Jolie’s Choice: Why Have a Preventive Mastectomy?

Woman with nurse

When a woman decides to have her breasts removed to prevent cancer, the choice is never easy. But it can be the right choice — with the right information.

When actress Angelina Jolie announced today in The New York Times that she had a prophylactic (preventive) double mastectomy, she brought new attention to this procedure. Jolie had a mutation in her BRCA1 gene. That means she had a much higher chance of developing breast and ovarian cancers in her lifetime.

Around 13 percent of women in this country will develop breast cancer. Out of that group, around 5 percent have a BRCA1 or BRCA2 mutation. High-profile cases such as Ms. Jolie’s shine a light on the decisions these women face.

“It comes down to you and your doctors considering all the available information and — just as Ms. Jolie did — making the right choice for you.”

Charis Eng, MD, PhD

Founding Chairwoman of the Genomic Medicine Institute

How big is the risk?

If you have a BRCA1 mutation, your lifetime risk for developing breast cancer is up to 80 percent. The risk really picks up after age 25, so women with this mutation should be screened with MRI and mammograms every single year starting at an early age. The high risk is why many women choose to have a bilateral prophylactic mastectomy to remove both breasts — after careful consultation with a clinical cancer geneticist, genetic counselor and breast specialist.

But the risk does not stop with the breasts. Breast cancer risk makes headlines, but women with a BRCA1 mutation also have up to a 40 percent risk of developing ovarian cancer. The risk picks up in a woman’s mid-30s. Many women will consider having their ovaries, fallopian tubes and uterus removed, often after having children.

Does family history play a part?

When you read Ms. Jolie’s personal story, you can tell she did her research before making her decision. In her case and others, family history played a big part. She watched her mother struggle with cancer, as so many other women have done.

If you’re concerned because of your family history or other red flags for cancer, don’t hesitate: Ask to visit a genetic counselor. They can assess your history and test you for a mutation if needed. It’s a crucial step in knowing whether you are at risk — and what you can do to reduce that risk.

How much does surgery help?

Having both of your breasts removed does not take your chance of breast cancer down to zero. But it does take the risk down to the single digits, a big difference from 80 percent. Removing the ovaries offers similar results. Women who choose these procedures should still be monitored for life, but they also may spend less time fretting over the future.

These decisions are never easy. They’re also highly personal. Many women will opt for careful monitoring rather than surgery. It comes down to you and your doctors considering all the available information and — just as Ms. Jolie did — making the right choice for you.

More information

Cleveland Clinic Breast Center

Download a Breast Cancer Treatment Guide

Breast Cancer Clinical Trials at Cleveland Clinic

 

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Charis Eng, MD, PhD

Charis Eng, MD, PhD is founding chairwoman of the Genomic Medicine Institute and founding director of its Center for Personalized Genetic Healthcare. Dr. Eng is a global leader in cancer genetics and cancer genomic medicine.