Christ. I hope someday we’ll be able to look back on the days of privatized insurance the same way we look back on slavery, but I guess there’s quite a bit of work to do before that can happen.
Why? Men get breast cancer and also carry the BRCA gene.
How is that strange? She is hardly the first woman to choose prophylactic mastectomy, and if you’re going that route you’d be a fool not to choose the best reconstructive surgeon you can afford. This course actually is considered acceptable treatment for women at very high risk of breast cancer.
Oh, please – exaggerate much? Assuming you’re speaking of the US, no way is it “100 million or so women” who will get breast cancer, it’s not nearly as common as that. Also, as already mentioned, it’s not unheard of for insurance even in the medically backward US for this to be covered for women at demonstrated high risk of cancer. You know why? It’s a heck of a lot cheaper to do a prophylactic mastectomy than a reconstruction after cancer treatment.
Given how lucrative her career is she’d be an idiot NOT to factor that into the deal, wouldn’t she? Or isn’t her career important?
I will also mention that for women who are considering this doctors recommend they perform such preventive surgeries after they are done bearing their children, which usually means mid 30’s or later. In other words, she’s at an entirely appropriate age for this sort of action.
^ And that’s exactly why she wanted the best reconstruction possible. Are you saying that because she has taken this step she shouldn’t be allowed to act every again? She shouldn’t have had her breasts reconstructed? What exactly is your objection here?
How so? You seem angry that she dared to get surgery that is arguably preventive. Is it somehow wrong to prevent cancer?
She is most certainly NOT advocating this for everyone. She underwent testing that determined she was at enormously greater risk than the average woman and decided to reduce her risk.
Yeah, reportedly 87% susceptible which is no small thing. If you’re more likely to get cancer than not are you seriously suggesting waiting until cancer actually appears?
I think you’re also neglecting to consider that reconstruction a breast/performing plastic surgery on a healthy person who has not been subjected to either chemo (which is a form of poison – that’s how it works) or radiation (which adversely affects healing) is going to give better results than performing that same surgery on someone who has already been through a grueling course of treatment(s).
To continue your car analogy – it’s a heck of a lot cheaper to restore an old car to near-mint condition if that car has never had a major accident or case of rust. Restoring something beat to heck is always going to be harder and more expensive.
Actually, she underwent a procedure to conserve her nipples. They’re rather easily monitored after all, just as the external skin is. The result is still not going to look as good as her natural breasts.
This isn’t a one-size fits all answer. It’s important to keep in mind that the testing (that came out of all that research) shows that she will almost inevitably get cancer. The research results have allowed us to identify people at extraordinary high risk, which is the only reason this sort of drastic step makes sense.
There are some other cancer-causing genes that also lead to near-inevitable cancer, the two I recall off the top of my head being one for colon cancer and another for eye cancer. For the colon-cancer gene some people are having their entire colon removed as early as their early 20’s. The eye cancer crops up in infancy, requiring a choice between eye-removal or death. We don’t go causally digging out colons or eyeballs, but when the alternative is a high chance of death a surprising number of people decide to live without the offending parts. These days, they can remove the parts before the get actual cancer, have to undergo treatments that can damage their entire bodies, or worry about metastases.
On the flip side, we’ve also been able to identify cancers that are vulnerable to specific drugs, or are less aggressive and thus require less aggressive therapies, or in some cases don’t need to be treated (certain slow-growing, less aggressive cancers in the elderly need not be treated, as the person will likely die of something else first, or the treatment is more likely to shorten their lives than the cancer). The research has identified some people who don’t need the most mutilating treatments, even it as identified people at higher than usual risk.
Higher than average – BRC1 and BRC2 are both associated with a higher risk of several other cancers (I’m wondering if she also had her ovaries removed, too). She’ll require frequent monitoring for the rest of her life for those. For her gene, though, breast cancer and ovarian cancer are the highest risk.
I’m very surprised she was able to keep her nipples, as they contain milk ducts which are at risk of becoming cancerous. I wonder what her risk of developing Paget’s disease is?
I suspect the intention was to keep the external appearance more than the internal structures.
Also, Paget’s Disease is pretty easy to spot, as opposed to a tumor deep inside the mass of a breast. Her risk is not zero, both she and the doctors were pretty clear on that. It reduces risk, it does not eliminate it.
Really? People are thinking she’s doing this as some sort of publicity stunt? Oh come on.
I won the reverse lottery on this one. My mother had breast cancer about 12-15 years ago, and ovarian cancer 1.5 years ago. We go in tomorrow to get the results of her latest PET scan to see if it’s come back. She was tested for BRCA (her insurance covered it), it came back “inconclusive.”
You better bet I’ve considered getting a full mastectomy, hysterectomy, and both ovaries removed, even with the inconclusive result of the genetic test. It’s fookin’ scary living with something like that. I haven’t done it yet, but I haven’t stopped thinking about it, either.
As it is, I get all kinds of attention from my gynecologist. Every little minor thing they find, I get to go for ultrasounds or MRIs or whatever. They’ve told me my mother’s history of cancer will pretty much cover whatever I want removed. It’s a huge decision, not fun to go through, and I highly doubt that Jolie went through it for “new boobs.” She’s a gazillionaire; she can have new boobs 3 times a year and would probably never notice the cost.
I want to ask a question about the 87% figure, is that for real? My immediate reaction was “no-one who doesn’t yet have a cancer diagnosis ever has odds *that *bad”, and I suspected what she was told was she had an 87% *increased *chance of breast cancer over the norm, which I believe is about 12.5%. So 12.5 * 1.87 = 23.375% . Am I off-base here, does having that gene really give an over-50% chance of diagnosis?
