Jolie's mother, actress Marcheline Bertrand, died from ovarian cancer in 2007, at the age of 56. Jolie tested positive for the BRCA1 gene, and her doctor said she had an 87% chance of getting breast cancer and a 50% risk of developing ovarian cancer in her lifetime. (Media reports suggest that she plans to have her ovaries removed as well.)
Jolie's courageous choice is already encouraging many women to consider gene testing. The phenomenon has been dubbed "the Angelina Jolie effect."
BRCA testing: Should you or shouldn't you?
Mutated copies of the BRCA1 or BRCA2 genes increase a women's risk for developing breast and/or ovarian cancer.
Knowledge is power, 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. But genetic testing is not for everyone. For starters, it can be costly. (The Affordable Care Act now requires insurance companies to pay for gene testing among high-risk patients.)
It may be recommended that you consider counseling and/or testing if you have:
- Personal history of early-onset breast cancer diagnosed under the age of 50,
- Personal history a triple negative breast cancer, meaning that the tumor is estrogen receptor-negative, progesterone receptor-negative and her2-negative,
- Family history of breast cancer as defined as two first-degree relatives diagnosed with breast cancer (one of whom was diagnosed at age 50 or younger), three or more first-degree or second-degree relatives diagnosed with breast cancer regardless of their age at diagnosis, a combination of first- and second-degree relatives diagnosed with breast cancer and ovarian cancer (one cancer type per person), one first-degree relative with cancer diagnosed in both breasts,
- Personal or family history of ovarian cancer as defined as of two or more first- or second-degree relatives diagnosed with ovarian cancer regardless of age at diagnosis, first- or second-degree relative diagnosed with both breast and ovarian cancer regardless of age at diagnosis; and breast cancer diagnosed in a male relative; or
- Ashkenazi Jewish background plus a single case of breast or ovarian cancer diagnosed among a first-degree relative family or two second-degree relatives on the same side of the family diagnosed with breast or ovarian cancer.
It's not just your mother's side of the family either, Hampel says. "These genes can hide on the father's side too."
It is a complicated issue, she admits, which is why counseling is recommended before anyone gets tested. After discussing your personal family history with a gene counselor, you can make an informed decision. If your tests come back "positive" as Jolie's did, preventive breast-removing surgery and breast reconstruction are options.
The surgeries do dramatically cut your risk of breast cancer, but there are no guarantees. "With a mastectomy, we can never get every breast cell. There are millions under the skin and chest wall so some may still be left behind, "Hampel says. "Your risk is significantly reduced because you have removed so many breast cells."
After breast reconstruction with implants, any errant breast cells are likely pushed to the surface so future cancers can be diagnosed early as they are superficial lumps placed above implant and just below the skin, she says.
Angelina Jolie's experience reportedly went smoothly, but reconstruction does carry risks and recovery time. For more information on the newest options in breast reconstruction, visit http://www.surgery.org, http://www.plasticsurgery.org.
-Additional reporting by Denise Mann
Wendy Lewis is President of Wendy Lewis & Co Ltd Global Aesthetics Consultancy, author of 11 books and Founder/Editor in Chief of http://www.beautyinthebag.com.
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