Yesterday Angelina Jolie shocked us in a very public New York Times op-ed, on a topic most women only talk about in whispers—the risks of breast cancer and how to avoid it. I applaud her for this—I have very strong feelings about women’s reproductive health and cancer risks, especially after witnessing an acquaintance be diagnosed with breast cancer in her twenties.
The woman I knew also had a faulty gene and an extensive family history. She chose to receive a double mastectomy, even though she was only presenting with cancer in one breast. And in one of the most poignant memories of my life, as we sat around another’s friend’s living room, she stopped, looked at all of us there, and said,
“One in ten of us will get breast cancer. There are ten of us here. I guess I am the one.”
Just try not to care deeply about breast cancer after that, I dare you.
But– and this is a big but– is a double mastectomy for a woman who does not have cancer the best option? We know that Jolie and her doctors thought it was, for her (and hey—do what you want with your breasts, Angie—enlarge them, reduce them, remove them, place them on your back, like Cher threatened to do—I’m all for you doing what you want with your own body), but what are the recommendations for other women? And how does one go about deciding if prophylactic removal of breast and/or ovarian tissue is the best option?
Well, the National Cancer Institute at the National Institute for Health has some opinions on that. Some things one should consider (keep in mind, men can get breast cancer too—especially if they carry one of the faulty genes) before considering surgery are below:
- Only 12% of women get breast cancer. Now, for those who have a genetic mutation of the BRCA1 or BRCA2, the risk does increase to five times the norm; 60% of women with the mutations will get breast or ovarian cancer. If you don’t have the genetic mutations, there are many other less-invasive ways to prevent and even detect breast cancer in the early stages.
- What if you don’t know if you have the genetic mutation? Well, there are some indictors that may lead you to consider having the blood test. Are you of eastern or central European Jewish descent? Or, do you have Norwegian, Dutch, or Icelandic ancestors? Then you have a higher chance of carrying the mutation (but please, keep in mind, only a small percentage of those ethnicities have the mutation). More telling is your family history of breast or ovarian cancer. Do you know more than one person in your family who has had breast, ovarian or both types of cancer? Were they close to you (like a sister or mother)? Is there a man in your family that had breast cancer? Did those with cancer have it while they were 50 or younger? Did anyone have multiple types of cancer present (meaning primaries cancers that were not related to one another—like breast and colon cancer)? The family history of a disease can be much more telling than your ethnicity.
- Are there any other options other than surgery? Absolutely. I think it’s important to note that surgery is not the only option, nor is it the most popular option. What the NCI calls ‘surveillance,’ or heightened early detection and screening measures are very popular. So is any lifestyle change (diet, exercise, you know the drill) that can be easily incorporated into one’s daily routine. Finally, and much more common that surgical intervention, is Chemoprevention. This is where women with the mutated gene or extensive family histories will take low doses of breast cancer chemotherapy drugs (by mouth) in order to prevent the occurrence (or recurrence) of breast cancer. In fact, Tamoxifen has been shown to reduce the chance of getting breast cancer by 50% in women who carry the mutation.
All in all, what Angelina did yesterday was brave. I’m a big believer that celebrities should speak more openly about real life and real problems. She got the conversation started for many women. She wrote something open and truthful without being gory or holier-than-thou. Her surgery and her open admission—what she did was right for her. That being said, it may not be right for all women concerned with the risks of breast cancer.