Angelina Jolie’s double mastectomy: What you should know according to Fred Hutch experts
By Colleen Steelquist, Hutchinson Center Science Editor
Angelina Jolie’s disclosure in today’s New York Times of her recent preventive double mastectomy made headlines around the world. Her celebrity spotlight illuminates the decisions faced by many women who share a similar family history of breast and/or ovarian cancer.
Jolie learned she carried a mutation in BRCA1, which along with BRCA2, are genes that act as tumor suppressors. For most people who develop cancer, cancer-causing gene mutations happen over the course of a lifetime, leading to cancer later in life. But some people are born with a gene mutation inherited from their mother or father. The risk of developing breast and/or ovarian cancer is greatly increased in women like Jolie (and men) who inherit these mutations.
We all, of course, want to reduce our risk of getting cancer. But it’s important to remember that genetic testing isn’t recommended for everyone—only about 5 percent to 10 percent of breast cancer cases are thought to be hereditary. It’s better to start by evaluating your risk with your doctor than rushing for genetic testing.
According to population research led by Fred Hutch’s Dr. Kathi Malone, among breast cancer cases with a family history of ovarian cancer, 14 percent were found to carry a BRCA1 mutation. Among those who had a family history of both breast and ovarian cancer, 27 percent carried the mutation.
Fred Hutch researcher Dr. Julie Gralow, who directs the Breast Medical Oncology program at Seattle Cancer Care Alliance, said testing should be considered in families that have faced multiple cases of breast and ovarian cancer, young ages at diagnosis (40 or younger), male breast cancer incidence, and multiple cancers in the same family member.
And it’s optimal to test the family member who has cancer, Gralow said. “Otherwise, a negative result could mean either no gene mutation in the family or a family with a gene mutation that the tested person didn’t inherit,” she said.
For a BRCA1 or BRCA2 carrier, removing the ovaries is definitely recommended after childbearing and by age 40. “We don’t find ovarian cancer early or treat it well,” Gralow explained.
However, for women with either mutation, a double mastectomy is an option, but it’s not a solid recommendation, according to Gralow. “Mastectomy reduces risk for developing breast cancer, but because we would follow such a patient closely, we’d likely find a cancer early and it wouldn’t impact her survival,” she said.
Genetic tests are available to check for BRCA1 and BRCA2 mutations and genetic counseling is recommended before and after these tests through a clinic like SCCA’s Breast and Ovarian Cancer Prevention Program.
For the vast majority of people who face breast cancer, their risk stems from being female and getting older. Second to those, an individual’s reproductive history—childbearing, breastfeeding, age of first menstruation and menopause, use of hormone replacement therapy—plays a role.
The good news: Many Fred Hutch research studies show factors we can control, like our weight, activity levels and alcohol consumption, also impact our risk.
And as Gralow is quick to point out, even if there is controversy about the age to start them and how often to get them, mammograms save lives.
Read more about how to reduce your risk of breast cancer on our website.