Details about Angelina Jolie’s Double Mastectomy Decision

After recent news about death of  Angelina Jolie’s Aunt to breast cancer social media’s focus in back on to the topic. Conspiracy theory fans talking about hidden agenda behind public disclosure by Jolie are hiding in hoods now.

There is a certain kind of confusion to paranoia about whether everyone should do genetic testing to know their risk.Actually,her message is not about promoting mastectomy or genetic testing but that about encouraging us to take charge of our health. The fact of the matter is that it was her choice, and without understanding the psychology, the rationale and the science behind it, we will end up with very different conclusions. In this article, I would discuss about her choice in the context of the majority, 99% of the women who have no more than average expected risk of cancer.

Before,we come to that topic,let me revise the basic facts by this illustration from DoctorSpring.

Now,let us discuss,how to make the decision about going for genetic testing.

It is to be noted that people should weigh pros and cons of genetic testing. Few highlights being –

1. The testing is predictive i.e. the test predicts what might or might not happen but not will or will not.
2. Negative results don’t completely ensure that there’s no-risk.
3. Interpretation of these tests is poorly understood.
4. Genetic testing Is expensive and is covered by Insurance, if recommended by your Doctor.
5.  Counselling is recommended before undergoing genetic testing to weigh pros and cons of testing, cost, limitations, emotional and psychological impacts.
6. Tests are not available for all of the genes that affect breast cancer risk and  are not tightly regulated and standardized.

***It’s really important to note that genetic testing for BRCA1 / BRCA2 gene mutations is not appropriate for the general population.  

In Canada, doctors follow the following referral guidelines to decide if it’s appropriate for a patient to undergo genetic testing for BRCA1/BRCA2 gene mutations:

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Referral for genetic counseling or testing should be offered to patients who meet the following criteria:

• multiple cases of breast or ovarian cancer on same side of the family, especially

  • — in closely related relatives,

  • — in more than 1 generation, and

  • — when breast cancer is diagnosed before age 50;

• a family member with breast cancer diagnosed before age 35;

• a family member with both breast and ovarian cancers;

• an Ashkenazic Jewish heritage, particularly with relatives with breast or ovarian cancer;

• a family member with primary cancer in both breasts, especially if diagnosed before age 50;

• a family member with ovarian cancer;

• a family history of male breast cancer; or

• a family member with an identified BRCA1 or BRCA2 mutation.”

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To counter her high risk, Angelina Jolie decided to undergo a preventive mastectomy (removal of all breast tissue) and breast reconstruction. In near future she might undergo Prophylactic Oophorectomy (Preventing cancer by surgically removing your ovaries) to reduce her risk for ovarian cancer to about 6%.

Here is what you need to know about Preventive Mastectomy and breast reconstruction –

1. Reduces the risk of breast cancer to 5%.
2. As is true with any surgery, prophylactic mastectomy comes with risks including potential complications like Bleeding, Infection, Pain, Swelling, Development of scar tissue, and possible psychological issues like anxiety and disappointment with respect to looks.
3. Great advances in this field have lead to little to no scars, though the cost is about USD 50,000.
4. Counselling may be needed to quell Anxiety or disappointment about changes in one’s appearance.
5. A skilled surgeon can perform mastectomy procedure in about 1.5 hours.

Here are the options available which were available to Jolie, but given her high risk she decided against –

1. Increased surveillance by periodic screening and imaging. These include regular mammograms, MRIs to test for breast cancer, and regular pelvic sonograms and blood-tests to watch for ovarian cancer.
2. Less radical procedures, like lumpectomies (removal of only some of the breast tissue) may be sufficient to treat breast cancer if it does occur.
3. Medication – One may reduce your risk of breast cancer by taking drugs that block the effects of estrogen, because estrogen can promote breast cancer development and growth. These drugs may reduce the risk of invasive breast cancer by approximately 50 percent. However, they carry a risk of side effects. Talk with your doctor about the risks and benefits of these medications.
4. Surgery to remove the ovaries – Prophylactic oophorectomy can reduce the risk of both breast cancer and ovarian cancer. Women with BRCA mutations also have an increased risk of ovarian cancer. Prophylactic oophorectomy may reduce the risk of breast cancer up to 50 percent in women with a high risk of breast cancer.

The lesson here is AJ made an informed decision on the basis of her personal situation and it should inspire people to recognize their health risks and becoming proactive about them.

1. Maintaining a healthy and active lifestyle – avoid/reduce tobacco, alcohol, high-fat diet.
2. Undergoing periodic screening (Mamography, Clinical Breast Exams (CBE), Magnetic Resonance Imaging (MRI), Breast Self Exam (BSE) as per one’s risk profile (family pre-disposition, genetic screening, breast-tissue density, menstrual and reproductive history, age etc)
3. Use of chemoprevention or medication
4. Education to look out for potential signs of breast cancer and options about Breast Cancer.

So, when is mastectomy an option?

1. Already had cancer in 1 breast – the unaffected breast is remove to reduce the possibility of another breast cancer.
2. Family predisposition to breast cancer – high expected risk
3. Positive results of increased risk from gene testing and family predisposition
4. Markers (breast changes) that increase risk of breast cancers
5. Dense breast tissue especially if other risk factors are involved
6. Radiation therapy before the age of 30
7. Pregnant and hence can’t use radiation therapy

“Life comes with challenges. The ones that we should not scare us are the ones we can take and take control of”, thanks Angelina for encouraging people to take charge of their health. Be proactive by understanding your risk and consulting a Doctor at the right time! Go for second opinions and re-tests to avoid fake positives but most important lesson of all understand and be conscious of your health.

More:

• How Angelina Jolie’s Double Mastectomy Shed Light on the BRCA1 Gene