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Angelina Jolie's breast surgery sparks cancer discussion


Orlando Sentinel

05-15-13

May 14--Angelina Jolie's news that she elected to have both breasts removed to reduce her chances of developing breast cancer has brought awareness to a decision more women are facing.

Advances in genetic testing along with a better understanding of the BRCA genetic mutation, which greatly increases a woman's risk of developing breast or ovarian cancer, are forcing more women to confront this choice.

"I was encouraged, and thought it very brave," said St. Cloud resident Terri Johnson of Jolie's announcement.

Johnson, 52, made the decision to have the same procedure Jolie had -- a bilateral mastectomy -- six weeks ago. Johnson's mother was diagnosed with breast cancer at age 43 and died 11 year later.

Johnson got tested, and learned she carried a worrisome BRCA genetic mutation.

"I know I made the right decision," said Johnson, who works as a financial counselor in a cancer center. "I see cancer patients every day, and I saw what my mother went through. I don't want to be one of those people to go through treatment for something I could have prevented."

Nationwide, there's an increasing trend for women who have the genetic mutation to opt for bilateral mastectomy, said Dr. Anees Chagpar, a cancer surgeon at Yale Cancer Center and director of the Breast Center at Smilow Cancer Hospital at Yale-New Haven.

"That's because the surgery is the best way to reduce their risk of developing breast cancer, and because, with the reconstructive techniques now available, women can look very normal," said Chagpar.

Those who find they do carry the genetic mutation, must make a very personal decision, said Chagpar.

Some choose to have breast screenings more often and try to catch cancers early; others take medication to suppress estrogen production, and some, like Jolie, opt for surgery.

"...the decision to have a mastectomy was not easy," wrote Jolie in her op-ed piece in the New York TImes. "But it is one I am very happy that I made. My chances of developing breast cancer have dropped from 87 percent to under 5 percent. I can tell my children that they don't need to fear they will lose me to breast cancer.

"It is reassuring that they see nothing that makes them uncomfortable. They can see my small scars and that's it. Everything else is just Mommy, the same as she always was. And they know that I love them and will do anything to be with them as long as I can. On a personal note, I do not feel any less of a woman. I feel empowered that I made a strong choice that in no way diminishes my femininity."

Everyone has the BRCA gene, which normally protects against cancer, said Chagpar. Genetic testing looks for a mistake in the gene.

Women who have a mutation to that gene, most commonly called BRCA 1 or BRCA 2, have an 87 percent chance of developing breast cancer in their lifetime, and a 60 to 65 percent increased chance of developing ovarian cancer, said Chagpar.

Men who have the gene also have an increased of developing breast cancer.

The majority of women who develop breast cancer do not have a genetic risk. "The risk of carrying the actual gene is pretty small," said Chagpar.

However, about 15 percent of women will have a family history. Of them, 5 to 10 percent will have the genetic mutation.

"If you have a family history and are worried about carrying the cancer gene, have your doctor do a thorough genetic history," advises Chagpar.

If together you decide to get tested for the gene, seek out a genetic counselor first, she said.

"The counselor will help you map out your genetic risk, and determine which tests are most appropriate, and also help secure insurance coverage for the testing."

The genetic test can run more than $3,000. Generally, the test is covered by insurance, as is the subsequent surgery and reconstruction, said Chagpar.

"What's important," said Chagpar, "is that women understand their risks and options, and have a conversation about that with their doctors and loved ones."

mjameson@tribune.com or 407-420-5158

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(c)2013 The Orlando Sentinel (Orlando, Fla.)

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Copyright Orlando Sentinel 2013

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