Angelina Jolie and "Pre-Surgery" —
Is This a Smart Way to Beat Cancer?
The whole world knows about actress Angelina Jolie's decision to have an elective double mastectomy. She didn't choose the surgery because she has cancer — she was cancer-free. She chose it because she carries the BRCA1 gene, a "flawed" gene that sharply increases her risk of developing breast and ovarian cancer.
But having both breasts removed when you don't have cancer is a drastic step, to say the least. Did she do the right thing? Let's take a look. . .
Continued below. . .
Ms. Jolie has seen firsthand how cancer can ravage the body and bring suffering to a whole family. Her mother battled breast cancer and ultimately died of ovarian cancer at age 56. By that point, she'd been struggling against the disease for a decade. Ms. Jolie's maternal grandmother was also diagnosed with ovarian cancer.
Quick facts on breast cancer
Before we get into whether her decision was smart or crazy, let's talk more about the BRCA1 gene. The term "BRCA" comes from the first two letters of each of the words "breast" and "cancer." If you develop breast cancer, normal BRCA genes help you fight it. But when the BRCA gene is mutated, it can't do its job, and cancer risk sharply increases.
Prior to surgery, and by her doctor's estimate, Jolie's risk of breast cancer was an alarming 87 percent. Her risk of ovarian cancer landed at 50 percent.
Some of my readers may be surprised, but on the whole, I think Ms. Jolie made a reasonable decision. It wasn't the only thing she could have done, but it was not a "crazy" thing to do. I would choose a policy of regular monitoring for cancer, plus a healthy diet and the supplements we talk about all the time in this newsletter and in our books. Early detection IS possible and surgery comes into play only when you actually have cancer. But I understand a person can become panicky when faced with the kind of odds she faced. Men with small, nearly harmless prostate tumors are the same way. Most of them want the whole thing cut out NOW!
Though only a tiny fraction of breast cancer diagnoses stem from the BRCA1 gene mutation, if you happen to be one of the unlucky women who have it, you face a 65 percent risk of breast cancer and a 39 percent chance of getting ovarian cancer. Those are averages. Ms. Jolie's risk was boosted by the fact that her mother and grandmother were cancer victims.
The breast cancer odds are more than five times worse for women with the gene mutation than for those without. For the latter, the risk of breast cancer is only 12 percent and the risk of ovarian cancer is less than 1 percent. I don't mean to belittle the risk for any woman, but as you can see it's much worse for women with the gene mutation.
Men can inherit the BRCA1 mutation as well, bringing their own breast cancer risk up to 8 percent.
The general risk of having a BRCA mutation is 1 in 500 people. If you're of Ashkenazi Jewish heritage, risk rises to 1 in 40.
Jolie's choice was to minimize her risk. I can't imagine what a hard decision it must have been. After three months of intensive medical procedures that included removing the tissue in both her breasts, her chances of developing breast cancer have dropped from a high of 87 to a low of 5 percent. She paid her dues and got the reduction in risk she was seeking. As I said, it's a reasonable choice.
Mastectomies don't really mean medical progress…
The big risk in Ms. Jolie's public announcement is that other women will draw the wrong conclusions. Some worry that she's opened the gates to a new trend in mastectomies that are medically unnecessary.
It's no secret that the past several years have unleashed a virtual epidemic in preventive mastectomies for women with one cancerous breast who decide to remove the healthy breast as a precaution. These women, by and large, do not carry the genetic mutations that elevate their risk. That means their odds for cancer developing in their remaining breast are quite low.
Preventive mastectomies make sense for women with the same high-level risk of cancer Jolie faced. But very few women share that risk. For women without the gene mutation, I'm prepared to say without a doubt that removing a healthy breast is unnecessary and unwise, even if the other breast has cancer.
The trend toward mastectomies is even more frustrating given that lumpectomies for actually existing cancer have been proven just as effective as mastectomies. In a lumpectomy, only the tumor and nearby tissue are removed, not the entire breast. And, yes, that's all you need. The statistics indicate you gain nothing by "radical mastectomy," i.e.removal of the whole breast.
I like the reaction of Dr. Susan Love, breast surgeon and author of Dr. Susan Love's Breast Book. In an interview with The New York Times, she pointed out that Ms. Jolie was an unusual case. Said Love, "What I hope that people realize is that we really don't have good prevention for breast cancer. When you have to cut off normal body parts to prevent a disease, that's really pretty barbaric when you think about it." 1
If anything, we can hope that Ms. Jolie's public disclosure will shed light on a topic that deserves more research. For now, the only definitive answer is drastic surgery.
