Three years ago, Ali Feller’s life changed forever. At just 38 years old and a single mom to a seven-year-old daughter, Annie, Feller was diagnosed with stage one invasive ductal carcinoma. Genetic testing determined that she carried the BRCA-2 gene, meaning she had been genetically predisposed to develop the disease. “When I found out about the gene, my first thought was, Is Annie going to have it?” says Feller. “She will have to get tested for it when she's older, and if she does have the gene, it means there's a 50-50 chance she'll get breast cancer.”
Sadly, cases like Feller are becoming more and more common: Between 1990 and 2019, the number of adults under 50 diagnosed with cancer worldwide rose by nearly 80 percent. Two-thirds of those cases were women, many of whom were diagnosed with breast cancer. Mary Beth Terry, Ph.D., a professor of epidemiology and environmental sciences at Columbia University and executive director of the Silent Spring Institute, said the key to understanding this uptick is in our genes: “The majority of these cancers are the result of genetic changes caused by environmental factors,” she explains. “We’ve learned these changes, which are known as acquired genetic changes or somatic mutations, likely occur before age 25.” In other cases, generally when there is a strong family history of cancer, these cancer-causing genes are inherited.
For Feller, carrying the BRCA-2 gene meant the best course of action to fight her disease was to get a double mastectomy, followed by chemotherapy. Upon completing treatment, Feller had eight months in which she was told she had no evidence of disease. But at her 40th birthday party, a comment to her surgical oncologist started what would be the second leg of a long journey: “I told her about the pain [I’d been feeling in my chest], and right there as we were celebrating, she felt a tiny bump.” A biopsy confirmed the worst: Feller’s disease had returned and spread to her bones; the pain she had been feeling in her chest was a result of cancer in her sternum.
When she learned her disease had progressed to stage four, Feller became preoccupied with time. “I kept asking the doctor, ‘What does this mean? How much time do I have left… She told me five to ten years,” she remembers. “My immediate thought was, how old would that make Annie? Eleven or seventeen? That’s not good enough.”
Feller is now on an aggressive treatment course including immunotherapy, hormone therapy, and a prophylactic oophorectomy, during which her ovaries will be removed. Regardless of her own feelings about her prognosis, her thoughts always return to the fear that one day, her daughter may experience this battle as well: “While that’s hard to face, I have to remind myself that knowledge is power,” she says.
In addition to understanding and getting tested for inherited genes like BRCA, Dr. Terry says there’s another way to protect yourself from diseases caused by genetic mutations: Limiting your exposure to carcinogens. “Every day, we’re exposed to chemicals in the air we breathe, the food we eat, and the water we drink,” says Dr. Terry. “Of the 900 chemicals we’ve found [that relate to cancer], about 400 of them are in plastics.”
That doesn’t mean developing cancer is as simple as encountering a single harmful chemical. Rather, researchers believe risk is shaped by a lifetime of exposures that can begin surprisingly early, including during childhood and even before birth. While scientists are still working to understand exactly which exposures matter most and how they interact with our genes, Dr. Terry says the growing body of research underscores the importance of reducing unnecessary contact with known carcinogens whenever possible.
For Feller, the hope is that the information she has today will help protect her daughter tomorrow. And as researchers work to better understand both inherited cancer genes and the environmental factors that may trigger disease, experts agree on one thing: The sooner we identify these risks, the more opportunity we have for better outcomes — both for patients today, and for generations to follow.
Feller has also made a conscious decision to live in the here and now: “I used to focus so much on the future, but now I am very present,” she says. “I am a yes mom. And it’s a strange duality…While these have been the hardest and darkest days, I am also experiencing more joy now than I ever have in my life.”
