Angelina Jolie's Double Mastectomy: Will More Women Choose This Surgery?


Confession: I have never been a fan of Angelina Jolie. Someone with so many blessings in her life (brains, beauty, babies, Brad) seemed a little too good to be true. And so annoyingly poised! But the latest B in her life—breast cancer—has changed my mind about Jolie. Yes, she still seems annoyingly poised, but in her op-ed article in The New York Times, she also finally seems human: she’s a mom worried about being around for her children, a daughter still grieving her mother who died from ovarian cancer, and a woman who made a difficult medical choice and isn’t afraid to talk about it.

In the article, Jolie, who is 37, reveals that she’s had a prophylactic double mastectomy because she carries the BRCA1 gene. That gene puts her at an elevated risk for breast cancer and ovarian cancer.

She says in the article: “My doctors estimated that I had an 87% risk of breast cancer and a 50% risk of ovarian cancer, although the risk is different in the case of each woman. Only a fraction of breast cancers result from an inherited gene mutation. Those with a defect in BRCA1 have a 65% risk of getting it, on average.”

After her breasts were removed, Jolie had breast reconstruction with implants. In the article she says, “the results can be beautiful.” Coming from Angelina Jolie, that statement, more than anything, may reassure women who are considering preventive mastectomy.

Jolie is not the only celebrity to talk about breast cancer treatment or prevention; Christina Applegate and Giuliana Rancic also have helped raise awareness about prophylactic double mastectomies. (Both women had both breasts removed even though cancer was only present in one breast; Applegate also has the BRCA1 gene.)

Having options really does give women the feeling of power in the midst of a frightening cancer or gene mutation diagnosis. But will all of this “awareness” push women toward a surgery that may not be needed? In a study done last year by Sarah Hawley, MD, an associate professor of internal medicine at the University of Michigan, nearly 70% of women with breast cancer who opted to have a healthy breast removed as a precaution (a procedure called a contralateral prophylactic mastectomy) actually had a very low risk of developing cancer in that breast. The study prompted all sorts of “Most Women Who Choose Double Mastectomy Don’t Need It” headlines.

"Women appear to be using worry over cancer recurrence to choose contralateral prophylactic mastectomy. This does not make sense, because having a non-affected breast removed will not reduce the risk of recurrence in the affected breast," Hawley said in a University of Michigan press release.

The double mastectomy trend isn’t all that new. Between 1998 and 2003, the number of women with early stage breast cancer in one breast who had both breasts removed rose by 150%, according to a University of Minnesota study. Peace of mind (even though not statistically supported) along with advances in reconstructive surgery (that’s covered by insurance thanks to The Federal Women's Health and Cancer Rights Act of 1998) may be prompting this rise.

Will the desire to get new breasts like Angelina Jolie’s drive even more women with breast cancer to choose prophylactic mastectomy? Maybe. But Angelina Jolie speaking out is more likely to prompt women to ask smart questions, to consider getting tested, and to understand the repercussions of testing positive for mutations in the BRCA1 or BRCA2 genes or of having a family history of two or more immediate family members with breast or ovarian cancer. For women who do test positive, prophylactic mastectomy can be a smart choice. In Jolie’s case, it dropped her risk of getting breast cancer from 87% to below 5%, she said.

Of course, just like when Christina Applegate had her prophylactic mastectomy, I’m sure all eyes will be on Jolie’s chest the next time she walks the red carpet. Her boobs may be on view, but what I’ll be seeing is her bravery.

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