By Vera Viner
What is on the minds of all breast cancer survivors and oncologists this week? Angelina Jolie and her decision to have a preventive mastectomy. The famous actress wrote an Op-Ed piece for the New York Times detailing her surgery and the reasons behind it. Jolie chose to have the surgery because she has a mutation in her BRCA1 gene, which greatly increased her chances of being diagnosed with breast cancer. Her mother passed away in her 50s due to this disease and Jolie wrote that she does not want to leave her children behind.
While Jolie explained that she had an 87 percent risk of contracting breast cancer, the choice to have a mastectomy is very personal and not all women should feel forced to undergo such a surgery before even being diagnosed with the disease.
There are some major points that we must consider before comparing the lives of an ordinary woman – say, a single mother with two children – to the resources available to a wealthy actress and director. The first point I’d like to mention is that a genetic test that determines whether a person is predisposed to a certain disease will be expensive. The BRCA1/2 gene tests cost between $3,000 to $4,000. The majority of women will be unable to afford this test and insurance carriers will only pay for the test if the woman has multiple blood relatives with the disease. Breast implants and the MRIs needed every two years after surgery are also cost-prohibitive for many women.
The next steps to consider is whether these gene mutations really put women at as high of a risk as they think. The average woman with a BRCA1 mutation has a 65 percent risk of contracting the disease according to new studies, but we must also keep in mind that regular exercise and remaining at a healthy weight reduces the risk of breast cancer. Smoking, alcohol, and sugary, fatty junk food, on the other hand, increases our risk. In addition, it is important to understand that the statistic of 1 in 8 women in the U.S. being diagnosed with breast cancer relates to the entire lifetime of a woman. This means that many women will not contract the disease until late in life, in their 70s or 80s.
Also, medical research advances quickly and treatment has become much better than in previous decades. There are hundreds of thousands more breast cancer survivors living in the United States today than in the past. While having a preventive mastectomy may be the right decision for some women, it is not the only decision available. Regular screening and cyst removal, for instance, are also valid choices.
“Is breast cancer so frightening that it is better for a woman to remove her breasts before she is even diagnosed?” Diana Zuckerman, PhD, president of the Cancer Prevention and Treatment Fund, wrote in an article for the Huffington Post. “As an actress [Angelina Jolie] whose appeal has focused on her beauty, surgically removing both her breasts when she didn’t have cancer was a very gutsy thing to do. But if we care about women’s health, we need to stop thinking of mastectomy as the ‘brave’ choice and understand that the risks and benefits of mastectomy are different for every woman with cancer or the risk of cancer.”
While breast cancer is on the minds of many women around the country, the largest killer of of females in the U.S. is heart disease. I have no problem with Angelina Jolie’s decision but women who have had friends or family members affected with the disease should be aware that there are other options.
“We live with risk. And breast cancer is one of those risks,” Breast cancer survivor Peggy Orenstein told a show host on National Public Radio. “When your risk is not particularly elevated, removing a body part has its own risks. I’ve had a mastectomy; it’s pretty tough … She [Angelina Jolie] had to make a decision about a very elevated risk in a family where there’s been significant death from cancer. That’s a different situation from where you have not a particularly elevated risk in your other breast. So what my doctors said to me was, if you make a decision to remove your other breast that’s a psychological decision having to do with your risk tolerance – not a medical decision.”
The best option of all is to eradicate this disease so that no woman has to choose to remove her breasts ever again. With the research taking place at Dr. Vincent Tuohy’s laboratory at the Cleveland Clinic, we may be able to develop a preventive breast cancer vaccine to save future generations of women from this deadly disease.
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