This modern-day Greta Garbo undergoes a double mastectomy

Privately, one can only imagine what the delectably iconic screen goddess must have gone through, although probably not. Publicly Angelina Jolie tried to make the announcement sound as matter-of-factly as possible, attempting to buffer where people’s imagination would take them. She appeared to want, above all, to move on and not to dwell on how her fans and business associates would construe what she had undergone -where her future would take her. “I do not feel any less of a woman,” she said in a first post-surgery piece she wrote for the New York Times. “I feel empowered that I made a strong choice that in no way diminishes my femininity.” A brief sentence that addressed several of the misgivings she needed to allay.

BRCA1 and BRCA2 – A diagnosis that can spell trouble

BRCA1 and BRCA2 are also known as Breast Cancer Susceptibility Genes 1 and 2. They are tests used to detect mutations that indicate a high risk for developing breast and ovarian cancer. When one family member contracts Genes 1 and 2 mutations, then other family members can be tested for the same mutation. It is significant to note that only 0.2% of the U.S. population carries a BRCA1 and BRCA2 mutation, and it is thus not practical to test the entire population. Particularly vulnerable –and should be tested- are persons with a strong family history of breast or ovarian cancer, someone who has a family member with a BRCA1 and BRCA2 mutation, or someone who is of an Ashkenazi Jewish ancestry as the mutation is known to be prevalent in that ethnic grouping.

Angelina’s post-test diagnosis

A genetic counselor would want to interpret an individual’s results in conjunction with the individual’s personal and family history. The National Cancer Institute (NCI)¹, estimates that women with BRCA1 or BRCA2 mutations have an 85% risk to develop breast cancer and a 30 – 50% risk of developing ovarian cancer. Angelina Jolie’s risk of developing ovarian cancer was not made clear, although it was announced that her diagnosis portrayed her as having an 87% risk for developing breast cancer. She responded with a decision to undergo a double mastectomy, to be followed soon after with surgery to remove her ovaries.

Worldwide, it is estimated that breast cancer accounts for over 450,000 deaths annually, mostly in third-world countries. In the U.S., It is estimated that 232,340 women will be diagnosed with -and 39,620 women will die of- breast cancer in 2013²
Table I-1 (http://seer.cancer.gov/csr/ 1975_2010/results_single/ sect_01_table.01.pdf).

A brouhaha that went all the way to the Supreme Court

There is a whole commotion about the company that holds the exclusive patent to conduct the gene 1 and 2 tests, a company called Myriad Genetics that charges $3,000 a test. So far, they have been protected by the land’s patent laws, but the furor involves arguments such as: “A gene is a part of the human body, just as much as a liver or kidney,” an argument that goes on to say that “no one can have a patent over body parts.” Myriad’s army of patent lawyers respond energetically however, with the result that the Supreme Court now finds itself in a quandary, hesitant to dissolve the patent protections in this case. There are many venture capitalists who would be put off if they had no safeguards at a time when it is of critical importance that research and investment in health be invigorated, not curtailed.

A double mastectomy with reconstructive surgery

A lumpectomy is breast-preserving surgery in which only the tumor is removed from the breast. A Mastectomy, whether unilateral (one breast) or bilateral (both breasts) removes all breast tissue, frequently as a preventive measure. Angelina Jolie did not have cancer, she had a high risk for cancer, and she decided in favor of a double mastectomy as a preventive measure. One or both mastectomies could have also been an option for her had she had early breast cancer. What Angelina did is considered to be a highly effective way of going through a whole lifetime cancer-free. Breast reconstruction surgery, aka skin-sparing mastectomy, is usually done at the same time as a double mastectomy and, simply put, it involves a technique that preserves the individual’s breast skin that in due course will permit a more natural breast appearance.

Women with a very high risk of breast cancer –such as Angelina- would typically undergo a prophylactic mastectomy. The risks are typical of significant procedures: bleeding, infection, buildup of blood in the surgical site known as hematoma, and pain.

A 90% cancer-free prognosis for Angelina

Angelina Jolie can take considerable solace from Christina Applegate’s similar experience in 2008. By the time she went for the big surgery, tests had shown that Christina had a BRCA1 gene mutation and two prior lumpectomies to remove tumors in one breast. She went for the prophylactic operation as a preventive and so far successful move. This type of surgery –it is thought- reduces the chance of either recurring or new tumors by 90%. It is also to be noted that this type of over 80% risk factor that results from family history as well as genetic mutations is not the norm. It is thought that less than 10% of breast cancer patients or risk-bearers have that high a risk factor.

A gutsy move for the screen-goddess

A gutsy move by both Christina Applegate and Angelina Jolie, but entirely understandable when viewed through the prism of its alternatives. For the all-feminine Angelina, the iconic screen-goddess, At 87% risk of developing the dreaded growth at short notice, the flip side of the path that she took would have been to live a life in which she would have to keep looking over her shoulder. At least now she has a 90% chance of a cancer-free rest of her life.

¹Source: Lab Tests Online (A Public Resource on Clinical Lab Testing)

²Source:
Table I-1 (http://seer.cancer.gov/csr/ 1975_2010/results_single/ sect_01_table.01.pdf)National Cancer Institute (Surveillance Epidemiology and End Results)

About Mike Takieddine, the author:

Mine has been a privileged life, first for having traveled all over as son of a diplomatic family, then for having had the opportunity to study at Oxford, and finally for a gratifying career in business, in geriatric home care, and in writing. I look forward to using this wonderful medium to discuss the various aspects of life that are of interest to my readers.

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