Should you get a preventative mastectomy like Angelina Jolie?

HOLLYWOOD, CA - FEBRUARY 26:  Actress Angelina Jolie arrives at the 84th Annual Academy Awards at the Hollywood & Highland Center February 26, 2012 in Hollywood, California.  (Photo by Ethan Miller/Getty Images)
Angelina Jolie elected to have surgery after finding out that she has a higher genetic risk for breast cancer. Credit: Ethan Miller/Getty Images

Angelina Jolie made headlines Tuesday by announcing that she had undergone a preventative double mastectomy after testing positive for a mutated BRCA1 gene, which indicates a strong predisposition to breast and ovarian cancers.

In her New York Times op-ed piece, “My medical decision,” Jolie reveals that her doctor estimated she had an 87 percent risk of breast cancer and a 50 percent chance of developing ovarian cancer. “I decided to be proactive and to minimize the risk as much I could,” she writes. Now, post-mastectomy, her risk of breast cancer has dropped to 5 percent. Jolie’s mother died of cancer in 2007 at age 56.

BRCA1 and BRCA2 are two genes that, when mutated, have been linked to breast and ovarian cancers, as well as other types of the disease. Both women and men are susceptible to the faulty genes. Patients can undergo a blood test to see if they have the mutated genes, and genetic counselors can help patients decide on the best course of treatment for them. That might be a prophylactic (preventative) mastectomy, taking drugs like tamoxifen or raloxifene — which are proven to lower breast cancer risk — or simply continuing cancer screenings.

Indeed, the aggressive procedure Jolie had is not for everyone, says Dr. Fred Jacobs, chief medical officer of the eastern division of the American Cancer Society: “That decision needs to be made in conjunction with a very experienced medical oncologist and a genetic counselor who can make sense of the data the woman has.”

“If a woman has a family history which suggested that an evaluation for the BRCA mutation would be medically indicated, and they did it and she had [the mutated gene] — which increased the risk of them getting cancer to a very high number — then it’s a very personal thing,” he adds. “The women who have this issue have a problem with suppressing the development of cancer. Everybody has cell division that may go a little out of whack, but there’s natural body defenses [against that]. This gene suppresses that defense.

“Do you want to live with that risk, or do you want to take aggressive action to reduce it, meaning a rather extensive surgical procedure? [Jolie] spent three months doing it. That requires a bit of a commitment for a disease you don’t have.”

Jacobs also says that Jolie’s procedure does not mean everyone needs to be genetically tested.

“The U.S. Preventive Services Task Force recommend that only women with a strong family history be evaluated for genetic testing, and that only is about 2 percent of adult women in the U.S. But, that is a very large number of women.”

Those who opt for a mastectomy can expect a procedure that takes a few hours, more if the patient opts for reconstructive surgery during the same operation. Patients often choose the simultaneous procedure, Jacobs says, “because they go to sleep and then they wake up and still have breasts.” Reconstructive surgery involves a plastic surgeon recreating the breasts once the breast surgeon has finished his portion of the operation.

Insurance coverage “depends on the policy,” Jacobs says, though he argues that “insurance should cover it because it’s a legitimate form of therapy for a disease process,” when cancer itself has yet to manifest. In the future, Jacobs adds, we “may be able to attack the gene and prevent it from expressing itself in a way that would result in a risk of cancer.” Until then, post-procedure recovery is “like any major surgery, measured in weeks and months.”

Though Jolie greatly reduced her risk from 87 to 5 percent, Dr. Jacobs notes that even that number is still more than the average woman’s risk. “It’s because you can’t remove all the breast tissue in a bi-lateral prophylactic operation,” he says. “Some of the breast tissue is gonna be left behind. We’re gonna take out all that we can, so that her risk is now reduced from 9/10 to 1/20  — that’s a very substantial reduction, but she didn’t reduce her risk to zero.”

Still, Jacobs is quick to commend the actress and director on her decision. “She took the matter into her own hands and said, ‘I’m not gonna sit back and wait for this, I can’t live with that. Other women might be able to, [but] … I want to take charge of my life, and this is available to me.’ It’s a perfectly reasonable thing that she did for herself.”



News
Entertainment
Sports
Lifestyle
National

Dr. Dre is king of hip hop with…

With $620 million in estimated pre-tax earnings, veteran rapper and record producer Dr. Dre topped Forbes list as the highest paid hip hop artist, ousting Sean "Diddy" Combs from the…

News

Bin Laden son-in-law sentenced to life in U.S.…

A seemingly unrepentant Suleiman Abu Ghaith, a son-in-law of Osama bin Laden, was sentenced to life in prison on Tuesday in New York following his conviction on terrorism charges.

National

Bloomberg: Going green will grant you longer life…

Former NYC mayor Michael Bloomberg tells Metro that cities are where fighting global warming can make a difference, and increase people’s lifespan.

International

Ban Ki Moon: "Climate change is an issue…

My message to you is: make your voice heard and your actions count. Change is in the air. Solutions exist. The race is on. It’s time to lead.

Television

Craig Ferguson wants you to see his new…

Craig Ferguson thinks his new game show will become "a comedy show in which a game is played and money is won."

Television

Anthony Anderson on dealing with your 'ish'

Anthony Anderson discusses finding the humor in his "Black-ish" family.

Gossip

Photos: See who Robert Pattinson was caught holding…

Robert Pattinson has a new girlfriend.

The Word

The Word: Kris and Bruce Jenner's predictably public…

They said it wouldn't last — mostly because of that separation almost a year ago. And now, more than a year later, Kris and Bruce…

MLB

Bud Selig honors Derek Jeter as both prepare…

Bud Selig’s 22-year reign as commissioner will end Sunday, and while it’s had its share of negative moments, it also had Derek Jeter.

NFL

Column: Geno Smith not the answer for Jets…

There were highs for Jets quarterback Geno Smith in Monday night’s loss to the Bears and there were incredible lows.

NFL

3 things that went right in Jets loss…

It wasn't the result the Jets wanted, a 27-19 loss to the Bears, but this team deserves some credit.

Sports

Here's the 8 best and worst sporting goodbyes

With Derek Jeter set to retire following the 2014 Major League Baseball season, we look back at some of the great and not-so-great sporting goodbyes.

Home

NYC fall real estate hot list

The upcoming developments and areas everyone's buzzing about.

Style

Milan Fashion Week shows the best of Italian…

Metro rounds up the cut of the collections at Milan Fashion Week.

Tech

The 2014 Maker Faire saw robots, printers and…

Got a broken button maker? There’s a fix for that – and Tony Stanzione of the Fixers’ Collective says he can show you how.

Parenting

First look: Uniqlo's fall/winter 2014 kids collection

Get a sneak peek at Uniqlo's kids and babies fall/winter 2014 line.