http://www.nytimes.com/2013/05/14/opinion/my-medical-choice.html?_r=0
In this article, Jolie discussed BRCA1 and BRCA2 genes, her family history, the mastectomy and reconstruction all in an effort to educate and explain her personal reason for undergoing this process: to buy time with her children. Opinions vary on this topic -- but because she is a woman, it's her body, it's her options she's weighing without need of public scrutiny, it's her decision then-- for her -- it was the right decision. A mastectomy is no walk in the park; she is brave in choosing this route. But this approach is not for everyone. And, she is not advocating that women do what she did.
I applaud her in raising awareness the mastectomy, reconstruction, and the currently known genes that have been linked with breast cancer.
What I hope the media does with this information is further the awareness of breast cancer, the genes linked to certain cancers, and the reconstruction process -- especially in an appropriate way. I would hope that empowerment and not sensationalism is the goal.
For instance, if a parent has breast cancer then the child or children of that parent has an increased risk of getting breast cancer -- but this does not mean the message is to get a mastectomy at any age, like 12, 18, 21, etc. Other things go into the equation. Age, age the mother died with breast cancer, density of the breasts (if BRCA positive and the woman has dense breasts then it might be harder to catch using just mammogram), personal feelings, etc.
In talking about breast cancer as Venn Diagrams then if we draw three Venn Diagrams overlapping it would look like this: one big circle is all women with all types of active, invasive or aggressive breast cancer; the second big circle is all women with no breast cancer; the third is smaller one of all women with the BRCA gene of which applies only to women of a certain Jewish ancestry. The overlapping portion of all these three circles is women with breast cancer. So, if a parent died of breast cancer and did not have the BRCA gene, then it does not mean the child of that parent will get breast cancer. It applies only to the population of that smaller circle of the Venn Diagram -- and even within this smaller circle many factors are weighed when considering a preventative mastectomy. Different decisions are made depending on the circle one applies to; but in all cases or all circles of the Venn Diagram then all should monitor one's health including getting regular breast exams.
If a woman has the BRCA gene -- the one gene so far that has been identified as a linked with breast cancer- then we know for certain that a person's chance of getting breast cancer is 87%. That applies to subcategories of BRCA which one might see as BRCA1 or BRCA2 genes. A mutation here causes certain cancers-- like cancers in the uterus and cancer in the breast. This is what Angelina Jolie has. This is what her mom died of. This is what she had to weigh in her decision to have her breasts removed when no cancer is currently found. For her, factors like her age, the age her mother had her aggressive and invasive cancer, the amount of children she currently is a mother to, etc all weighed in her decision to take this route. Again, it was a good decision for her because it was her decision. The percentage of women having these particular BRCA genes is very small but if within this group a person must weigh several factors like Jolie did.
But in terms of the general public I hope the media educates us in sharing info about breast cancer, reconstruction -- and as far as genes are known in the breast cancer world -- how small the BRCA gene percentage is. In fact, it is so small that when I had my genetic test for the BRCA gene my doctor said she'd bet I didn't have the BRCA gene based on my ancestral history (no link to Jewish history or Middle Eastern countries with this particular Jewish history). The genetics test is an easy one in which you spit into a container (many genetic tests are available in this format nowadays). Sure enough, I tested negative for the BRCA genes.
An analogy to the BRCA breast cancer link is Autism Spectrum Disorder (ASD) and known genetic links. A child with ASD may have a known gene that has been linked to ASD (not caused, but linked); he or she may have a gene that is linked yet has not been discovered yet; but overall, when diagnosed, the doctor either knows of the gene that is linked with ASD or gies simply by the child's behaviors. The diagnosis is made by known genetics or by known behaviors. In my son's case he had signs of ASD but a gene linked to his ASD was not discovered until he was 4. There are now many genes discovered by scientists as being linked with ASD. Overtime, more will be discovered. The same thing can be said about genes and breast cancer. It just so happens only the BRCA has been 'discovered' but I'm sure in our lifetime more will be found.
Now let's say one did test positive for the BRCA gene and did not currently have breast cancer, then it does not mean that one would be recommended a mastectomy. Nor does it mean that one would be recommended a mastectomy because a parent who had the BRCA gene who died of breast cancer. The recommendation is to be proactive in monitoring one's health --- like in getting regular screenings including screenings now done for women with dense breast tissue (next level magnification mammogram, ultrasound, and yearly screens regardless of age). And, weigh in the options like age, age of parent with BRCHA gene when breast cancer was discovered and died from it, as well as other issues. It's a complex problem involving complex factors for decision making. That would be the message I would hope the media passes on to the public; that would be the message I'd want to pass on to my child.
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