She wowed us onscreen as butt-kicking stunners like “Salt” and “Lara Croft”. But none of Angelina Jolie’s movie roles has sparked such fierce discussion as her recent shocking announcement about her preventive double masectomy in a bid to wrestle off the possibility of future breast cancer.
“Life comes with many challenges. The ones that should not scare us are the ones we can take on and take control of.” – Angelina Jolie
In her article titled “My Medical Choice” in the New York Times, the 37-year-old actress shared how she lost her mother to ovarian cancer at age 56, which prompted her to undergo BRCA gene testing. Her positive test for a BRCA 1 mutation predicted a breast cancer risk of 87 percent and ovarian cancer of 50 percent. Brad Pitt, amongst many others, applauded her “absolutely heroic” decision to have both healthy breasts removed to cut her odds of future malignancy (now everyone discussing when she’d remove her ovaries!).
We believe that her radical choice was probably the best she made for herself. But to broadly recommend an expensive and anxiety-provoking genetic testing to all women with a family history like Angelina Jolie is advocating, followed by extensive surgical recommendations to those who test positive, is unlikely to be the best nor the most informed and empowering decision for everyone.
SKIN spoke to Dr Felicia Tan, Consultant Breast Surgeon at FeM Surgery, to slash through the media sensation and delve deeper into the hard facts.
What’s the deal about BRCA gene testing?
The fact remains: A “faulty” BRCA 1 or BRCA 2 gene does significantly increase your risk of breast and ovarian cancer.
Given the present prevalence of breast cancer, it is likely that many of us may have a loved one who had to battle this heart-wrenching big ‘C’. But before you rush off to your doctor’s for gene testing, know this: Angelina Jolie forgot to mention that the BRCA gene mutation is uncommon, accounting for only about 5 percent of all breast cancers and 10 to 15 percent of ovarian cancers. Most breast cancers are sporadic – vast majority of women with an elderly distant aunt with breast cancer are at average risk.
Who should consider getting their genes tested?
An inherited BRCA mutation may be suspected when:
When a family is identified to be of high risk, genetic counseling may be advised. The youngest family member who developed breast cancer can be tested for the BRCA gene mutation. If the result is negative, then other family members would not benefit from gene testing.
What does the test involve?
Blood testing is available in Singapore at centres like FeM Surgery. Your sample will be sent for DNA analysis at patented labs in Australia or the United States. It costs between S$2500 to 5000.
Results may take up to 3 months to be available. You’ll learn whether you have a BRCA gene mutation, and receive an estimate of your personal risk of breast and ovarian cancer if you are a carrier. Genetic counseling is a vital part of this gene testing process.
What went on in Angelina Jolie’s breast surgery?
For a highly simplistic description, the underlying breast tissue is removed in a prophylactic masectomy, preserving the nipples and overlying skin.
In the subsequent reconstruction of the breasts, the space is replaced by an implant, similar to that used for breast augmentation. In those who request for their reconstructed breasts to be larger than before, a tissue expander is placed into the space. This allows for gradual expansion of the skin to accommodate a bigger implant at a later stage, which is most likely what Angelina Jolie had.
These surgical procedures (note: plural) do carry risks. Unfortunately, preventive surgery does not eliminate all cancer risk (it reduces the breast cancer risk by approximately 90 percent). Cancer might still develop in any tissue that couldn’t be removed.
What are the other options for reducing your cancer risk in the event of a positive gene test?
Even if you do test positive for the BRCA 1 or BRCA 2 gene mutation, keep in mind that a positive result only reveals a person’s risk of developing cancer – it is not a life sentence dictating that you will actually develop the disease in the future. What’s more, testing positive for the genetic mutation doesn’t mean a double mastectomy is your only option.
Diligent breast screening with 6-monthly mammograms and yearly breast MRI can help detect cancer at an early and curable stage. Medications such as tamoxifen and raloxifene may also be taken for chemo-prevention in these high risk cases. Maintaining a healthy lifestyle and normal weight are great things anyone could do to for their bodies as well.
At the end of the day, there is no single correct choice for a woman in Angelina Jolie’s position. Luckily, it is a choice most women don’t have to face.
To talk to a health professional for a clearer picture of your personal breast cancer risk or to find out more about breast screening, please contact FeM Surgery.
– By Emily Wong