Surviving AmericanSurviving
American Medicine

Everyone has heard the news: one of our favorite stars, Angelina Jolie, knew that her mother had died of breast cancer. So she had her blood checked and news reports told us that she tested positive for a gene mutation that causes a very high risk of breast cancer, the BRCA gene mutation. So she made a life-changing decision: she would undergo a bilateral mastectomy and breast reconstruction. What does this story mean you have to think about to see if you should be concerned?

Breast cancer is the most common cancer in women, but it is easily treatable if discovered early by mammogram, breast self examination and in some instances breast ultrasound or breast MRI. the causes of breast cancer are sometimes genetic. If there is a family history of breast or ovarian cancer or if a person is from a group with a high risk of gene mutation (Ashkenazi northern European jews, or Hispanic), there is a higher risk that the genes BRCA1 or 2 might have a mutation. If they have a mutation, the lifetime risk of breast cancer may be 50 to 80%, and the lifetime risk of ovarian cancer might be 30-60%. So prevention and early detection become important issues for such individuals to face and to control.

What does this mean for you, what tips do you need to relate to Angelina’s story?

• To determine your lifetime risk of breast cancer, go to www.cancer.gov/bcrisktool 
  
• If you have relatives with breast or ovarian cancer, be certain to discuss this with your doctor
• Be certain your doctor advises you if you are at any increased risk of breast or ovarian cancer
• If your doctor cannot advise you, ask for a second opinion from an oncologist or a genetics counselor
• If you know you are at increased risk of breast cancer, ask your doctor for a clear set of instructions of how to prevent the disease, and how to detect it early. Discuss exercise, early child-bearing
  

  Sunrise of prevention

  , diet, alcohol, smoking, frequent mammograms, ultrasounds, and breast MRI exams, medications (tamoxifen, aromatase inhibitors, or raloxifene), prophylactic oophorectomy and salpingectomy (removal of ovaries and tubes), and even prophylactic bilateral mastectomy and reconstruction (like Angelina did). If you cannot get a clear answer, or if you want more assurance of the right advice, get a second opinion.

• Never ever leave your doctor’s office without having once gotten good advice on your risk and prevention and early detection. Your life depends upon it. Angelina has courageously shown you the importance of having a life path.

For more information about genetic assessment and prevention, see my book “Surviving American Medicine” Chapters 9 and 10, and you will be better prepared to work with your doctor to confidently live longer and happier.