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05-31-13 | Posted by

When actress Angelina Jolie says or does something, photographers and paparazzi point, click and pursue. Whether on the red carpet, a movie set, or soap box, she has a way of capturing our collective attention.

And she has done it again.

Jolie has championed human rights and international adoption and is now doing the same for breast cancer prevention.  It’s always personal with Jolie, but this time it seems almost intimate. Jolie underwent a preventive mastectomy to reduce her risk of breast cancer after testing positive for the breast cancer genes and told the world all about it in a New York Times Op-Ed piece.

As a result of Jolie’s shocking admission, doctor’s phones began ringing off the hook. If it can happen to Angelina Jolie, can it happen to me? Should I be tested? What is the next step?

Mutated copies of the BRCA1 or BRCA2 genes increase a women’s risk for developing breast and/or ovarian cancer. Jolie’s mother, actress Marcheline Bertrand, died from ovarian cancer in 2007 at 56, which is why she sought genetic testing.

There are no hard and fast rules or easy answers when it comes to gene testing. In general, genetic counseling and/or testing is reserved for people with a personal or familial history of breast or ovarian cancer. This can be on your mother or father’s side of the family.

The first step is to schedule a consultation with a genetic counselor to see if you are a candidate, says Heather Hampel, MS, CGC, the co-director of the division of human genetics in the department of internal medicine at Ohio State University’s Wexner Medical Center’s Comprehensive Cancer Center in Columbus, Ohio.

If you do test positive for the genes, a mastectomy can dramatically reduce your chances of ever developing breast cancer. It doesn’t eliminate your risk, it just lowers it substantially. Women who are at risk for ovarian cancer may also opt to have their ovaries removed.

The good news is that breast reconstruction options are much better today than ever before. Reconstructed breasts look and feel as natural as the real thing. This is because surgeons have a better understanding of how breast cancer spreads and travels, which has allowed them to develop surgeries that can spare the skin and the nipples—while still removing all traces of cancer, explains Tracy M. Pfeifer, MD, MS, a New York City-based plastic surgeon.

In addition, the advent of form-stable, gummy bear breast implants have also helped improve women’s satisfaction with the cosmetic results of breast reconstruction. Other advances include the use of fat to soften the appearance of implants, Pfeifer says.

Removing an organ to reduce cancer risk is a lot different than removing an organ with cancer. It’s not an easy decision to make, and all surgeries—even preventive ones—do confer their share of risks. “Angelina Jolie’s willingness to discuss her personal situation and choices will help educate many women and that’s a very good thing,” Pfeifer adds.

As it stands,  seven out of 10 women eligible for breast reconstruction following cancer surgery are not being informed of their options.


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