovarian cancer surgery. They also increase a man's chance of developing male breast cancer and prostate cancer. If a woman wishes to reduce her risk of developing breast cancer she could consider risk-reducing mastectomies. This is the surgical removal of breast tissue to try to prevent the development of cancer. There are various types of operations, but, in general, as much breast tissue as possible is removed. There will be some breast tissue remaining but the lifetime risk of breast cancer would generally be reduced by 90-95%. Women who have the risk-reducing surgery will no longer need annual mammographic screening because they will have very little breast tissue left. Reconstructive surgery can be offered at the same time as the risk-reducing mastectomies. Resources Campbell, M., Farrell, S., and Owen, M. (2018). Biochemistry, 9th Edition. NJ: Cengage Learning. Casey Grutzmacher 3.​ I actually have a good friend who was tested for the BRCA genes as breast cancer and uterine cancer runs in her family. If a person tests positive for either BRCA gene, they are more likely to develop cancer, however this does not mean that it is a sure thing. My friend tested positive for BRCA1 and decided to go though with a preventative double mastectomy. I really believe this comes as a personal decision and you must do what is going to help you sleep the best at night. I think that with where I am in my life, after having two successful pregnancies and nursing both babies, knowing that I do not want to have anymore kids, I would personally get the double mastectomy so I would not have to worry as much. However, if I was younger and had not felt I was finished having children, or hadn't started having children, I believe I would wait to have the double mastectomy. If a person (man or woman, because it can apply to both) decides that they are not ready or do not want to have a double mastectomy, they have other option to keep themselves healthy and safe. "Some women who test positive for harmful BRCA1 and BRCA2 variants may choose to start breast cancer screening at younger ages, have more frequent screening than is recommended for women with an average risk of breast cancer, or have screening with magnetic resonance imaging (MRI) in addition to mammography" (National Cancer Institute, 2019). Chemoprevention is another option for people who cannot or wish to not undergo surgery. "Two chemopreventive drugs (tamoxifen [Nolvadex] and raloxifene [Evista]) have been approved by the Food and Drug Administration (FDA) to reduce the risk of breast cancer in women at increased risk, but the role of these drugs in women with harmful BRCA1 or BRCA2 variants is not yet clear. Data from three studies suggest that tamoxifen may be able to help lower the risk of breast cancer in women who carry harmful variants in BRCA2 (34) and of cancer in the opposite breast among BRCA1 and BRCA2 variant carriers previously diagnosed with breast cancer (35, 36). Studies have not examined the effectiveness of raloxifene in BRCA1 and BRCA2 variant carriers specifically" (National Cancer Institute, 2019). National Cancer Institute. (2019). BRCA Gene Mutations: Cancer Risk and Genetic Testing Fact Sheet. Retrieved January 21, 2021, from https://www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet#whatdo-brca1-andnbspbrca2-genetic-test-results-mean Leticia Heath 4.​ Based on my research on BRCA1 and 2 I have discovered that these are mutations in genes that are a reliable identifier and can lead to an increased chance of developing ovarian or breast cancer (1). These genes produce proteins that aid in repairing damaged DNA (1). However, when these genes develop certain mutations, cancer can then develop (1). Because the risk for cancer increases so much when these gene mutations are identified, and the risk increases drastically with each decade that passes, I believe that surgical prophylaxis is a viable option and should be discussed with patients (2). Surgical prophylaxis, or a mastectomy, decreases the risk of breast cancer by 90% (2). And a bilateral salpingo-oophorectomy (BSO) decreases cancer risk by 80% (2). To further show that surgical prophylaxis is a viable option, a study was conducted which included 2482 women with CRCA1 or 2 mutations. Of the 247 women who underwent mastectomies, there was no diagnosis of breast cancer. In the 1372 women who did not undergo the procedure, 98 of those women were diagnosed with breast cancer (2). References: (1) NIH (2019). BRCA Gene Mutations: Cancer Risk and Genetic Testing. National Cancer Institute. https://www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet (Links to an external site.) (2) Bougie, O., Weberpals, J. I. (2011). Clinical Considerations of BRCA1 and BRCA2-Mutations Carriers: A Review. Hindawi. https://www.hindawi.com/journals/ijso/2011/374012/ Ronak Dabo 5.