If you had the ability to lower your cancer risk by at least 80 percent, would you?
In an op-ed piece published in the New York Times, Angelina Jolie revealed she was faced with that reality after testing positive for the genetic mutation BRCA1 for which she had an 87 percent chance of developing breast cancer. She decided to have a double mastectomy, which lowered her risk to less than five percent.
“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,” Jolie, 37, said describing her decision to remove her breasts.
Jolie’s news has drawn praise from advocates and inspired others. CNN anchor Zoraida Sambolin said Jolie's announcement gave her strength to reveal her breast cancer diagnosis to her fans. Jolie's medical choice has also received criticism from those who fear the actress’ choice could be misinterpreted.
“She was looking at a high risk of developing breast cancer in her lifetime,” Dr. Marisa Weiss, 54, a breast cancer oncologist and founder of breastcancer.org, told the International Business Times. Weiss pointed to Jolie’s mother, who died from ovarian cancer, and the benefits of preventative surgery, which lowered the actress’ risk by nearly 90 percent. “Her decision looks reasonable not radical.”
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Jolie is among many who have decided to undergo preventative surgery.
In 1983, Nancy Brinker, founder and CEO of Susan G. Komen for the Cure, was diagnosed with breast cancer at the same age as Jolie. She had a mastectomy following her diagnosis. In 2006, after testing positive for BRCA, she opted to have her other breast removed.
“By and large, I’m glad I did it,” Brinker, 66, told IBTimes, describing that preventative surgery is a complex choice that high-risk women need to make. “My sister is dead. She didn’t have this option.”
Brinker lauds Jolie’s public announcement about her double mastectomy.
“I think it’s so great and courageous for a young woman with a great profile to step out. It would have been unlikely 25 years ago,” she said. “She has brought so many issues to the surface.”
One of these issues brought to light by Jolie is genetic screening. The two known genetic mutations that increase a woman’s risk of developing breast and ovarian cancer are BRCA1 and BRCA2. The genetic test, which either involves a blood or saliva sample, can cost between $3,300 to $4,000, Weiss said.
Myriad Genetics, the leading provider of the genetic test, performs 250,000 BRCA tests per year, the company said in a statement.
“This is a process. It starts by collecting family history,” Weiss said. A genetic counselor helps patients determine whether or not they qualify for the test. “If you fit the criteria, most insurance companies cover the costs.”
But not everyone is insured, and Jolie’s announcement begs the question on what happens to those women. “Where a woman lives should not determine if she lives,” Brinker said, recounting one of her nonprofit’s mantras about the need for affordable cancer treatment.
Brinker pointed to the Affordable Care Act, in which provisions have been made to extend cancer treatment options to the uninsured.
“They ought to be able to get the tools and not break the bank,” she said about accessing affordable options that can determine an individual’s cancer risk. “It would be good to see people offered the opportunity of risk assessment.”
In an FAQ section for the Affordable Care Act, costs related to BRCA testing and genetic counseling will be covered for patients who have been determined to be at risk.
Brinker saw this as progress. “The Affordable Care Act brings better cancer care,” she said.
As for the BRCA genetic mutations, their prevalence in breast cancer patients is comparably rare.
“Only 5 to 10 percent of breast cancer cases are largely due to these genes,” Weiss said. “Most people that go for genetic testing don’t have it.”
A breast cancer survivor and mother of three, Weiss said, if she was in Jolie’s position, she would have opted for the same course of action. “If I were her, I definitely would have,” Weiss said.