Should Angelina Jolie have had a Bilateral Mastectomy?
We can't blame Angelina Jolie for choosing to have a bilateral mastectomy because of the BRCA 1 gene defect. She has every right to deal with this issue. However, we can blame her and the press for sensationalizing her choice and influencing millions of women when it comes to their making a choice about how to deal with having the BRCA 1 or BRCA 2 gene defect when there are other options that are equally valid that got no press at all.
In addition, the timing of publishing the articles about her choice in the NY Times and People Magazine is suspicious. Myriad Genetics owns the legal rights to any and all uses of these genes. Because this may be a violation of the First Amendment and also stiffles diagnostic testing and researach, this issue is now being debated in the US Supreme Court.
The question arises concerning how to deal with having the BRCA gene defects. Only about one in a thousand women will be affected by these defects and having the mutations in and of themselves does not mean you will necessarily get the disease. There are epigenetic factors that are necessary to trigger the development of a cancer and lifestyle modification may be a very good way to protect against this. Keep in mind that these genes were present 100 years ago, but breast cancer was a relatively rare disease.
There is also the issue of how to screen for cancer in women with a BRCA gene defect. Conventional wisdom recommends doing serial mammograms. This is insane when we know that radiation accelerates the risk for developing breast cancer. In fact, a study was published a few years ago showing that having just a single chest x-ray before the age of 20 increased the risk of developing breast cancer in this setting by 250%. A mammogram has far more radiation to the breast than a chest x-ray! Of course, the solution is to follow these women with breast thermograms at 6 month intervals. There is no risk of radiation and the test is completely safe, accurate, and affordable.