Last week Angelina Jolie made a courageous statement by announcing that she made a very personal decision to undergo a double mastectomy and reconstruction. Instead of keeping the decision personal, Jolie wrote an op-ed piece in The New York Times. Jolie unfortunately watched her mother pass away from breast cancer at the age of 56. She learned that she tested positive for the BRCA gene.
The impact of Jolie’s decision can be tremendous for the fight against breast cancer. Not only did Jolie raise awareness but when one of the world’s most beautiful women makes a decision regarding her perceived beauty and femininity, it also lifts the stigma. Women are not defined by their breast, but their feminine identity is inextricably tied to their figure and how the world sees them. Jolie’s livelihood is based on how the world perceives her; she chose her health over her image.
The BRCA mutation is hereditary and has been tied to breast and ovarian cancer. Five to 10 percent of the population will test positive for the gene mutation; it is most prevalent in the Ashkenazi Jewish population. The mutation has the lowest prevalence in Blacks and Asians. Women with the BRCA mutation are at a five times higher risk of developing breast cancer and a 10-30 times higher risk of developing ovarian cancer.
Women should think about getting tested if:
- More than two family members have breast cancer
- One family member with breast cancer in both breasts
- A family member diagnosed under the age 45
- A relative with ovarian cancer
- A male family member with breast cancer
- A family member with BRCA mutation
Testing positive for the mutation opens the door for discussions regarding prophylactic mastectomies and removal of the ovaries. Before reflexively making such a huge personal decision, it is important that women speak with their physicians and/or a geneticist.
While highlighting breast cancer, Jolie’s decision can also have the unfortunate effect of sending women into a panic to remove their breast. It is imperative that women realize that a family history of breast cancer doesn’t mean that the mutation runs in their family. If women are mutation negative, but are still considering mastectomy, a risk analysis with a breast surgeon or a geneticist would be an important first step.
Perhaps the most important thing that Jolie has done by sharing her personal journey is that she has diminished some of the fear associated with breast cancer, and more importantly opened the dialogue.