No, it’s not OVER the norm. It’s 87% percent chance of getting it, according to some sources. According to this page, chances of breast cancer is 40-84% with the positive mutation. Ovarian cancer is a 15 to 40% chance.
I unfortunately know these statistics too well.
True, they are more easily monitored than deeper breast tissues, but they still contain milk ducts and can develop breast cancer (unlike the rest of her skin). Paget’s disease isn’t quite as bad as invasive ducal carcinoma, but it’s still plenty nasty. I suppose it comes down to balancing minimizing risk versus obtaining reasonable aesthetics and feeling, and I bet different patients draw that line in different places.
Very true! They won’t have the same feeling as her natural breasts, either (although she’ll at least have nipple sensation). How anyone could look at his surgery and see it as anything but a regrettable but necessary mutilation utterly baffles me.
There are at least two, involving different genes: familial adenomatous polypoasis, and Lynch syndrome.
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That would be hereditary retinoblastoma.
Exactly. Once you know you’re at a very high risk of developing a particular cancer, undergoing prophylactic surgery can be emotionally easier to cope with than living with he long-term anxiety that your particular genetic time bomb could explode at any time.
This is currently one of he fastest-developing areas of oncology. We’re really beginning to make big strides in customizing cancer therapies based on what gene mutations each patient’s particular cancer carries. It’s progress.
Yeah, the biggest problem is that there is no gross anatomical feature that clearly delineates where the axillary tail of the breast ends, and the surgeon doesn’t want to risk creating chronic lymphedema by taking out too much axillary tissue. So some breast tissue may be inadvertently left behind in that area.
No, that figure is lifetime risk, not increased risk over normal. Some gene mutations virtually guarantee that you will develop a particular cancer (while others may only raise the risk slightly).
Any woman who has seen a mother or a close relative die from breast cancer would do what Jolie did or at least consider it. My best friend’s mom died from the disease far too early. It was heartbreaking. She had beaten the stupid thing a year ago. She had a relapse and was gone a short time later. At the time my friend’s mom was running for NYC council and was expected to take the nomination and win the seat. I was helping her daughter write speeches for her mom while my husband served as her finance person.
I will never forget Jen’s voice as she told me her mom had died. Never.
I say bravo for Jolie to having the guts to tell us of her choice. I know my friend Jen lives with the horror of what happened to her mom and what could happen to her every single day of the year.
The only real horror is that we do not have better methods of treatment.
Yegads, what a horrible and yet somehow wonderful news item to read.
I believe she did this for her children, many of whom she and Mr Pitt have adopted from various nations.
She didn’t want to leave them earlier than she eventually must.
Sounds like a great mother to me.
From the cancer.gov link…
According to estimates of lifetime risk, about 12.0 percent of women (120 out of 1,000) in the general population will develop breast cancer sometime during their lives compared with about 60 percent of women (600 out of 1,000) who have inherited a harmful mutation in BRCA1 or BRCA2 (4, 5). In other words, a woman who has inherited a harmful mutation in BRCA1 or BRCA2 is about five times more likely to develop breast cancer than a woman who does not have such a mutation.
Also, different BRCA mutations can carry somewhat different risks. And of course some very unlucky people inherit two bad BRCA gene copies instead of merely one.
This is one area of medicine where it really pays to talk with a good genetic counselor.
One of my aunts had breast cancer, detected thanks to being pregnant at the time (the nurse wanted to show off the brand new ultrasound machine, the first one in Spain). She refused to have “a procedure that will let us begin treatment straight away”, changed doctors, got inducted at 7months, and she was whisked away to the nearest hospital with an oncology wing while her youngest stayed behind in an incubator. That’s a case where a preventive mastectomy would probably not have taken place already, if she happens to have that gene, as she was still having kids. But, knowing she was at risk, she would have been monitored more often than other women. For the last almost-40 years she’s never missed a chance to tell women to learn and perform self-exams, and never skip a mammogram.
My aunt on the other side has had breast cancer twice, fifteen years apart, of two different types. Her breasts look very different due to the advances in surgery in those fifteen years. I can assure you that if she’d been able to have preventive surgery as soon as she was done breastfeeding her youngest, she would have.
Completely different illness, but a relative of my sister in law’s has a degenerative disease that’s genetic and develops during late adolescence/young adulthood. She completely refused to have children because she was terrified of getting/transmitting that same disease. Eventually she was able to get gene-tested, got a clean bill of health for that particular disease, I now have two nephews.
To the critics: do you also think people shouldn’t have moles or colon polyps removed until and unless they become cancerous? How big does a prostate need to be, before being extracted?
It is not at all remarkable that someone with infinite financial resources can get the exact breasts she wants through surgery.
Also, now everybody in the world will be looking at her breasts, every time she appears, anywhere.
I mean, I don’t think it was particularly brave of her to do it, and not particularly brave of her to hold a press conference announcing it. I’m not suggesting she lie about it, but really, it’s none of our business.
Absolutely not! Legitamate proactive healthcare decision.
Some may think *talking about it *is the publicity stunt.
Right… because it was so much better in the days when no one ever said the word “cancer”…[/sarcasm]
You’re right, it’s none of our business - until she decides to make it public. It was her choice to bring this up for discussion. What she did is an option, one that might make sense for women at particularly high risk but is not the correct choice for everyone. Although I am getting a little tired about hearing about Ms. Jolie’s breasts every 10 minutes on the TV I think prophylactic mastectomy is a valid part of the discussion on on to treat and/or prevent a serious disease.
They are now reporting she is also getting her ovaries removed next. I was wondering why she had only had the mastectomy if she had the BRCA1 gene.