Crossville Chronicle, Crossville, TN

May 20, 2013

Tidbits: Jolie’s move a conversation starter

By Heather Mullinix
Assistant editor

CROSSVILLE — Angelina Jolie, named the “Sexiest Woman in the World” by People Magazine in 2005, stunned the nation last week when she revealed she had chosen to have a preventative mastectomy after genetic testing revealed she had about an increased risk of developing breast cancer.

Jolie knew her mother had died of ovarian cancer at age 56, after fighting it for almost a decade. She had taken advantage of genetic testing, something many women are unable to do because of the cost, and learned she carried a “faulty” BRACA1 gene which, her doctors estimated, increased her risk of developing breast cancer to 87 percent and her risk of ovarian cancer by 50 percent.

Her preventative mastectomy has lowered her risk of breast cancer to under 5 percent. She’s also planning to have her ovaries removed to reduce the chance of developing ovarian cancer.

That decision has been lauded as brave, and also bashed as being an over-reaction. But in the end, Jolie said, “I 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.”

That’s the crux of the whole thing — she made a decision based on the information available to her and in consultation with her doctor and her family, to do what she felt was right for her and her family.

The decision to undergo a mastectomy, whether preventative or therapeutic, is intensely personal. Each woman has to consider their risks, lifestyle and their own reaction to losing a part of their body, especially a part of the body that is so wrapped up in personal appearance. Perhaps having the “Sexiest Woman Alive” share her decision to have her breasts removed can help others deal with the emotional and psychological effects of a mastectomy. It certainly gets people talking, and talking about risks, treatments, research, etc., is important for everyone.

Was this the only option available to her? Certainly not. There are drugs that can reduce risk of cancer and close monitoring with mammograms and MRI scans.

Regardless of the decision made, women should have access to the best available medical advice. That includes genetic counseling and testing for those who are at elevated risk. In many cases, that’s a level of care reserved for those able to afford it. Very few women fall into such a high-risk category. For those who do, genetic testing for BRCA1 is about $3,000, and surgery and reconstruction can cost thousands of dollars. A preventative mastectomy and the reconstruction surgeries may not be covered under health insurance plans.

What is BRCA1 Breast cancer susceptibility genes, BRCA1 and BRCA2, repair cell damage so breast cells can grow normally. Everyone has BRCA 1 and 2 genes, but sometimes these genes mutate and cannot function as they are designed. Research has found BRCA1 gene mutations are associated with familial breast cancer.

Many times, private health insurance does not cover genetic counseling and testing. However, new insurance plans that began on or after Aug. 1, 2012, are required by the Affordable Care Act to provide coverage for these costs when recommended by a provider.

There are specific guidelines in place for who needs to be tested for BRCA1 and BRCA2 gene mutations. Those include a personal history of breast cancer at age 50 or younger; a personal history of triple negative breast cancer — breast cancer that is estrogen receptor-negative, progesterone receptor negative and HER2/neu receptor-negative; a personal or family history of male breast cancer; a personal or family history of breast cancer in both breasts; a personal history of ovarian cancer; a parent, sibling, child, grandparent, uncle, aunt, nephew, niece or first cousin diagnosed with breast cancer at age 45 or younger or diagnosed with ovarian cancer; a family history of both breast and ovarian cancers on the same side of the family; and Ashkenazi Jewish heritage and a family history of breast or ovarian cancer.

I’m glad Jolie shared her story with the world. It helps shed light on a growing area of research and helps make the discussion of mastectomy expand so that those who choose mastectomies, preventative or therapeutic, can hopefully find the information and support they need.

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Heather Mullinix is assistant editor of the Crossville Chronicle. Her column is published on Tuesdays. She may be reached at hmullinix@crossville-chronicle.com.