Sheryl Lanman Nichols had everything to look forward to in life as a newlywed — a great job, many friends, and a loving family. She had a master’s degree in social work from Rutgers University and was a bilingual domestic violence social worker with Woman-space in Lawrenceville. She traveled twice with Habitat for Humanity to build homes in the Dominican Republic.
However, one month before her wedding day she received devastating news: She had breast cancer. Nichols had surgery, and doctors told her family they “got everything,” according to her mother, Sandra Lanman of East Brunswick. Nichols followed up the surgery with a course of chemotherapy, but a year later, she felt a pain in her side.
“They found the cancer had spread all over,” said Lanman.
In 2015, three years after the initial diagnosis, Nichols died at age 34.
What Nichols didn’t know until it was too late was that she carried a hereditary BRCA gene mutation more common among Ashkenazi Jews than the rest of the population.
But even as the illness spread and weakened her body, she was determined to promote awareness about the need for genetic testing for those at risk. When it became clear Nichols would not live much longer, she enlisted her family and friends to fulfill her vow in her memory.
“She was an amazing person,” Lanman said. “From her earliest childhood to the end of her life, her mission was to help people.”
Honoring their promise, Nichols’s family arranged a “Day of Caring” at Anshe Emeth Memorial Temple in New Brunswick. The event, held on May 7, featured medical experts, counselors, and a friend of Nichols who also carries the BRCA gene mutation. The program was presented by Anshe Emeth’s Va’ad G’milut Chasadim, the Caring Community Committee.
“She was the bravest fighter I’ve ever known,” Lanman, who attended with her husband, Steven, and son-in-law, Justin Nichols, told those gathered.
Like Nichols, up to 85 percent of those with the gene mutation will develop breast cancer, as opposed to 12 percent of the general population, said Hetal Vig, a genetic counselor specializing in cancer at Rutgers Cancer Institute of New Jersey (RCINJ) in New Brunswick. Depending on the mutation of the gene, another 40 to 60 percent will develop ovarian cancer, which is highly treatable in its early stages but often deadly because it is usually asymptomatic until it is too late.
While one in 500 people in the general population have a BRCA mutation, Vig said one in 40 individuals of Ashkenazi descent have this deviation. Everyone is born with BRCA genes, but those with an inherited mutation are likely to develop cancer at a much younger age than the typical breast cancer victim. The mutation could also result in an increased risk of triple negative breast cancer, which is more resistant to treatment than other breast cancers, and an increased risk of recurrence.
BRCA mutations also increase the risk of male breast cancer, pancreatic cancer, prostate cancer, and melanoma.
Vig said researchers know “the vast amount of breast cancer and all cancer is sporadic, meaning we don’t know why it occurs.” She also said there is a common misconception is that the mutated genes can only be passed through the mother.
“It can be passed through your dad’s side,” she said. “Both sides are equally important.”
Lanman said she is the carrier in her family and doctors continually express surprise she has never developed cancer. Fortunately, her son tested negative, although her daughter-in-law is positive, meaning her granddaughters, ages 2 and 4, are at risk.
Dr. Deborah Toppmeyer, chief medical officer and director of the Stacy Goldstein Breast Cancer Center and the LIFE Center and chief of solid tumor oncology at RCINJ, said there have been “remarkable” advances in the understanding of hereditary cancers in the last 10 years that “have driven up survival rates” and changed the way it is treated.
For instance, Toppmeyer said breast removal for those with the gene mutation reduces a woman’s chances of developing cancer to 5 percent.
Those with the BRCA gene should have a breast MRI at age 25 and regular mammographies by age 30, according to Toppmeyer, “But we do not recommend [genetic] testing for women under 25 unless the risk is so compelling, because they are too young for the onset of the disease.”
Dr. Thomas Bock, a former oncologist and pharmaceutical executive, founded HeritX, an international research and development non-profit working to protect people from developing inherited cancers. He did so because of his wife, Irina, who had breast cancer and melanoma because of a BRCA mutation she inherited from her father who died of pancreatic cancer. He believes that the BRCA gene is the gateway to all cancer prevention.
“We vaccinate against polio. I take cholesterol-lowering drugs,” said Bock. “But with cancer we don’t do that. We wait until it occurs.”
Abby Grayson, who became close with Nichols through her work in the mental health field, said her friend kept urging her to get tested. Grayson, who is of Ashkenazi descent, did not have any family history that would indicate she had the mutation.
“Sheryl died in mid-August, but around the beginning of August she got tearful that she was not going to live long enough to be the advocate she wanted to be,” said Grayson, who made a deathbed promise to Nichols that she would get tested. Grayson’s gynecologist agreed that her family history would not indicate that she would have the gene, but had her tested nonetheless. When the doctor called at 8 a.m. as Grayson was rushing to get her kids to school, she knew it was a bad sign.
In the end, Grayson, who already had her ovaries out because of complications with childbirth, decided to have her breasts removed, an emotional and physically painful decision she described as “horrible” and “draconian.”
“I was a sitting duck, but I lived to tell the tale,” she said, urging others to get tested. “Knowledge is power.”