​ BRCA1 and BRCA2 Genes BRCA1 and BRCA2 are genes responsible for the production of proteins that help in the repair of the damaged DNA (Foulkes & Shuen, 2013). Besides, these genes ensure that ovarian, breast, and other cells exhibit normal growth. Each of these genes contains two copies of the genes, in which each copy is usually passed to offspring from each parent. BRCA1 and BRCA2 may also be referred to as "the tumor suppressor genes" because when they are subjected to harmful variants, then they become responsible for the development of cancer (Foulkes & Shuen, 2013). This occurs when the genes undergo mutations, which are then inherited to various generations. The mutation makes the genes stop functioning normally. Individuals who end up inheriting harmful variants in either of the aforementioned genes are subject to a number of cancers, but the most prevalent ones are breast and ovarian cancer. Besides, such people have a higher tendency of developing cancer at their young ages as compared to people with no such variants. The risk of cancer can be reduced in a person who happens to have inherited either BRCA1 or BRCA2 gene variant through chemoprevention, enhanced screening, and risk-reducing surgery. Enhanced screening entails early breast cancer screening for women who turns out to be positive for BRCA1 and BRCA2 at their younger age (Levy-Lahad & Friedman, 2007). In this case, such a woman would undergo more frequent screening as compared to women who have an average risk of getting cancer. There is no effective screening method for ovarian cancer. Besides, there is also no effective method of detecting BRCA1 or BRCA2 that causes breast and other cancer in men. From age 35 henceforth, it is recommended that men should undergo breast examination on an annual basis. Risk-reducing surgery is also known as prophylactic surgery, entails getting rid of the "at-risk" tissue. In this regard, women may opt for double mastectomy as a way of reducing the chances of breast cancer. In addition, women may also choose to have surgery to remove their fallopian tubes and ovaries in an attempt to combat ovarian cancer. By removing ovaries, the risk of breast cancer is also reducing especially in the premenopausal women who produce hormones, which can be the source of some other types of cancer. Once the surgery is performed, nothing can be done to reverse them (Kuchenbaecker et al., 2017). This method, however, does not always necessarily guarantee that there will be no more development of cancer since it is not always possible to remove all tissues during these procedures hence the name "risk-reducing." Chemoprevention makes use of medicines in an attempt to reduce the chances of cancer by the use of chemopreventive drugs, namely raloxifene and tamoxifen. FDA has approved these drugs for the use of reducing cancer of breasts. The use of these drugs may be an alternative to surgery. The drugs have their side effects, such as stroke, menopausal symptoms, allergic reactions, and even possible development of endometrial cancer. It is important to determine whether the harmful BRCA1 or BRCA2 variant was inherited in order to determine whether family members would also be at risk and to also determine other potential cancers. References Foulkes, W. D., & Shuen, A. Y. (2013). In brief: BRCA1 and BRCA2. ​The Journal of pathology,​ ​230(​ 4), 347-349. Kuchenbaecker, K., Hopper, J., Barnes, D., Phillips, K., Mooij, T., & Roos-Blom, M. et al. (2017). Risks of Breast, Ovarian, and Contralateral Breast Cancer for BRCA1 and BRCA2 Mutation Carriers. ​JAMA​, ​317​(23), 2402. doi: 10.1001/jama.2017.7112 Levy-Lahad, E., & Friedman, E. (2007). Cancer risks among BRCA1 and BRCA2 mutation carriers. ​British journal of cancer,​ ​96(​ 1), 11-15. Payalbahen Vora 6. ​ BRCA1 and BRCA2 Genes According to Breast Cancer. Org, 2020, most inherited cases of breast cancer and ovarian cancers are associated with two specific genes-BRCA1 & BRCA2. Women who have abnormal changes (mutations) in any of these two genes, inherit them from either of their parents. Such women are at higher risk of getting breast cancer or ovarian cancer. BRCA1 is located on chromosome 17, whereas BRCA2 is located on chromosome 13. They Both confer a high degree of susceptibility to breast cancer, but they differ in the degree of risk of ovarian cancer (2). The risk of getting ovarian cancer increases with the presence of BRCA1, but BRCA2 does not increase the susceptibility to get ovarian cancer. Women with a ​BRCA1​ or ​BRCA2​ genetic