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.
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