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Dr. Shicha Kumar MD
Roswell Park Cancer Inst.
The 37-year-old Oscar-winning actress says she decided to go public about her decision to encourage other women to be proactive to see if they are also at risk.
In an op-ed in The New York Times Tuesday, Jolie says the BRCA1 gene "sharply increases my risk of developing breast cancer and ovarian cancer." She says doctors put her hiked ovarian cancer risk at 50 percent.
Here's a crash course in the procedure Jolie had and why.
Q: What kind of surgery did Jolie have?
A: Jolie had a preventative double mastectomy, meaning she chose to have both her breasts removed even though she had not been diagnosed with cancer.
Q: Why did she have the mastectomies?
A: Jolie says that she has a "faulty" version of the BRCA1 gene that means she has an 87 percent chance of getting breast cancer. By having both breasts removed preventatively, she said her breast cancer risk drops to 5 percent.
Q: What did the procedure involve?
A: In double mastectomies, surgeons typically remove as much breast tissue as possible. In Jolie's case, because she was having a reconstruction done shortly afterward, the doctors preserved the skin covering her breasts, inserting "fillers" where the breast tissue would have been, to keep the skin elastic, and then following up with implants put in nine weeks later.
Q: How many women have this faulty gene?
A: Only a small percentage of women have this same faulty gene, or a similar mutated version of a related gene, BRCA 2. These mutations are most commonly found in women of Eastern European Jewish descent; one study found 2.3 percent of women in that group had the mutations - about five times higher than in the general population. Other ethnic groups, including the Norwegian, Dutch and Icelandic people, also have slightly higher rates of these mutations.
Q: How do these genes increase a woman's risk of breast cancer?
A: The average woman has a 12 percent risk of developing breast cancer sometime during her life. In comparison, women who have inherited a faulty version of a breast cancer gene are about five times more likely to get breast cancer. In the U.S., about 5 to 10 percent of breast cancers are thought to be linked to BRCA1 and BRCA2 genes.
Q: How can women find out if they have these gene mutations?
A: A genetic test using a blood test can usually detect these genes. In the U.S., there are no standard guidelines recommending women for BRCA1 or BRCA2 genetic testing. The tests usually cost at least several hundred dollars.
Q: What other options might Jolie have had?
A: Doctors would likely have suggested earlier screening tests, including mammograms or MRIs, although those would only help them spot breast cancer earlier, not prevent it. They might also consider using breast cancer drugs preventively, though trials into their long-term use is still ongoing.
Jolie, whose mother died from cancer at 56, says she "decided to be proactive and to minimize the risk as much I could. I made a decision to have a preventive double mastectomy. I started with the breasts, as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex."
Jolie says she had three mastectomy-related procedures over three months, finishing the last one on April 27. They included two operations - the second of which was breast reconstruction.
"I am writing about it now," Jolie says, "because I hope that other women can benefit from my experience. Cancer is still a word that strikes fear into people's hearts, producing a deep sense of powerlessness. But today it is possible to find out through a blood test whether you are highly susceptible to breast and ovarian cancer, and then take action."
Jolie adds that she "wanted to write this to tell other women that the decision to have a mastectomy was not easy. 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."
"I am fortunate," she continues, "to have a partner, Brad Pitt, who is so loving and supportive. So to anyone who has a wife or girlfriend going through this, know that you are a very important part of the transition.
Brad was at the Pink Lotus Breast Center, where I was treated, for every minute of the surgeries. We managed to find moments to laugh together. We knew this was the right thing to do for our family and that it would bring us closer. And it has.
"For any woman reading this, I hope it helps you to know you have options. I want to encourage every woman, especially if you have a family history of breast or ovarian cancer, to seek out the information and medical experts who can help you through this aspect of your life, and to make your own informed choices"
-- Angelina Jolie
Jolie says, "I choose not to keep my story private because there are many women who do not know that they might be living under the shadow of cancer. It is my hope that they, too, will be able to get gene tested, and that if they have a high risk they, too, will know that they have strong options.
She is anything but private in the details she provides, giving a description of the procedures.
"My own process began on Feb. 2 with a procedure known as a `nipple delay,'" she writes, "which rules out disease in the breast ducts behind the nipple and draws extra blood flow to the area."
She then describes the major surgery two weeks later where breast tissue was removed, saying it felt "like a scene out of a science-fiction film," then writes that nine weeks later she had a third surgery to reconstruct the breasts and receive implants."