mutation have up to a 72% risk of being diagnosed with breast cancer during their lifetimes (compared to 12-13% for women overall) (1). Thus, BRCA1 & BRCA2 seem reliable predictors of breast and ovarian cancers. Although double mastectomy is popular and many women might want to get it done as a preventive measure, I think a woman shouldn’t think about double mastectomy surgery before getting diagnosed with cancer for several reasons. First of all, BRCA1 & BRCA2 are reliable predictors of breast cancers, and women who have them are at higher risk of getting cancers, but that doesn’t mean they will definitely get cancers. Some women might be in that 25% who don’t get cancer even though they carry genes associated with it. Second, women are used to seeing their figure a certain way, and it is not easy to see it without breasts. Double mastectomy will change their physical appearance drastically. Although prosthetics are always an option, they are not natural. Third, a good thing about double mastectomy is that you can do it after getting cancer, too so, I think women should undergo double mastectomy only if ever they get breast cancer. Women who have inherited those two genes, usually go for mammography test regularly or any other check-up necessary so, if they develop a tumor, they will notice it for sure. Another reason is even though getting an infection after surgery is low, like any other surgery, there are complications of double mastectomy as well. Common complications include phantom breast syndrome (the sensation of breast tissue still being present, sometimes with pain), collection of fluid under the skin (seroma), wound infection, skin flap necrosis, and pain (3). Some women also experience pain, swelling, lymphedema, and numbness. So, why should a woman go through all this trouble even before being diagnosed with breast or ovarian cancer? It also depends on age; if a woman is above 50, she should consider surgery. However, if a woman is in her early 20s or 30s when she finds out about having those two genes, she may want to wait as she may have kids in the future and may want to breastfeed the kids. References Breast Cancer. Org. (2020). BRCA1 &BRCA2 Testing. Retrieved from https://www.breastcancer.org/symptoms/diagnosis/brca Campbell, M., Farrell, S., and Owen, M. (2018). Biochemistry, 9th Edition. NJ: Cengage Learning. Retrieved from https://ng.cengage.com/static/nb/ui/evo/index.html?eISBN=9781305962941&id=159357 329&snapshotId=454923& The Unity Point- Live Well. (n. d.). What You Might Not Know About Double Mastectomy. Retrieved from https://www.unitypoint.org/livewell/article.aspx?id=76614c4b-9881-4680-b861-93d127d 5157d Part 2 Question: Reflect on a time you were conversing with a friend or loved one when you noticed that the manner in which you were communicating was influenced by the instrumental/relational gender norm. Discuss the conversation you engaged in with the friend or loved one and analyze how that conversation illustrates the differences in communication styles between men and women. Student responses: Jillian Redd 1.​ For this discussion post, I was able to immediately recall an applicable situation, whereas usually, I have to think about a discussion post for a few hours or even a day before I am ready to write. I am very good friends with someone who owns quite a few businesses not only in the Gaslamp (San Diego classmates will know this location) but throughout the rest of the county as well. He was hit especially hard by COVID-19 restaurant closures. All of his businesses were forced to close AND he had to suffer from the guilt of furloughing hundreds of employees, once again, right before the holiday season. Anyway, I went to his office for a drink one afternoon and we started talking about COVID-19 and our local politicians. He and I have opposing political views, but we are able to have open communication and come into a conversation with an open mind, potentially have a change of heart, or perhaps just with the intent to understand the line of thinking on “the other side.” Anyway, when our conversation flipped from casual to political, his demeanor changed immediately. This is not something I read about in this week’s reading, as the reading was centered around verbal communication between sexes, but many non-verbal cues were sent my way. Men will generally take up more space than a woman to appear larger and dominant. If you have observed a board of men and women on stage, you’ll likely notice the women sitting with their legs crossed, taking up minimal chair space, and the men sitting back in their chair, arms on the armrests, and the ankle of one leg placed on top of the opposing knee, taking up