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Why Angelina Jolie Decided to Undergo Preventative Double Mastectomy

May 15, 2013 at 12:00 AM EDT
In a New York Times op-ed, actress Angelina Jolie disclosed she had a preventative double mastectomy because she carries a greater genetic risk of developing breast cancer. Gwen Ifill talks with genetic counselor Beth Peshkin of Georgetown University and Dr. Kenneth Offit of Memorial Sloan-Kettering Center in New York.

GWEN IFILL: Finally tonight: dealing with the risks of breast cancer.

Angelina Jolie’s surprise disclosure that she had a preventive double mastectomy three months ago has opened the door to a wider conversation. The 37-year old actress and director announced her decision in yesterday’s New York Times, writing: “I hope that other women can benefit from my experience. Cancer is still a word that strikes fear into people’s hearts, producing a deep sense of powerlessness. But, today, it is possible to find out through a blood test whether you are highly susceptible to breast and ovarian cancer, and then take action.”

Jolie carries the genetic mutation BRCA1, which places her at a much higher risk for breast and ovarian cancer. But how have and how should other women deal with the risks inherent in that surgical option?

For some expert insight, we turn to Beth Peshkin, a genetic counselor and professor of oncology at Georgetown University, and Dr. Kenneth Offit, chief of clinical genetics services at Memorial Sloan-Kettering Center in New York.

Welcome to you both.

So, Dr. Offit, give us a little more elaboration on who exactly is at risk from this BRCA gene that we keep talking about.

DR. KENNETH OFFIT, Memorial Sloan-Kettering Cancer Center: Well, we should first make it clear that this is a minority of women with breast cancer.

We think only about five percent of women with breast cancer will have this hereditary high-risk form. And those are the individuals who would benefit most from genetic testings. Individuals who are very early age with breast cancer, 30s and the 40s, and we think all women with ovarian cancer should have genetic testing if you have a family history of breast and ovarian cancer in your family. Male prostate cancer can also run in these families.

And individuals who are of Eastern European Ashkenazi Jewish heritage are also at increased risk for this type of hereditary cancer, but it’s still a small part of the overall amount of breast cancer.

GWEN IFILL: Beth Peshkin, when we talk about genetic testing, what does that involve?

BETH PESHKIN, Georgetown University: Well, the first step in the process is genetic counseling.

So, for women who are concerned about their risk of cancer, the first step is to get a comprehensive risk assessment, to learn about their personal and family history, and to determine what exactly risk is that they may carry an inherited form of the risk.

GWEN IFILL: Are there options short of surgery?

BETH PESHKIN: Absolutely. And I think it’s very important for people to understand that there are many different options for women to consider who find that they’re at increased risk for breast cancer, including screening, such as early and frequent mammography, breast MRI, other options for risk reduction, including Tamoxifen, as well as the surgical option that we have heard much about.

GWEN IFILL: But, Dr. Offit, we’re not necessarily talking about the same options for ovarian cancer, are we?

KENNETH OFFIT: Well, that’s a very important point.

And it’s probably the most important point, one that we certainly learned when we published our paper at Sloan-Kettering about this. The surgery discussion here is focusing on breast cancer. And, as Beth said, that’s an option to discuss. But the ovarian cancer surgery is not an option.

And we feel that this has to be done in women after childbearing, because we have no means of finding ovarian cancer at an early stage. When we wrote that article, one of the really dramatic findings that we will always remember was that three to four percent of these women, three to four out of 100 who had this preventative ovarian cancer surgery after BRCA tests, had an early curable ovarian cancer.

And at Sloan-Kettering, I had never seen that until we started doing genetic testing. So while the focus is on breast cancer surgery, your question is right. We want to think about the ovarian surgery first.

GWEN IFILL: I also want to ask you, briefly, this — who’s paying for this? Is this something that is covered, this kind of radical, almost elective surgery? Is it covered by insurance?

KENNETH OFFIT: Absolutely.

And, you know, one of the fears that we have — Beth will remember — you know, she was with us in New York when we were first starting all of this. And we were — we were very nervous the insurance companies would actually discriminate against women, and not — not only not insure them, but charge them more.

