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Angelina's Choice: What Every Woman Needs to Know

Image by Reuters

She did the research.  She had the surgery.  She made a very personal decision about what was right for her, and she bravely chose to share that decision with the world.

Angelina Jolie is one of the biggest movie stars of our time.  Her life may seem like something out of a fairy tale, full of Academy and Golden Globe awards, travel, and high-profile humanitarian efforts; but the crisis Jolie navigated was a very human and highly individual one: how to face the possibility of cancer.

Marcheline Bertrand, Angelina Jolie's mother, died of ovarian cancer at age 56. Since then, Jolie received a BRCA test that told her she was at risk as well - an even higher risk than most with the BRCA mutation. Women who carry BRCA mutations have, on average, about a 65% risk of eventually developing breast cancer, as opposed to a risk of about 12% for most women.  Doctors told her she had an 87% chance of developing breast cancer, and a 50% risk of developing ovarian cancer.

According to the National Institutes of Health (NIH), BRCA mutations can increase lifetime risk of breast cancer for women from the standard 12% to 60% on average, and of ovarian cancer from 1.4% to 15-40%.  There are a lot of factors involved that can change that risk, including other gene mutations, family history, ethnic background, and environmental exposures. Genetic tests are available to check for BRCA1 and BRCA2 mutations. A blood sample is required for these tests, and genetic counseling is recommended before and after the tests. Insurance does not always cover testing, and the cost can run as high as $3,000. Women who should consider testing are those who have had 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. Men with breast cancer and their families should also ask about the possibility of a genetic predisposition to the disease.

Many research studies are being conducted to find newer and better ways of detecting, treating, and preventing cancer in BRCA1 and BRCA2 mutation carriers. Additional studies are focused on improving genetic counseling methods and outcomes. Our knowledge in these areas is evolving rapidly.

Doctors and researchers do not always agree on the most effective way to manage the care of women who have a prominent family history of breast cancer. Some doctors may advise very close monitoring (periodic mammograms and regular checkups that include a clinical breast examination, as well as monthly breast self-exams) to increase the chance of detecting breast cancer at an early, treatable stage. Some doctors may recommend preventive mastectomy, while others may prescribe tamoxifen or raloxifene, medications that have been shown to decrease the chances of getting breast cancer in women at high risk of the disease.

Most women with BRCA mutation do not opt for preventative mastectomies. According to Dr. Kenneth Offit, chief of clinical genetics at Memorial Sloan-Kettering Cancer Center in New York, only about 30 percent of women who are found to have BRCA mutations choose to do so. It is important for women considering preventive mastectomy to talk with a doctor about their specific risk of developing breast cancer (with or without a mastectomy), the surgical procedure itself, the potential complications, and the realities of the recovery process. All women are different, so preventive mastectomy should be considered in the context of each woman’s unique risk factors and her level of concern. 

So what’s the takeaway here? Hopefully it means more women will not only become curious about their family history of breast cancer, but about the highly individual implications of genetic testing. Every woman is unique, and every woman deserves access to the knowledge that will allow her to make the wisest cancer-prevention choices for herself.

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