The news that Angelina Jolie – one of the world’s most glamorous women – had undergone a double mastectomy at the age of 37 stunned the world this week and brought a very relevant debate to the forefront of international media.
Faced with an 87% chance of developing breast cancer in the future, Jolie underwent her procedure as a preventative measure – one that brought her risk of developing the disease down to just 5%. And her journey isn’t yet at an end, with the actress and mum of six reportedly planning to continue her preemptive fight against cancer by removing her ovaries.
In an article published in the New York Times, Jolie expressed her hope that, by speaking out about her decision to undergo a prophylactic mastectomy, she might empower women everywhere.
‘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,’ she wrote. ‘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% to under 5%. I can tell my children that they don’t need to fear they will lose me to breast cancer.’
Jolie’s decision was no doubt fuelled by her own personal experience of cancer, having witnessed her mother battle the disease for almost a decade before finally succumbing, aged 56, back in January 2007.
Although most breast cancers are not hereditary, the presence of a ‘faulty’ gene – the BRCA1 or BRCA2 gene mutation – can greatly increase the chance of a woman developing breast cancer. Whilst the risk the gene poses to each woman differs, doctors estimated Jolie had an 87% risk of developing breast cancer and a 50% risk of developing ovarian cancer.
Genetic Testing
Since the news broke on Tuesday, the Breast Cancer Network Australia (BCNA) has thanked Jolie for speaking out, noting that between 5 and 10% of breast cancers occur in men and women whose families, like Angelina Jolie’s, carry the BRCA1 or BRCA2 gene mutation.
‘A number of high risk gene mutations have been identified including BRCA1, BRCA2, TP53, PTEN and CHEK2,’ says the Breast Cancer Network Australia. ‘Risk of breast cancer is increased by 2 to 10-fold in women with mutations in these genes.’
However, the organisation points out mutations in high-risk genes are rare. ‘A number of “low-risk” genes have been identified that are associated with small changes in breast cancer risk, and more research is being done in this area. Despite the small effect of these variants on breast cancer risk they might account for a large number of breast cancer cases because some of them are common. They might also account for the increased incidence of breast cancers in some families.’
It’s thought around 5% of Australians – both men and women – carry the BRCA1 and BRCA2 gene and the availability of genetic testing varies across the country.
‘BRCA1 and BRCA2 testing is not subsidised by Medicare, so much of this testing is done through the public hospital system, which means it’s funded through state health departments,’ explains clinical geneticist at Brisbane Genetics, Dr Michael Gattas. ‘But the criteria by which the test is offered does vary from state to state. So the difficulty is you can have a family member who lives in one state who would be eligible for BRCA1 or 2 gene testing as a public hospital patient, but the state next door they might not meet the criteria.’
Dr Allan Spigelman, clinical director at the Kinghorn Cancer Centre in Sydney, expects Jolie’s revelation to spark interest in cancer gene testing in Australia.
‘I fully anticipate there will be very significantly renewed interest in breast cancer gene testing across the world as a result of this high-profile person very sadly carrying the gene change but very bravely going ahead to have preventative surgery,’ he told the ABC.
Double Mastectomy
In Australia, it’s estimated that around 20% of women who discover they carry the genes predisposing them to cancer go on to have prophylactic mastectomies. The remainder – an estimated 80% – opt for regular screenings.
Having discovered she was a carrier of the BRCA1 mutation, Jolie decided to undergo an elective double mastectomy – details of which were shared both by Jolie herself and by Dr Kristi Funk, who treated Jolie at the Pink Lotus Breast Centre in Los Angeles.
‘My own process began on Feb. 2 with a procedure known as a “nipple delay,” which rules out disease in the breast ducts behind the nipple and draws extra blood flow to the area. This causes some pain and a lot of bruising, but it increases the chance of saving the nipple,’ wrote Jolie in My Medical Choice.
‘Two weeks later I had the major surgery, where the breast tissue is removed and temporary fillers are put in place. The operation can take eight hours. You wake up with drain tubes and expanders in your breasts. It does feel like a scene out of a science-fiction film. But days after surgery you can be back to a normal life.’
Nine weeks later, Jolie’s breasts were reconstructed with implants.
According to Dr Funk, the actress’ mental state was of crucial importance going into the extensive procedure. ‘To a large extent, I believe recovery reflects expectation. Angelina expected to feel well, to be active,’ she said. ‘On day four after her mastectomies, I was pleased to find her not only in good spirits with bountiful energy, but with two walls in her house covered with freshly assembled storyboards for the next project she is directing. All the while she spoke, six drains dangled from her chest, three on each side, fastened to an elastic belt.’
Jolie’s main surgery took place on February 16th and, just two days later, her surgeon was able to deliver good news. ‘The pathology returned and I called Angelina to confirm our biggest hope: all the tissue was benign.’
Breast cancer awareness
Whilst Jolie’s story has gone a long way to open debate surrounding the availability of genetic testing, and demystify what can be seen as a daunting procedure, it’s also a timely reminder to maintain vigilance when it comes to checking the health of your own breasts. Breast cancer remains the most common form of cancer among Australian women, accounting for 27% of all cancer diagnoses in 2009. Approximately a quarter of those are women under the age of 50.
Despite a number of significant advances in the early detection, prevention and treatment of breast cancer, Cancer Australia, an initiative by the Federal Government, projects that, by 2015, the number of new breast cancer cases among women will be 22% higher than in 2006: totalling an estimated 15,409 people.
To ensure the best possible outcome, early detection is all-important. As with all types of cancer, the risk of breast cancer spreading from the breasts to other parts of the body increases dramatically if it is not detected early on.
The good news is that the knowledge, technology and medical expertise is all readily available here in Australia to help women take charge of their breast health.
It is critical every woman knows how to do breast self-examination. As of age 20, it should be a monthly routine:
- Most doctors recommend lying down with one arm behind your head. With the other hand, feel each breast with your middle three fingers for any irregular lumps, cyst-like formations, thickening or unusual dimpling. Be sure to feel the entire breast area – from the top of the chest, under each arm, around the breast mound and down towards the rib cage.
- You can also look at your breasts in the mirror, both with your hands on your hips and in the air. Check for changes in colour, shape, nipple location, dimpling or anything that is irregular.
- Use your thumb and forefinger to gently press the nipple and check for any irregular discharge.
- It is not a cause for panic if you do come across an anomaly – 80% of lumps turn out to be benign – but you should consult with your doctor as soon as possible to be sure.
- For pre-menopausal women especially, aim to perform the self-exam at the same time each month, ideally after your period. As your breasts change as you go through your menstrual cycle, by examining them at the same point in your cycle, you can make a more accurate comparison.
Some changes to look for:
- A new lump, or lumpiness, especially if it is in one breast.
- Nipple discharge.
- Change in the size or shape of the breast or nipple.
- Change in the skin over the breast, such as redness or dimpling.
- Unusual persistent pain, especially if it is one breast.
If you’re concerned by a family history of breast cancer, or by any changes to your breasts, speak to a doctor as soon as possible.
