May 14, 2013

Jolie admired for bravery in mastectomy revelation

The Oscar-winning actress says she made the choice with thoughts of her six children after watching her own mother, actress Marcheline Bertrand, die too young from cancer.

The Associated Press

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Angelina Jolie: "I do not feel any less of a woman. I feel empowered that I made a strong choice that in no way diminishes my femininity."

AP

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"It might not necessarily be surgery," Nagy said. "It might be much more frequent screenings. Surgery isn't right for everyone."

That's the decision that Gabrielle Brett made — at least initially. Brett was only 23 when she tested positive for the BRCA1 gene. She had just met her future husband, James, a month earlier. She wanted to have a family, so she waited.

But at age 29, her husband said she shouldn't wait any longer. She should have her breasts removed before they had kids, even though she wouldn't be able to nurse them. She ultimately agreed. She had the surgery and then had two children. Now 35, she is two weeks from her due date with her third.

Brett woke up in the middle of the night Tuesday, read about Jolie's article on Facebook, and excitedly woke her husband. "It's amazing to hear that someone so famous went through the same thing," she said in a telephone interview. "It makes me realize we are all on the same journey."

Brett, who lives in Shaker Heights, Ohio, also figures that Jolie went through some tough moments, however serene she sounded in her article.

"I'm sure it wasn't quite so simple," she said. "There's sadness, anger, fear. I did a lot of crying alone in the car. But once I had the surgery, I felt a huge weight come off of me. I was no longer worrying whether there was cancer growing inside me somewhere. I felt nothing but relief."

And, she said, it was crucial that she was accompanied throughout her journey by "my own Brad Pitt" — her husband, who was there through every moment, as Jolie says partner Pitt was for her at the Pink Lotus Breast Center in southern California.

There is one part of the journey Brett has not tackled yet: removal of her ovaries. That, she said, will come a bit later, when she is 40.

Doctors stress that no one solution is right for everyone who tests positive. And even for those with a risky family history, it's not necessarily always right to test right away, they say.

"You don't necessarily want to test an 18-year-old, sending her into a panic at such a young age," said Shenk. "You might consider that she's unlikely to get cancer in her 20s. You would maybe test her later."

Another potential downside to the testing: the cost, which can reach $3,000, though it's usually covered by insurance and there are programs for women who can't afford it.

And some women might simply not be prepared for the results, said Dr. Eric Winer, head of the breast program at the Dana-Farber Cancer Institute in Boston. "Once you get the information, you have to be able to deal with it," he said.

If one does test positive, Winer stressed, it could be a reasonable solution to undergo intensive surveillance with MRI tests and mammograms. Or, some women choose to remove only their ovaries, which in pre-menopausal women seems to reduce the risk of breast cancer, too.

But in Jolie's case, Winer said, it's hard to argue with her choice of preventive surgery. "I tend to be a less-is-more doctor," said Winer. "But I do think the choice she made is a rational, reasonable one."

There is a risk, he noted, that with the actress's celebrity power, people will see her choice and think it's the only one. If they do get cancer, "most women are well-served by conservative surgery, as in a lumpectomy," with chemotherapy and/or radiation, he said.

But any risk is outweighed by Jolie's ability to promote awareness, Winer added. "The more people who ask their doctors about this, the better."

Dr. Kristi Funk, founder of the Pink Lotus Center where Jolie was treated, agreed. "We hope that the awareness she is raising around the world will save countless lives," Funk said.

Jolie's most positive influence, some say, may be in the fact that such a glamorous woman has come forward — in great detail — to talk about how one can lose one's breasts and still remain, well, a woman.

"I do not feel any less of a woman," Jolie wrote in her article. "I feel empowered that I made a strong choice that in no way diminishes my femininity."

That impressed Nagy, the genetic counselor. "For women, so much is tied to sexuality, to sensuality," she said. "Many women feel defined by that. So for her to be such an icon and come out and say, 'Look what I did' — I'm hoping that prompts other women to have conversations, about their own options."

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