Breast Cancer and Elective Mastectomies – If You Knew You Had a Faulty Gene, Would You Delete It?


Angelina Jolie announced that she’s  had a double mastectomy to preempt her “faulty gene”.
photo courtesy of Reuters Facebook page

I am 46, and I have been getting a yearly mammogram every year since I turned 40; six mammograms, and so far each one has been normal. Breast cancer doesn’t run in my family, but that doesn’t stop me from feeling apprehensive every time I have to step up to the machine, and it doesn’t keep me from worrying during the “manual examination” when I go in for a yearly checkup with my gynecologist. Cancer is scary; cancer that attacks your lady parts seems even more so. I can’t imagine what it would be like to watch my mother suffer through a losing breast cancer battle, but it happens, and for far too many women, it is their reality.

Academy Award winning actress and director Angelina Jolie watched her mother, Marcheline Bertrand, fight breast ovarian cancer for ten years before she finally died at 56. Ms. Jolie (37) said that her doctors estimated that she had “an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer, although the risk is different in the case of each woman.” While “only a fraction of breast cancers result from an inherited gene mutation. Those with a defect in BRCA1 have a 65 percent risk of getting it, on average.”

Armed with that information, Ms. Jolie and her doctors decided the best course of action would be for her to undergo a double mastectomy; she completed the last of the associated medical procedures on April 27. She began a series of surgical procedures with a “nipple delay”, which increased her chances of being able to save her nipples; in the next surgery, her breast tissue was removed and replaced with temporary fillers. Now the last of her surgeries has been completed, and she has implants in each of her reconstructed breasts.

After going through the double mastectomies and reconstruction, Ms. Jolie says that her chances of breast cancer have dropped from 87% to 5%, which are definitely much better odds. In her New York Times opinion piece, Ms. Jolie mentions that the cost of testing for BRCA1 and BRCA2, the two genes that alter or mutate resulting in increased risks of breast an ovarian cancers, is more than $3,000. She doesn’t say what her series of surgeries cost.

Ms. Jolie is not the only famous person to make this decision; Sharon Osborne, Kathy Bates, Christina Applegate and others have done similar (some had cancer in once breast, but opted to have both removed), and there are plenty of non-celebrities who have opted for double mastectomies for the similar reasons based on similar test results.  My gut reaction when I first hear ‘double mastectomy’ is to wince. Breasts are a deeply personal and cultural representation of womanhood, sensuality, and motherhood. The idea of having them removed based on a percentage of a chance that you might get cancer, albeit a higher than average one, seems overly alarmist. But then, I get it. Watching someone you love die after battling it so valiantly for so long, and knowing that you carry the same “faulty gene” would feel similar to carrying a ticking time bomb. Sure, there is a chance that you might live a long and happy life without ever getting the disease. But with odds at over 50%, if you had the means to prevent the disease almost entirely, why wouldn’t you?

So this brings up a question that I would like to ask those of you reading, male and female — since either sex can get breast cancer: If money was no object, and if you had a family history of breast cancer, would you pay the ~$3000 to get the genetic test that would tell you if you had BRCA1 and/or BRCA2? And if that test came back positive, would you then go to such extreme lengths — possibly paying out-of-pocket for all of the required surgeries — to better your chances from getting cancer?

Read “My Medical Choice”, by Angelina Jolie at the New York Times

Read “Why More Women Are Choosing Double Mastectomies” at the CNN site


Categories: Editorials

Tags: ,

8 replies

  1. I have a lot of trouble figuring out how to translate this into what a guy would have to endure that would equal a double-mastectomy. Castration seems too much, but what about (say) testicular cancer, like Lance Armstrong? Or maybe something that leads to having to get a limb amputated? I dunno.

    But it’s a very, very tough question. But if the odds were 85% that I would get (say) testicular cancer, yeah, I’d probably go for it. But what if it were 40%? I just don’t know. It’s a tough question.

  2. Angelina Jolie’s mother died from ovarian cancer, not breast cancer. Ms. Jolie had the double mastectomy because the calculated odds of having breast cancer at some point in her life were so high. I believe that her op-ed called this the first step, so I wonder if she will be doing something to mitigate the 50% ovarian cancer risk in the future?

    Anyway, to answer the question, I’d do the same. If my mother or father had breast cancer, I’d strongly consider the test.

    However, here is the rub: my father is a prostate cancer survivor, for 14 years now and counting. However, my doctor tells me (with concurrence from the many national health organizations) that the PSA test is too unreliable, and has too many false positives, to be useful as a diagnostic tool for somebody like me, who is asymptomatic. (It’s more useful for my father, to see if there is a recurrence. Actually, there was last year, but it’s still under control with medication.) Also, prosate cancer treatment and surgery can have far more health considerations than mastectomy and breast reconstruction: impotence; incontinence; radiation scarring of the rectum. So, this is a harder decision.

    Also, a good analysis of how widespread this testing should be:

    • Urgh! Obviously I had breast cancer on my mind when I was writing this. Thanks for pointing out my error, Doug.

      From her op-ed, I got the impression that Ms. Jolie would be following up with at least a partial hysterectomy. I can’t say that I blame her, if it honestly makes her chances of not getting ovarian cancer better.

      I’m glad that your father’s prostate cancer is still under control; I didn’t realize that there were so many health considerations associated with it, but I guess it only stands to reason due to the location. Cancer sucks. That is all.

  3. Women need to learn to do whatever it takes to pay cash, take out loans, mortgage the home and go to a Cosmetic Surgeon that won’t argue with your own personal choice! Take your power back ladies.. because there is for sure a war against women and sadly it begins in the health field. Women for a fact live 10-20 years longer then men live. I read this article on a doctor that was obviously not fond of older women living long. He said only the younger ones should have the mastectomies because they have longer to live. Not true at all. Just because your a younger woman does not mean in your family/genes they live long. You can be an older woman whom have mothers and grandmothers like me living until they are well over 100. Just because your young does not mean you have a good gene or longevity pool to pull from. It is nonsense!

  4. FYI To all the brain washed women out there. Mamagrams will over a period of time cause your to get cancer. YES. It is true. It is proven and why the UK women do not start them until they are 55 I believe. Your outer skin layers get much thinner as you age. Eventually like paper. I am in my late 40s and my skin is thinning. You radiate this and you get more damage and problems. My friend an RN told me so! Docs won’t. They want the money! The insurance card that dictates when you live until. Your only as good as your policy! I know a man whom was choosing to take chemo. He was responding well his wife told me so. The doctors sent him home to die because his insurance maxed out. Ten grand a pop for chemo injections. Sure it did! Add that to ongoing tests and MRI’s and you have a problem. So.. they take your life. The end. The same with all the Synthetic drugs you put your hands out and agree to take. Many are on Commercials with Attorney law suites because they are making so much money out there off them and in the stock market, there are no laws to recall them most of the time. Unless people are dropping like flies. My mother and I seen this first hand was taking one for smoking to stop Chantex and another for high cholesterol and she had SERIOUS side effects. She almost died from both. One she almost wanted to kill herself and it is Chantex and still on the market. The doctor still wanted her to stay on it. The other was starting to give her organ damage. Yes. So… you need to choose life or death because there are MANY Alternative holistic options out there that won’t make your more sick, have your kidneys and organs shut down.. or give you cancer like the synthetic drugs can and do and the radiation will too.