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Why Angelina Jolie Chose a Preventive Mastectomy

Movie star Angelina Jolie, told she was at high risk for breast cancer, underwent a preventive double mastectomy, but a prominent cancer geneticist tells AARP the actress should also consider removing her ovaries to reduce her risk of deadly ovarian cancer.

Jolie, 37, revealed in a moving essay in the New York Times today that her own mother died of ovarian  cancer at 56, which is why Jolie got genetic testing that revealed she has the BRCA1 gene mutation. This "faulty" gene, as she put it,  greatly increases a woman's cancer risk.

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Jolie's doctors told her she had an 87 percent risk of developing breast cancer and a 50 percent risk of ovarian cancer. "Once I knew that this was my reality, I decided to be proactive and to minimize the risk as much I could. I made a decision to have a preventive double mastectomy," Jolie wrote.

The Oscar-winning actress said that she made the choice because she didn't want her six children to lose their mother at a young age, as she did.

Although she kept her decision and the subsequent surgery and breast reconstruction private for several months, she decided to write about it now "because I hope that other women can benefit from my experience. ... 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."

Charis Eng, M.D., founding director of the Cleveland Clinic's Genomic Medicine Institute, tells AARP that she hopes Jolie additionally considers having her ovaries removed in the next three years. Age 35 is when the risk of ovarian cancer begins to climb for women with the BRCA1 gene, Eng says.

"It's something she needs to think about because there's no good screening available for ovarian cancer," she adds.

For older women with a family history of breast cancer, Eng strongly recommends seeing a geneticist, who can determine the correct gene test for screening. "Older women who had cancer 20 years ago when they didn't have these tests should also consider having it done," she says.

With the advent of genetic testing, as well as improved reconstructive-surgery techniques that allow a woman to conserve more of her breast skin and nipple area, there has been a big jump in women choosing preventive mastectomies.

The increase has been both among women who have had breast cancer in one breast and chose to have both removed, and women like Jolie who chose a preemptive double mastectomy.

Fellow actress Christina Applegate, who had a BRCA1 gene mutation as well, had a similar procedure in 2008. And 24-year-old Miss USA contestant Allyn Rose, 24, who was 16 when her mother died of breast cancer, also opted for a preventive double mastectomy last year when genetic testing revealed she had the same faulty BRCA1.

Jolie wrote that her decision might not be right for every woman. She urged women, especially those with a family history of cancer, to seek out medical experts to determine possible options, and Eng agrees.

"Older women may elect to have MRI scans for early detection" instead of opting for preventive surgery, Eng says. "There is no one right answer."


Photo: Dan Steinberg/AP Images


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