Jolie's bold move sparks discussion of the C-word

  • Article by: ALLIE SHAH , Star Tribune
  • Updated: May 17, 2013 - 2:04 PM

The Hollywood icon’s disclosure about her cancer worries fuels discussion, but raises concerns about overestimating the risks.

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Angelina Jolie

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Forget the leg. Everyone’s talking about Angelina Jolie’s breasts.

The movie star and sex symbol, who’s famous for showing off her gams, wrote in the New York Times about her decision to have both her breasts removed to reduce her risk of developing breast cancer. Her op-ed piece put a spotlight on a dilemma faced by many women who fear they may be at similar risk.

“I am writing about it now because I hope that other women can benefit from my experience,” Jolie wrote in her May 14 piece. “Cancer is still a word that strikes fear into people’s hearts, producing a deep sense of powerlessness. But today it is possible to find out through a blood test whether you are highly susceptible to breast and ovarian cancer, and then take action.”

Jolie, whose mother died of cancer at 59, discovered through genetic testing that a mutation in one of her BRCA genes put her at a high risk for breast cancer.

“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. My chances of developing breast cancer have dropped from 87 percent to under 5 percent. I can tell my children that they don’t need to fear they will lose me to breast cancer.”

Minnesota medical experts lauded Jolie’s willingness to go public.“I thought it was very courageous of her to do that,” said Dr. Lynn Hartmann, an oncologist at the Mayo Clinic and a national expert on prophylactic, or preventive, mastectomy. “She really laid out the facts and described her own rationale for pursuing this strategy.”

Still, the experts cautioned against the tendency to overestimate the risks and urged women to consider their personal and family histories and consult with genetic counselors as well as their doctors before making any treatment decisions.

Having a double mastectomy is serious business, said Dr. Todd Tuttle, a breast cancer surgeon at the University of Minnesota. While he noted that Jolie had good reasons for the choice she made, he voiced concerns about breast cancer “hysteria.”

“There’s a growing body of literature indicating women who don’t have breast cancer substantially overestimate their risk of getting breast cancer,” he said. “We are in an environment of breast cancer frenzy. You can’t turn your radio on without hearing about breast cancer. There’s this almost hysteria in the U.S. with everybody thinking they’re going to get breast cancer.”

That’s why Hartmann and others are advising women to consider their individual circumstances.

“I think every woman should make her own decision, based on her own level of risk and her own priorities and knowing what the pluses and minuses of every option are before her,” Hartmann said. “I would hope that someone else’s decision wouldn’t sway them on an issue like this.”

We asked local medical experts to answer essential questions about genetic testing and preventive mastectomies:

 

Q: What is a genetic test?

A: It’s a blood draw that is sent to a lab in Utah, explained Diana Turco, certified genetic counselor at St. John’s Hospital in Maplewood. “They’re able to target and look at that specific gene that we’re concerned about and see if it’s functioning normally or if there’s a mutation,” she explained.

 

Q: How much does the test cost? Is it covered by insurance?

A: Cost estimates range from $3,000 to $4,000. In general, insurance covers the test for those who have personal or family history of breast or ovarian cancer. Each insurance plan is unique, though, so it’s best to speak with a genetic counselor and consult with the lab doing the testing.

 

Q: Who should get tested?

A: Women with certain risk factors should strongly consider genetic testing, Hartmann said. For example, those with relatives who had breast or ovarian cancer, especially if they were diagnosed before they were 50. In addition, people of Ashkenazi Jewish heritage are at a higher risk of inheriting a genetic mutation.

 

Q: How effective are double mastectomies at preventing cancer?

A: “If you look at most women who have a BRCA mutation, their lifetime risk of developing breast cancer is about 70 to 80 percent,” said Tuttle. “The studies seem to indicate that having a bilateral mastectomy would reduce the risk by 90 to 95 percent.”

He added: “There are a lot of women who are interested in having mastectomies to reduce their risk because they think they’re at high risk. It’s only a small subset of women who actually are.”

 

Allie Shah • 612-673-4488

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