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Ask the Experts: Spinal Cord Stimulation and Genetic Testing for Breast Cancer Risk

Ask the Experts: Spinal Cord Stimulation and Genetic Testing for Breast Cancer Risk

Find out the latest technology in spinal rejuvenation and when you should get genetic testing for breast cancer.

Q: Lately I’ve read about paraplegics with damaged spinal cords who are able to walk again using the latest technology. Can you explain how that works? —Angie B., Salisbury, MD

A: Sure. But to be clear, exoskeletons (structures outside of the body) have been around for a few years and they do help paraplegics walk. We believe what you’re talking about is spinal cord stimulation using 16 small electronic sensors implanted along the damaged area of the spine to increase the volume on nerve sensations so that the brain can “hear” the signals and move the limbs below the point of spinal injury.

That technology was applied by researchers at the University of Louisville to four people with spinal cord injuries who couldn’t move their legs. They had tried every other kind of rehabilitation imaginable, including intense treadmill training while having their weight partially suspended.

The patients who received the implants had sustained their injuries between 2.2 and 3.5 years earlier, according to the researchers. Two of them went through “278 sessions of epidural stimulation and gait training over a period of 85 weeks and [two worked through] 81 sessions over a period of 15 weeks . . . and all four achieved independent standing and trunk stability.” That’s a lot of work, but with intense training and intense electro-stim, it paid off. They certainly didn’t get back to where they were before their injuries, but it created a significant improvement in their lives.

Spinal cord rejuvenation was previously thought to be impossible, but we are now seeing great advances. Inspired by the success of this form of spinal cord stimulation, scientists are using small molecule compounds in mice models, coupled with limited zaps of electronic stimulation, to revive previously “quiet” spinal nerve pathways in paralyzed mice. That could be the next step for humans, so stay tuned.

Q: My aunt and my cousin have had breast cancer, now my sister has been diagnosed. Should we get genetic testing to see if it’s something that runs in the family? If it does, what’s my next step? —Kate G., Pauling, NY

A: Yes, you (and anyone in a similar situation) should consult a genetic counselor at a nearby academic center to discover what testing might reveal. You can also access such expert advice through a virtual medicine app.

According to Holly Pederson, MD, Director, Medical Breast Services, at Dr. Mike’s Cleveland Clinic, about 10 to 15 percent of breast cancer cases are truly hereditary, meaning there’s a genetic mutation passed down from generation to generation that markedly increases the chance of getting breast cancer.

Finding out if you have that increased risk of developing the disease is a good thing! If you’re a woman with a genetic predisposition (you carry the BRCA1 or BRCA2 mutation or both) you can have up to an 80 percent risk of being diagnosed with breast cancer during your lifetime. Testing gives you a chance to take preventive medications or have risk-reducing surgery. And if you are carefully monitored and you develop it, it’ll be detected early when treatment is very successful.

Unfortunately, most women who have a hereditary risk for breast cancer do not know it even if they’re aware that: 

  • A mother, grandmother, sister(s) and/or aunt(s) were diagnosed with the disease before age 50.
  • One close relative had both breast and ovarian cancer.
  • A related man had breast cancer.
  • They’re of Ashkenazi Jewish heritage.
  • A relative had triple-negative breast cancer.
  • Other cancers are present in relatives.

So talk to your doc about your risk factors and see if you should be tested. If you’re worried that genetic testing is too expensive, Dr. Pederson says, "The Patient Protection and Affordable Care Act identifies BRCA testing as a preventive service. Medicare provides coverage for affected patients with a qualifying personal history, and 97 percent of commercial insurers and most state Medicaid programs provide coverage for hereditary cancer testing.”

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