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May 15,2013
WASHINGTON — Actress and U.N. goodwill ambassador Angelina Jolie is in the spotlight for her decision to undergo a double mastectomy to reduce her chances of getting breast cancer, even though she is cancer free. The actress announced her decision, and her surgery, in an article she wrote for The New York Times. Jolie's decision was based on a genetic test she had -- and other options available to women facing a breast cancer risk.
She's beautiful, glamorous, and known for being outspoken whether it's about refugees or women's rights. Angelina Jolie's decision to have both breasts surgically removed when she doesn't have cancer, has put the spotlight on preventive surgery.
Jolie's mother died of cancer when she was 56 years old. The actress said her children wanted to know if she would, too. Jolie said genetic tests put her chances of getting breast cancer at 87 percent and at 50 percent for ovarian cancer.
Doctors have found that certain genetic mutations can increase the odds of developing breast and ovarian cancer. The two major genes associated with hereditary breast and ovarian cancer are BRCA1 and BRCA2.
One study found that if a woman develops BRCA-related cancer early in life, her daughter may get cancer even earlier than she did -- if she inherited the genetic mutation.
Women with BRCA-related breast cancer have the same rate of survival as other breast cancer patients at the same stage. But Dr. Marc Boisvert of Medstar Washington Hospital says there's a significant difference.
"The problem is that these cancers frequently appear in younger women, and younger women tend to have more aggressive cancers, and they’re not suspecting them," Boisvert said.
Women in their 20s and 30s are not likely to be screened for breast cancer. Those most likely to have the BRCA mutations are of east European Jewish descent. But "you can have it if you’re black, white, Hispanic, Chinese, Asian, any ethnic group can have it," Boisvert said.
The National Cancer Institute recommends genetic testing if close relatives have had breast or ovarian cancer. But not having the BRCA1 or 2 mutations is not an all-clear sign. And having the genetic marker doesn't mean getting the disease is a given. But geneticists can come up with the likely odds -- which is why Jolie said her chance of getting breast cancer was 87 percent.
The cost for genetic testing can run into the thousands of dollars.
The preventive surgery can lower the odds to less than five percent, but Boisvert says surgery isn't the only choice.
"I think education is important here because you can get peace of mind knowing that you are being monitored very carefully and knowing what the numbers are, what the chances of recurrence are,” Boisvert said.
Boisvert says in the end, the patient needs to be comfortable with her care, whether it involves careful monitoring or surgery.
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