Angelina Jolie, 37, underwent a double mastectomy because she had an 87 percent chance of developing breast cancer, she writes in a powerful op-ed in Monday’s New York Times. Jolie’s mother died of breast cancer at age 56, and the actress writes that her children had “asked if the same thing could happen to me.” She carries a “faulty” gene, or BRCA1. Women who carry BRCA mutations have, on average, about a 65 percent risk of eventually developing breast cancer, as opposed to a risk of about 12 percent for most women. For some mutation carriers, the risk may be higher; Ms. Jolie wrote that the estimate for her was 87 percent, which means she ... also has a 50 percent chance of getting ovarian cancer. “Once I knew that this was my reality, I decided to be proactive and minimize the risk as much as I could,” Jolie writes. On April 27 she had the last medical procedure as part of the mastectomies—and her chance of developing breast cancer dropped to under 5 percent.
Breast cancer experts and advocates applauded the manner in which Ms. Jolie explored her options and made informed decisions, saying it might influence some women with strong family histories of breast cancer to get genetic tests.
Her condition is rare. Mutations in BRCA1 and another gene called BRCA2 are estimated to cause only 5 percent to 10 percent of breast cancers and 10 percent to 15 percent of ovarian cancers among white women in the United States. The mutations are found in other racial and ethnic groups as well, but it is not known how common they are.
About 30 percent of women who are found to have BRCA mutations choose preventive mastectomies, said Dr. Kenneth Offit, chief of clinical genetics at Memorial Sloan-Kettering Cancer Center in New York. Those who have seen family members die young from the disease are most likely to opt for the surgery.
“It’s important to make it clear that a BRCA mutation is a special, high-risk situation,” said Dr. Monica Morrow, chief of the breast service at Sloan-Kettering. For women at very high risk, preventive mastectomy makes sense, but few women fall into that category, she said.
For women’s health advocates, the trend toward double mastectomies in women who do not have mutations is frustrating. Studies in the 1970s and 1980s proved that for many patients, lumpectomy was as safe as mastectomy, and the findings were seen as a victory for women.
Even so, there is increasing demand for mastectomy. Dr. Morrow says that she has often tried to talk patients out of it without success. Some imagine their risk of new or recurring cancer to be far higher than it really is. Others think that their breasts will match up better if both are removed and reconstructed.
Because the BRCA mutations are rare and the test expensive — about $3,000 — it is not recommended for most women. ...Women who should consider testing are those who have breast cancer before age 50, a family history of both breast and ovarian cancer, or many close relatives with breast cancer, especially if it developed before age 50. Any woman with ovarian cancer should consider being tested, as should Ashkenazi Jewish women with breast or ovarian cancer. ...
Because the cancer risks for carriers are so high, women with the mutations are often advised to have their breasts and ovaries removed as a preventive measure. It is generally considered safe to wait long enough to have children before having the ovaries removed, but the operation should be done by age 40, said Dr. Susan M. Domchek, an expert on cancer genetics at the University of Pennsylvania and the executive director of its Basser Research Center, which specializes in BRCA mutations. There is no reliable way to screen for ovarian cancer, and most cases are detected at a relatively late stage, when the disease is harder to treat and more likely to be fatal.
Ms. Jolie said that she herself had a 50 percent risk of ovarian cancer. “I started with the breasts, as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex,” she wrote.
“I think there is an important upside to the story, and that is that women will hopefully be more curious about their family history,” Dr. Bedrosian said. “We need to be careful that one message does not apply to all. Angelina’s situation is very unique. People should not be quick to say ‘I should do like she did,’ because you may not be like her.”
May 14, 2013 6:40 AM
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| JOE KLAMAR / AFP |
This isn’t exactly a shocker, but it’s sweet nonetheless. Brad Pitt hailed his fiancée, Angelina Jolie, as “heroic” after she opened up about her double mastectomy. “Having witnessed this decision firsthand, I find Angie’s choice, as well as [that of] so many like her, absolutely heroic,” Pitt told London’s Evening Standard on Tuesday. “All I want for her is to have a long and healthy life, with myself and our children. This is a happy day for our family.” ...