Angelina Jolie and the Dirty Little Secret of BRCA Breast Cancers

The actress was not only at high risk of getting breast cancer but of coming down with an exceptionally dangerous form of it

by Beth DuPree • MD, FACS, ABIHM
angelina jolie image
Photograph: PR Photos

Why would any woman elect to remove her healthy breasts as Angelina Jolie just did? Isn’t the surgery disfiguring and psychologically damaging? What kind of surgeon would even perform that surgery when there is no cancer in the breasts? I am one of those surgeons who feel that an educated patient can make the right choice for herself. But neither Jolie nor most commentators have specifically addressed the major reason her surgery, though dramatic, was such a sensible move.

Angelina Jolie’s public disclosure has created quite a buzz in the media. She has shared her personal journey to educate millions of women about the breast and ovarian cancer risk realized by women who carry the BRCA I or II gene. Her choice to have “risk reduction surgery,” as I like to refer to it, was clearly an empowered, educated, visionary decision.

BRCA gene-related breast cancers have a dirty little secret. They are associated with a high incidence of triple negative tumors. Although “negative” sounds good, it’s not. These fast growing cancers can show up as large tumors in just a few months. BRCA positive patients follow a six-month screening routine that alternates between mammogram and MRI. Even so, triple negative cancers can pop up in the interval between screening exams. This is one reason that more and more women who carry a BRCA gene choose to have risk reduction surgery with reconstruction. Surgically, we are often able to preserve the nipple complex providing patients with risk reduction and excellent cosmetic results. Triple negative cancers account for approximately 75 percent of the cancers that occur in BRCA I carriers and 30 percent of the cancers in BRCA II carriers.  (Less than 11 percent of breast cancers in the general population are triple negative.) These cancers are fast growing and aggressive, and almost all of them require chemotherapy as they lack certain cell surface proteins that can be targeted by medication. The drug tamoxifen is ineffective in preventing this specific type of cancer.

Angelina became educated and made the right choice for her. She has reduced her risk of breast cancer from 87 percent to less than 5 percent, and she can look her children in the eye and say with love in her heart, “Mommy did everything in her power to prevent breast cancer and be here with you!”

Dr. Beth DuPree is a breast surgeon and Medical Director, Holy Redeemer Breast Health Program in Meadowbrook, PA. She is a fellow of the American College of Surgeons and Board Certified in Integrative and Holistic Medicine.

Next: Celebs Who Survived Breast Cancer

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Comments


Dr. DuPree,
THANK YOU! Finally, an article addressing TRIPLE NEGATIVE CANCER and BRCA MUTATIONS...keep spreading the word, educating, sharing...I will too. THANK YOU MORE MAGAZINE for being uber on top of things,responsible and printing it...
Amy Byer Shainman
BRCA/HBOC Advocate, Previvor
TWITTER: @FloridaForce
South Florida Outreach Coordinator for FORCE
Facing Our Risk of Cancer Empowered

dee leads07.07.2013

I was DX with TNBC but not all of us can get or have this test done. Our insurances won't pay for this.
That out of the way I am glad that Angelina did do what she did. If not for her sake than for her family. I have three weeks more of radiation to go.
deezzz

06.18.2013

I've seen so many comments about Angelina's decision from people who have no idea what they are talking about it is scary. Thanks for this article. I'm a widow. My wife had the Braca Gene, was diagonosed with Ovarian cancer at 44 and died at 50. Her mother also has the Braca Gene Mutation and has had 3 seperate occurances of Breast Cancer beginning at 55 but is alive and well at 85 years old. My daughter has a 50% chance of having this gene, but being 21 has chosen not to be tested yet. My recommendation to her would be to have her family and then her ovaries removed. Before this article I would have suggested the twice annual breast screening as this Dr. mentioned is the standard procedure (and what my wife did), but that was based on my previous understanding that Braca related Breast Cancer was less deadly, not more. If you find yourself in this position get real advise from the best oncologist you can find. And a 2nd or 3rd opinion to convince yourself you are making the right decision.

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