It's also important to know that preventive surgery isn't the only option, even for those with BRCA1 mutations. Many doctors advocate mammograms and MRI scans, done alternately every six months. That way if cancer does surface, it's found early … assuming the mammograms do their jobs, which is debatable.
Readers of this newsletter know all about the shortcomings and dangers of mammograms. Themorgraphy is a better, safer way to screen for breast cancer. See our previous Issues #218 and #239 for more information on the best ways to find breast cancer early.
You should also consider purchasing my Special Report Breast Cancer Cover-Up. This report was written to explain all your best options for detecting, preventing and treating breast cancer. Needless to say, the report focuses on alternatives, not mainstream treatments.
How to heal the "Whole Body" from surgery
Ms. Jolie's advice is for all women, especially those with a family history of ovarian or breast cancer, to get a better understanding of their risk level. She advocates gene testing and preventive treatment. But she acknowledges that gene testing, which typically costs more than $3,000 in the U.S., is not an option for a great many women.
Many insurance carriers will cover genetic testing, but most of them require you to prove your risk through family history. If you're unsure about your increased risk, take this free quiz on risk assessment from the Pink Lotus Breast Center—the same center where Ms. Jolie was treated.
She also acknowledged that many alternatives to surgery are in the works. On top of that, I was interested to learn that much of her own surgery played by an alternative rule book.
For starters, Ms. Jolie's surgery was done on an outpatient basis at the family-owned, mostly female-run Pink Lotus Breast Center where they pride themselves on holistic care and wellness.
Following her surgeries, Ms. Jolie was placed on a variety of supplements. These included vitamin C, zinc, and multi-vitamins to improve healing at the site of each operation. A combination cream of arnica and bromelain, an enzyme extracted from pineapple stems, was used to help with post-operative swelling and bruising. The homeopathic remedies ExChem and Lymphomyosot were used to help eliminate anesthesia from her system.
In a situation like Ms. Jolie's where risk was high and intervention was believed to be the best course, it's nice to know she wasn't sentenced to a coarse and impersonal hospital stay with a stack of prescription drugs. It's proof that even in the event of extreme surgery, there are still ways to assist your body's natural healing faculties.
Is it fair to patent a gene?
It's possible that Ms. Jolie's public disclosure will bring about a different kind of positive change. I'm not talking about more women choosing preventative surgery, but about a woman's right to information and gene testing, even if she lacks the cash and her insurance doesn't cover it.
As it turns out, a Utah company called Myriad Genetics currently owns the patent on the BRCA1 and BRCA2 genes. This company developed the BRCAnalysis test that screens women for the gene mutation. And as long as they own the patent, no other company can develop a similar test. That's why the test costs $3,000.
The ACLU and the Public Patent Foundation have challenged Myriad's right to patent these genes on the grounds that they're preventing further studies and tests on the gene and delaying critical research. The landmark case will be decided before the Supreme Court in June.
Until then, Myriad argues that Medicare, Medicaid, and their own financial assistance program make testing available to what they consider "appropriate patients." But the bottom line is this: they'll retain control of the future of the BRCA genes, unless the Supreme Court decides otherwise.
It's not a one-size-fits-all problem
At the end of her op-ed piece in The New York Times, Ms. Jolie stated, "Life comes with many challenges. The ones that should not scare us are the ones we can take on and take control of."2
What's important is to know your options. Surgery will not be the right choice for everyone, and each woman's case is unique. Considering she had the gene mutation, I believe Jolie made a reasonable choice, but it's not the only choice. Another woman might have chosen frequent screening, a healthy eating plan and supplements — and then surgery only if and when cancer cells actually appeared. And as I said above, I'm opposed to such surgery for women who don't have the mutation.
Ms. Jolie's choice should not highlight preventive surgery as the single best option for avoiding breast cancer. Rather, her message lies in the power of genetic counseling and informed decisions. Instead of asking questions about surgery, first focus on asking questions about your family history.
As Dr. Isabelle Bedrosian, a surgical oncologist at M. D. Anderson Cancer Center in Houston, told The New York Times, "We need to be careful that one message does not apply to all. Angelina's situation is very unusual. People should not be quick to say 'I should do like she did,' because you may not be like her."1
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Marjory Abrams
