Angelina Jolie’s decision to remove her breasts and ovaries to prevent cancer (as she detailed in today’s New York Times op-ed) might sound extreme, but breast cancer experts say she was spot on.
“I understand what Angelina Jolie did, and I would have done it, too,” said Dr. Otis Brawley, the chief medical officer of the American Cancer Society.
Brawley said if he were Jolie’s doctor he would have advised her to do what she did because her mother, aunt, and grandmother all had ovarian cancer, and her mother had breast cancer as well.
Plus, Jolie has a gene that gives her about an 87% chance of getting breast cancer sometime in her life. “She has one of the particularly bad breast cancer genes,” Brawley said.
The decision is made even easier by advances in breast reconstruction and by hormone treatments that help ease women into menopause, which is induced by removing the ovaries. The ovary surgery was a no-brainer, doctors say, and some wondered why she didn’t do it sooner.
In her op-ed, Jolie explained that every year she’s had a blood test called CA-125, to monitor for ovarian cancer. But that test often has false positives and false negatives, said Dr. Dr. Funmi Olopade, director of the Center for Clinical Cancer Genetics at the University of Chicago. “You really can’t rely on it,” she said.
Instead of screening, experts in cancer genetics recommend that women at a very high risk for ovarian cancer, like Jolie, remove their ovaries as soon as they’re done having children. “I can’t emphasize enough how important this is,” Olopade said.
Olopade was glad to hear Tuesday morning that Jolie had decided to move forward. “What she’s done is really important to save her life, because there’s no way to detect ovarian cancer,” she said.
Jolie’s decision about her breasts (also documented in an op-ed), however, is not so clear cut, Olopade explained, because it would have been perfectly acceptable if Jolie had decided to keep her breasts and to get regular MRIs instead. “We have lots of survivors who went that route, and they’ve done well,” she said.
Some made the decision to keep their breasts because they couldn’t afford a good plastic surgeon for breast reconstruction, she added. “Celebrities have access to that kind of surgery, but that’s not the life everyone lives,” Olopade said.
Brawley added that Jolie’s decision likely wouldn’t be right for someone with a different kind of breast cancer gene mutation. For example, some women have a mutation that gives them a 15% chance of getting breast cancer in their lifetime. That’s not much higher than the 12% chance a woman has of getting breast cancer even if she has no mutation at all.
He says he worries that some of these women with just a slightly increased risk will hear about Jolie’s decision and want to remove their breasts, too. “To get surgery in their situation is really overkill,” he said. “Most of these women would be just fine if they took tamoxifen for five years and got regular mammograms.”
But all in all, doctors say they’re glad Jolie has been so public with her decision making. “These very publicly shared medical sagas from respected figures play a very powerful role in creating these teachable moments,” said Dr. Ken Offit, chief of clinical genetics at Memorial Sloan Kettering Cancer Center.