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Actress Angelina Jolie attends the Women in the World Summit 2013 on April 4, 2013 in New York, United States. Jolie spoke out this week about her preventative double mastectomy. How should women best screen for and protect against breast cancer?
The actress made a stunning announcement in a New York Times op-ed that she underwent a double mastectomy to reduce her risk of contracting breast cancer. Jolie said she was a carrier of the “faulty” gene BRCA1.
The gene can be detected with a blood test and can alert patients to a higher-than-average risk of breast and ovarian cancers. What is the BRCA1 gene and how do you test for it? Are the tests reliable? If you are a carrier of the gene, what are your medical options? Is preventative surgery the best way to cut down your cancer risk?
Dr. Nova Foster, surgical director of the UCLA Santa Monica breast center
Dr. David Agus, Professor of Medicine at the University of Southern California; Director of the USC Westside Cancer Center
Dr. David Agus on what makes the testing process so difficult?
"If there isn't a history of breast cancer in the family and we look at the genes and there's an abnormal letter, we don't always know what it means. So we really only know how to understand it in the context of a family history of breast cancer."
Dr. Agus on why its so expensive to get tested:
"When you start to look at it, there's a company that patented the gene, and there's a Supreme Court case that should be decided in the next month saying 'should they be allowed to patent the gene?' because the test costs over $3,000. People who's insurance companies don't pay for, or don't have insurance, don't have the ability to look at their own gene. To run the test costs several dollars, yet they charge thousands of dollar. So should we be allowed to patent genes and not allow people without the resources to look at their own DNA. There is a cheaper version of the test for people of Ashkenazic Jewish descent because we know exactly where to look and we don't have to sequence the whole gene in those patients."
Dr. Agus on whether pre-existing conditions:
"Bush passed a law called GINA, the Genetic Information Nondiscrimination Act, so based on that nobody, whether an employer or insurance company an discriminate based on a preexisting genetic condition. That being said even before that law was passed, there aren't cases in the courts where people have discriminated against, but I'm glad that the protection exists, because it needs to. All of us need to be empowered with knowledge. With knowledge comes the ability to prevent."
Dr. Agus on how men factor into the discussion:
"A man, if he carried BRC1 or 2 has a higher risk of pancreatic cancer, colon cancer and prostate cancer [and male breast cancer], so they themselves need to be aware. They also need to be aware that they will pass it on to their children, so they need to be aware for themselves and their children. If a young girl, a teenager, goes on oral contraceptives and she's BRCA1 positive, you're going to have a dramatic increase in breast cancer before the age of 20, so it's an issue that society hasn't even addressed. These kids aren't old enough to consent to genetic testing, yet obviously if we know we can do things differently in these young girls to hopefully make them live a long and better life."
Dr. Nova Foster on the advances of reconstructive surgery:
"The aesthetics of the reconstructive surgery have made great advances in recent years...Angelina Jolie decided to go with an implant based reconstruction, you can also do reconstruction of the breast with autologous tissue, so you can harvest your own tissue from the tummy area or other areas if the tummy tissue isn't available or appropriate. but certainly the aesthetics of the reconstructed appearance are quite amazing these days and I think she's made a very important point in saying that it in no way diminishes her femininity."
Dr. Foster on why the decision to undergo a double mastectomy is so difficult:
"In our culture breasts are a huge part of one's self-image, and it's a significant thing to contemplate losing your breasts no matter how nice the reconstruction is, it's still a big emotional thing that women have to deal with. You certainly can't underestimate that."