By Sang Hyo Kim, Staff Editor

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Angelina Jolie, the actress recognized for her charismatic beauty, revealed to the New York Times that she had undergone double mastectomy, the surgical removal of the breasts. Because her mother died of ovarian cancer at 56, when Jolie learned that she had a mutation in her BRCA1 gene, she proactively choose double mastectomy to diminish her chance of developing breast cancer.

Everyone has the BRCA1 and BRCA2 genes, members of a group known as “tumor suppressing” genes. Any mutation in these genes can increase the risk of ovarian, breast, and pancreatic cancer in women, and testicular, prostate, and a rare form of breast cancer in men.¹ Mutations in the BRCA1 gene occur in only 0.24% of the population and account for no more than 10% of all cases of breast cancer.¹ With a mutation in her BRCA1 gene, Jolie had a 87% chance of developing breast cancer and 50% chance of developing ovarian cancer.¹ By getting the surgery, she reduced the likelihood of getting breast cancer from 87% to just 5%.¹ Jolie will also soon undergo surgery to remove her ovaries to eradicate her chances of developing ovarian cancer.

A simple blood test that costs about $3000 can be used to detect mutations in the BRCA1 gene. The test is not available to everyone, especially to those not as wealthy as the Oscar winning actress. But women can still choose from other options to reduce the risk of cancer, such as imaging tests, chemoprevention or preventative pharmacotherapy. For those who choose surgery like Jolie has, there are additional factors to consider such as age, psychological impact and cost.² The cost from the surgical procedure to the reconstructive process of the breasts afterwards represents the tip of the medical iceberg of mastectomy, which can be daunting. Even though the precautions that she took may sound over cautious to many, the actress hopes to empower, educate, and inform people about genetic mutation and cancer risk by sharing her story.²

Angelina Jolie is world famous, which means that her body garners much attention; therefore, one can ask how she deals emotionally with the removal of what many would consider the most sensuous and feminine parts of her body. For Jolie, however, the surgery did not affect her self-esteem as a woman. She says, “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.”³

Jolie’s decision was courageous because she chose the operation even though she did not have cancer. Sarah Hawley, associate professor of general medicine at the University of Michigan, states that it took a lot of strength for Jolie to get to that point in the first place. Other experts say that the actress made a smart choice; Dr.Eric Winer of the Dana-Farber Cancer Institute said, “[Angelina Jolie’s case is] one of the truly unique situations where most medical professionals would say if a woman chose to have both breasts removed, it’s a pretty reasonable thing to do.”¹ Indeed, the fall in the probability of her getting cancer proves that the decision she made for herself and her family was smart and life changing.

Every year, about 250,000 women go for genetic testing, just like Angelina Jolie has.¹ The advanced technology in genetic testing detects the patient’s possibility of developing diseases such as breast cancer, Lou Gehrig’s Disease (ALS), Huntington’s disease, cystic fibrosis, and hemophilia.¹ With genetic testing, doctors can also determine the most effective chemotherapy  for the patient and determine the chance of recurrence by sequencing the tumor’s DNA. Despite the continuous research, however, there are still diseases prevalent that cannot be fully detected yet: Alzheimer’s disease, autism, diabetes, colon cancer, and obesity.¹

Genetic testing is useful in the early detection of disease and in the determination of the proper treatment for patients to live longer and healthier lives. Studies have found that actively taking preventative measures, such as genetic testing, depends on the geographical location of the patients and that the rates of employing different preventative testing vary tremendously worldwide. The 2004 ‘Intergroup Exemestane Study,” which is an analysis of surgical techniques used in an international trial of adjuvant treatment among 4,700 women with early stage of breast cancer in 37 countries, shows that the rate of mastectomy was highest in central and eastern Europe at 77% of women in that region.⁴ The United States was second at 56%, Western and Northern Europe at 46%, Southern Europe at 42% and Australia and New Zealand at 34%.⁴

The example of a famous celebrity like Angelina Jolie seeking genetic counseling and choosing mastectomy may inspire women who are fighting breast cancer to become more proactive and have more self-confidence after drastic procedures like mastectomy. It may also help other women overcome their fear of getting medically necessary mastectomies, and even empower women and help them feel that their decisions are progressive, instead of shameful, when they get post-operative breasts implants.

With every pros, however, there are always cons. Debates rise on whether Jolie’s case is an oversimplification of the fight against cancer. As mentioned earlier, some women do not have the money or the insurance coverage to go for genetic counseling. Although these realities cannot be denied, what Jolie did has a resounding effect. She has exemplified femininity, and her body was a key dimension to her fame. After revealing her personal story, TIME magazine states that “[her body] may even become a bigger and more inspiring dimension of her influence.”¹

Jolie encourages all women who have a family history of breast or ovarian cancer to seek out information. Medical experts can then help the patient in making a personal and informed choice. It was only natural for Jolie to receive the best treatment possible because of her wealth and fame, but we patients should not neglect or doubt what Jolie did. She educated the public to utilize all medical resources that are not just limited to costly surgeries, by finding other forms of cancer treatments or medications. In her own words, “life comes with many challenges. The ones that should not scare us are the ones we can take on and take control of.”³

SOURCES:

1. K Jeffrey, P Alice. The Angelina Effect. Time. May 27^th, 2013
2. Dr. Ashton, Jennifer. Angelina Jolie’s Mastectomy: What You Should Know. abc News. http://abcnews.go.com/blogs/health/2013/05/14/what-dr-ashton-wants-you-to-take-away-from-angelina-jolies-double-mastectomy/. Accessed May 31^st, 2013
3. Jolie Angelina. My Medical Choice. The New York Times.
4. What is a Mastectomy? News Medical Website. http://www.news-medical.net/health/What-is-a-Mastectomy.aspx. Accessed May 19th, 2013.