In fact, the insurance companies have acted the other way, and have paid for the testing. And, in fact, they will even pay for these types of surgeries and the MRIs that Beth just alluded to.

GWEN IFILL: Now, Angelina Jolie is not the first person to go through something like this.

But she is drawing a lot of attention to this. So, a woman calls you. I assume that you get a lot of phone calls on a day like today saying, should I be tested? Am I susceptible to this? What is the answer to those questions to people who are sitting home thinking, what about me?

BETH PESHKIN: The answer is to really consider it as a process of decision-making and to make an informed choice, so people who do have an elevated risk of caring a mutation in one of these genes certainly should consider getting the testing, and then to consider what all of the options are for risk reduction and screening, and also to consider what the emotional implications are for themselves and for their family members, because …

GWEN IFILL: If they’re still women of childbearing years, especially.

BETH PESHKIN: Absolutely.

And, also, I think it’s important to women to remember that the decision that they make soon after they get that information doesn’t necessarily need to be the decision that they make in a subsequent time period. So women may opt for screening when they’re in their 20s, and choose risk-reducing surgery later on.

But, as Dr. Offit mentioned, there’s a clear recommendation for removing the ovaries by the time women have completed childbearing.

GWEN IFILL: Dr. Offit, this is also — it’s surgery, but it’s tough surgery. So, what are the risks for actually going through this kind of — we found out after the surgery was done on Angelina Jolie that there was no sign of cancer in her breasts, at least, and now she’s going to have that secondary surgery we have been talking about, the ovarian surgery.

But are there a lot of risks also inherent in choosing the surgery, as opposed to not choosing it?

KENNETH OFFIT: Well, fortunately, for the ovarian surgery that we discussed, the way we do it in New York is laparoscopically.

You’re in and out of the hospital the same day. And we have really minimal risks. But the breast surgery, it’s plastic surgery. And it’s not straightforward. But, fortunately, it’s fairly safe.

One of our goals is to try to obviously move away from surgery. And we have been very involved in research here to discover new genetic modifiers that will give women a better idea of what their risk is, even those women that have the BRCA mutations. And we’re hoping in the next year to be able to be more precise about giving women these risk figures, so that they can make these surgical decisions.

GWEN IFILL: Beth Peshkin, how have improvements in breast reconstruction affected people’s decisions to have this kind of surgery? Because people originally felt this might be scarring, this might be disfiguring.

BETH PESHKIN: I think that’s it’s been a remarkable advancement and has given women a lot of comfort to know that they can often obtain the cosmetic results that they want to, so that they have the quality of life that they’re after.

GWEN IFILL: I want to ask you both before we go, do you think that Angelina Jolie’s op-ed in The New York Times, her admission about her surgery and plans for her health, do you think this has provided a teaching moment for something that maybe people hadn’t been paying much attention to?

BETH PESHKIN: Absolutely.

I think it’s opened up a national discussion that’s important to have, that femininity and sexuality are not defined only by one’s breasts, and that it’s a really complete picture of how she feels about her confidence and ability to make decisions that are right for her.

But I also think the other message is, it’s not just the option that she chose, the surgery, but it’s the power of genetic testing and personalized medicine. And that’s really an important goal, to be aware of family history and get testing when it’s indicated.

GWEN IFILL: Dr. Offit?

KENNETH OFFIT: Well, it’s always admirable when someone in the public eye shares health information to create this type of teachable moment that we’re having now.

I taught for years Cornell medical students the Betty Ford story we remember. And after her diagnosis, the number of mammographic breast cancer diagnoses bumped and lives were saved. And I think this is that same opportunity. Watching this show tonight, some lives will be saved because women, aware of their own family histories, will be inspired to come in to talk to Beth, to talk to us, and to take these actions to detect cancers at a curable stage or to prevent them entirely.

GWEN IFILL: Dr. Kenneth Offit of Sloan-Kettering in New York and Professor Beth Peshkin of Georgetown, thank you both so much.

BETH PESHKIN: Thank you.

KENNETH OFFIT: Thank you.