I’ve asked Elizabeth Prier, MD, FACS, Idaho’s only fellowship-trained breast surgeon and director of the Saint Alphonsus Breast Surgery Center, to comment on the recent news from actress Angelina Jolie and how her admission might help raise awareness about breast cancer.
The recent announcement by Angelina Jolie that she elected to remove both her breasts, followed by breast reconstruction, to reduce her risk of breast cancer, highlights the importance of genetic testing in people with a strong family history of breast and ovarian cancer.
The genetic mutation referred to as BRCA mutation that Jolie said she carried accounts for only 5 percent of breast cancers. However, women who have this mutation have a lifetime risk of breast cancer ranging from 60 to 80 percent. (The average woman’s lifetime risk of breast cancer is only 12 percent.)
While Angelina Jolie’s decision may sound extreme, considering the significant increased risk of breast cancer due to the BRCA mutation, preventative surgery is certainly a reasonable strategy to decrease the possibility of developing breast cancer.
Thankfully, the advent of breast MRI technology and its improved ability to screen for breast cancer in high-risk women means that close screening with breast MRI and mammograms is also an option for BRCA mutation carriers. While this strategy will not prevent breast cancer, it can help in diagnosing the disease in its earliest stages when it is very treatable.
Genetic testing for women with a strong family history of breast cancer or a diagnosis of breast cancer at an early age is widely available in the Treasure Valley. If a woman is diagnosed with the BRCA mutation, the genetic counselors at Saint Alphonsus Health System work closely with a breast surgeon to help a woman understand her options for screening and preventative surgery.
Angelina Jolie discussed undergoing a nipple-sparing mastectomy with reconstruction. This procedure is offered at Saint Alphonsus for women who would like to consider preventative surgery. The advantage of a nipple-sparing mastectomy is that it can create a much more natural appearance to the reconstructed breast. Retrospective studies evaluating the risk of developing breast cancer following a nipple-sparing mastectomy in BRCA mutation carriers shows no increased risk of developing breast cancer.
Just as Betty Ford’s 1974 admission of her breast cancer diagnosis helped bring awareness to the diagnosis and treatment of breast cancer, Angelina Jolie’s admission of her BRCA diagnosis can be an important watershed moment. This will hopefully highlight the importance of recognizing one’s family history and the role that genetic testing can play for women at high risk of developing breast cancer over their lifetimes.