The massive news coverage of Angelina Jolie's decision to have a preventative double mastectomy following testing positive for the BRCA1 gene mutation has people thinking and talking. Jolie's decision to go public about her circumstances is sure to heighten awareness about testing for the gene mutations that increase one's odds of getting breast and ovarian cancer. The news also may influence those who also have the gene and are wrestling with the choice of whether to undergo surgery or continue to monitor closely to go forward with a double mastectomy, as well as oophorectomy.
Whether women who test positive for the BRCA1 and/or BRCA2 gene mutations should have prophylactic surgery is a matter of choice. It is a decision that takes into account one's personal risk of getting these cancers, health status in relation to having surgery, and psychological factors. Cost may be a factor as well. Those who are faced with this decision are routinely advised to consult one's doctor and make an informed personal choice.
One important fact that people may not realize is that the vast majority of women who get breast or ovarian cancer do not have BRCA1 or BRCA2. Breast cancer may occur due to environmental and/or individual biological (but non-genetic) factors. Testing negative for BRCA1 and BRCA2 does not mean that one does not need to monitor routinely for breast cancer. And given the prevalence of the disease (12% of all women), it is important for every woman to be appropriately vigilant. Those who have several and/or close relatives who had breast or ovarian cancer, and also who test positive for the BRCA1/BRCA2 gene mutations are at the highest risk for getting these cancers (though they may never develop them). The level of vigilance therefore needs to be higher, and of course, the anxiety tends to be worse. Still, how to cope with that anxiety and what to do about it is an individual choice, and is likely not an easy one.