Preventative Mastectomy is an Option for Women Who are at a Very High Risk

From the Meadville Tribune

People around the world were shocked to learn that actress and activist Angelina Jolie opted to have a double mastectomy in 2013 to reduce her risk of breast cancer. Jolie, who was 37 years old at the time of the procedure, reportedly learned that she carries a mutation of the BRCA1 gene, which sharply increases her risk of developing breast cancer and ovarian cancer. In addition, the actress has a family history of cancer. Her mother, Marcheline Bertrand, died of ovarian cancer in 2007 at the age of 56.

By having a preventive mastectomy, Jolie reduced her breast cancer risk from 87 percent to 5 percent, according to an op-ed piece she authored in The New York Times. Jolie is not the only well-known actress to opt for a preventive mastectomy, as fellow thespian Christina Applegate had a similar procedure in 2008 after learning she had a mutation of the BRCA1 gene. These highly publicized cases have left many women wondering if a preventive mastectomy is something they should consider.

BRCA stands for "breast cancer susceptibility genes," a class of genes known as tumor suppressors, says the National Cancer Institute. Mutations in these genes have been linked to hereditary breast and ovarian cancer. A person's risk of developing breast and/or ovarian cancer is greatly increased if he or she inherits a harmful mutation in BRCA1 or BRCA2. Mutations in these genes could also put a person at increased risk for other cancers.

Genetic tests can check for mutations in BRCAgenes. During such a test, a blood sample is taken, and if a mutation is found, a person may get genetic counseling and work with a doctor to develop a plan of action. It is important to note that not all people with a genetic mutation will get breast cancer or ovarian cancer. The National Cancer Institute's "SEER Cancer Statistic Review" states 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.

Although there is no surefire way to determine if a person with a mutated gene will develop breast cancer, many women who are considered high risk opt for a preventive mastectomy to reduce their risk. Women who have a family history of breast cancer, have received positive results from gene testing, have already had cancer in one breast, or have dense breasts that make testing difficult may want to get a preventive mastectomy.

The decision to get a preventive mastectomy is not one to take lightly. Many breast centers are staffed with breast-health specialists, genetic counselors, breast surgeons, and reconstructive surgeons who can help patients make the best decision. Second opinions are strongly recommended for women considering a preventive mastectomy.

Women should understand the options available to them if they have an extremely elevated risk of breast cancer or ovarian cancer.