How Angelina Jolie’s breast cancer journey can help you find out if you need to be tested for the BRCA gene (and how to deal with the results).
Although the buffed out gun-toting superhero image of Angelina Jolie as Lara Croft in Tomb Raider is likely burned in our collective movie-going brains — the film star made a courageous announcement yesterday that she’s all too human.
In an op-ed in the New York Times, Angelina recounts her double mastectomy journey which started in early February, after she discovered she carried a “faulty” gene (BRCA1 to be exact). The BRCA1 amplified her risk of breast cancer to 87%.
And Angelina is definitely not alone in opting for this sort of surgery (a.k.a. double prophylactic mastectomy) — as the procedure is not uncommon. In fact, between 1998 and 2005, the number of prophylactic mastectomies doubled and continues to increase.
Here are five things that all women (including the those in the superhero category) should know about Angelina, genetic testing and preventative mastectomy:
How did Angelina discover she was high risk for breast cancer?
In January 2013, Allyn Rose, a hopeful in the 92nd Annual Miss America Pageant, told of her own struggle in deciding to undergo prophylactic mastectomy — like Angelina, she lost her own mother to breast cancer.
Turns out, your mom, grandma, aunts (and even uncles) play a huge part in risk determination — as women that carry BRCA1 or BRCA2 gene run a greater risk with a family history of breast cancer. Likely, the push-off for Angelina’s surgical journey was found in her family tree.
It’s also important to know that risk is amplified for women with a family history of both breast and ovarian cancer (especially with diagnosis before age 50) and Ashkenazi Central and Eastern European Jewish backgrounds. Although, not every woman who carries a BRCA1 or BRCA2 genetic mutation will develop breast cancer.
I do have a family history…so how do I get tested?
A simple blood test ordered by a doctor can start this conversation. Although, genetic counseling is also recommended throughout this process. Your actual percentage of breast cancer risk depends not only on what’s swinging from your family tree — other factors like your personal history (i.e., a pack-a- day habit, not-so-healthy eating and an aversion to cardio of any kind) also count.
And, if it is determined I’m high risk and a potential surgical candidate — can you describe the surgery?
Basically, there are two types of prophylactic mastectomies: total mastectomy where the entire breast is removed and the subcutaneous (“nipple-sparing”) mastectomy (that Angelina opted for) where the entire breast is removed except for the nipple.
Patients, like Angelina, can then select to continue with reconstructive surgery — with either silicone or saline implants placed under the chest muscle to create new breasts. Tissue flap reconstruction is also a surgical alternative; in which fat from other areas of a woman’s body are harvested and placed into the breast.
So, what reduction in cancer risk can be expected after all is said (and done) surgically?
For women at high risk, a prophylactic double mastectomy can drastically reduce a breast cancer diagnosis by 90 percent. Although, even this isn’t a 100% guarantee, as it’s impossible to predict with absolute accuracy if the surgery will prevent cancer. Breast tissue is situated on the chest wall and sometimes appears near the armpit, collarbone (and even the in stomach) and it may not be possible for the surgeon to locate and remove it totally.
“The potential benefit of this surgery is a dramatic reduction in the risk of developing breast cancer. Nevertheless, there remains a remote risk of cancer because no form of mastectomy can remove absolutely all microscopic breast cells.”
And lastly, if I am possibly interested in a prophylactic double mastectomy, where do I start?
The risks of prophylactic mastectomy are physical as well as psychological. So, the final choice to opt for surgery versus increased surveillance (via mammogram and/or MRI) should involve a team approach.
“The psychological ramifications are substantial. Even with reconstruction in its most modern form, this is not a cosmetic breast surgery which also conveniently removes one’s risk of cancer. It is full blown cancer surgery even though there is no cancer present.”
“The best choice is to confer with an oncologist and surgeon to find out one’s true level of risk. After that, doctors help [the patient] weigh the best options. While the effectiveness of a double prophylactic mastectomy is high, so is the emotional risk, especially to one’s self-esteem. It’s not a simple choice to make,” says Rand.