most of the space in the chair. When my friend and I started talking, he stood up from his office chair and started walking around the room, while I stayed seated. He was much more animated in his speech, as his arm and hand gestures seemed like they were having a conversation of their own. He was very direct in his speech (this is something the book did mention), while I was more polite and indirect. “There are considerable gender differences in politeness. Among the research findings are, for example, that women are more polite and more indirect in giving orders than are men. Women’s greater politeness is also seen in the finding that women express empathy, sympathy, and supportiveness more than men” (DeVito, 2016). Circling back to last week’s topic, I also spent much more time during that conversation listening than I did speaking. We learned in module three that men spend less time listening than women and that was apparent in our political conversation. I was able to make my points when necessary, but I noticed he was much more passionate about speaking than he was about listening. Nonetheless, it was a positive and productive conversation, but it was not without its fair share of gender differences in communication styles. References DeVito, J. A. (2019). ​Essentials of human communication​. Upper Saddle River: Pearson. Rachel Nelms 2.​ Reflect on a time you were conversing with a friend or loved one when you noticed that the manner in which you were communicating was influenced by the instrumental/relational gender norm. This morning, I was having a conversation with my best friend, Gabby. She expressed to me that she was no longer happy in her relationship with her boyfriend. She has been with him for over two years. She focuses a lot of time and energy on pleasing him and making him happy. I let her know that she must prioritize herself as much as she does her boyfriend. I told her that it would be good for her to get out and find a hobby—something she enjoys that she can do for herself. I suggested a few things, such as meditating, yoga, getting a gym membership, taking art classes, painting pottery, etc. Of course, these suggestions can be made by both men and women. I think where the "relational gender norm" comes in is when I am sitting down and hearing about how she feels about her relationship with her boyfriend. More often than not, women tend to go to each other when in times of hardships or struggles, and they are more emotionally connected and understand each other on a different level that not many men understand. As a society, we have set precedence where men are meant to be "strong and prideful"; they tend to confide in each other less than women do and as women, we are created more for caring and nurturing, which is why we have babies and not men. Discuss the conversation you engaged in with the friend or loved one and analyze how that conversation illustrates the differences in communication styles between men and women. I think that I mentioned this above, but I believe that women have a different form of communication. Men apply practical methods to reduce or communicate any emotions they do not like due to their pride. They may have something that is bothering them, but they are more likely to keep it bottled up for long periods. When a woman has something that is bothering her, the chances are that she will need to deal with it sooner than later so that it doesn't drive her crazy. Women have different needs than men. Although men and women do share similar requirements in many ways, there are several ways men and women are different. Women will express the way they are feeling either through words, actions, or lastly, tears if it comes to this. I don't know too many men who cry when communicating, whereas I know many women who cry when expressing their feelings. Of course, there are those rare few men who cry more often than expected (which is ok), but most often, the man will hold his feelings inside because he's prideful. I also think that women verbalize their weaknesses a lot more than men do. Again, due to pride. According to Katarina Soerensson, "It's men and their pride; the fantasy of saving the fallen maiden appeases their egos and feeds that never-ending desire for control. It's the minute they falter, the very thought of depending or even relying in the slightest on a woman that appears to be incomprehensible—men and their pride: the downfall of numerous relationships" (Soerensson & Mertes, 2019). Resources: Soerensson, K., & Mertes, J. (2019, October 16). ​Men And Their Pride: The Downfall Of Numerous Relationships.​ The Odyssey Online. https://www.theodysseyonline.com/shes-going-to-leave-you.