While I respect Angelina Jolie’s personal decision to have a prophylactic mastectomy, I fear she has given the wrong impression to millions of women with a family history of breast cancer or those who carry a BRCA gene mutation. She missed an important opportunity to share vital information about this gut wrenching decision that women wrestle with.
I’m one of those women. In fact, my family history for breast cancer is so strong that we’ve been studied by two major universities. We are one of the largest known families who carry the BRCA1 gene mutation in North America. I chose against elective mastectomy, and I think it’s important to explain why.
I understand the pain, suffering, and fear caused by cancer. I’m an ovarian cancer survivor and my beloved sister has beaten breast cancer three times. We lost our mom way too soon to pancreatic cancer, and many women on both sides of my family have had their lives cut short by cancer—breast and ovarian.
I also understand that Jolie did not make her decision lightly, and I’m confident it was the best decision for her. But I worry that the recent press is giving women the impression that Jolie’s choice is the right one for them. The fact is, it probably isn’t. My interview with epigenetic experts, as well as an in-depth study of the scientific literature, has given me a clear picture of just how complex this decision is—and that’s what I want to share.
Getting The Facts Straight
Jolie seems to be lumping family history and BRCA into the same category. These are two very different things. Family history means that you have had a primary relative (mother or sister) with breast cancer. It may increase your predisposition to breast cancer, but it does not mean you carry the mutation. In fact, many experts argue that family history without the BRCA1 genetic mutation may be the result of unhealthy diet and lifestyle factors that have been passed down for generations.
Because of the present prevalence of breast cancer, it is likely that many of us have a family member who has had this condition. It is irresponsible to broadly recommend expensive genetic testing to all of these women, followed by extensive surgical recommendations to those who test positive.
Genetic mutations are very different, but even they are not totally predictive of cancer. In fact, only 5 to 10 percent of breast cancers can be attributed to the BRCA genetic mutations. Obesity is linked to far more breast cancers than genetic mutations. In fact, being overweight will more than double a woman’s risk of dying of breast cancer.
Understanding These Mutations
Any number of the numerous genes in our body can have mutations that cause them to function poorly or improperly. Breast and ovarian cells that lack fully functional BRCA1 or BRCA2 are unable to detect DNA damage, and they use error-prone repair processes that lead to instability and cause the cell to divide more rapidly. That’s how these genetic mutations can set the stage for cancer growth. However, although BRCA1 is a significant repair gene, it is one of many. In fact, we have many genes that carry out these same or similar tasks.
Epigenetic Factors Intervene
The scientific study of epigenetics shows us that we can actually influence how our genes behave. Our genes are not our destiny! In the case of BRCA1 or BRCA2, it is not possible to fix the mutation, but we know we can influence the expression of other genes to help compensate.
How do we do this? Diet and lifestyle significantly influence how our genes behave and can help us fill in the holes left by inherited mutations. Specific to BRCA1 and BRCA2, a 2009 study featured in the journal Breast Cancer Research and Treatment demonstrated that women with the inherited mutation who ate more fruits and vegetables significantly reduced their risk of developing cancer compared to the women with the mutation who ate fewer fruits and vegetables. In a 2006 study also featured in Breast Cancer Research and Treatment, women who carried the mutation and had normal weight and prevented weight gain as they aged also had much lower risk of developing cancer than women with the mutation who were overweight.
It would have been nice for Jolie to convey that empowering message rather than leaving women with the impression that painful, expensive, and life-altering surgery was the only proactive option available.
As Jolie describes her surgery you get the impression that it’s really no big deal. The reality is that these surgeries (plural!) are complex, lengthy, and painful. And then there is the reconstruction issue. This is also not an easy decision. We’ve all heard reports of disfiguring surgeries that lead to serious long-term quality of life issues. In fact, the scientific literature reveals that many women who have had preventative mastectomies can suffer with serious quality of life issues afterwards.
While the surgery does reduce the risk of developing breast cancer, which makes sense because you are removing most of the breast tissue, it offers no guarantees. In fact, there is no way to remove 100 percent of all breast tissue and cells. If breast cancer develops in women with implants or reconstructed breasts, it is likely to be much more deadly because the cancer will be deep in the chest wall and difficult to detect. And, of course, this surgery does nothing to reduce risk of other cancers.
Back to My Story
Based on conventional medical wisdom, you would be hard-pressed to find someone who is more at risk of developing breast cancer than me. I have chosen to keep my breasts because they are healthy and I do not have cancer or any precancerous signs of the illness. I am diligent about screening and I use an integrative prevention approach that includes diet, lifestyle, and dietary supplements.
Jolie presents her choice as the only option for women: either do the surgery or continue to be afraid of getting breast cancer. She positions the choice as empowering and proactive, but it’s important to note it’s not the only option—and in my opinion, it’s not the best or most empowering option for most women. I feel incredibly empowered every day when I make decisions that reduce my risk of developing breast cancer.
Not everyone agrees with my decision. But it was the right one for me, and it might be the right one for other people in my shoes. In the end, this choice is individual, very personal, and not easy. What is good for Angelina Jolie may not be good for others. I wish she would have made that clear in her op-ed and presented all of the options, including proactive prevention through screening, diet, and lifestyle. In not doing so, she missed an important opportunity to educate and empower women to take control of their own bodies.