Winnipeg Free Press - PRINT EDITION

Jolie situation unique, MDs say

Only a small number of women would benefit from surgery

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NEW YORK -- "I hope that other women can benefit from my experience," Angelina Jolie wrote in a powerful op-ed article Tuesday, explaining her decision to go public with having her breasts removed to avoid cancer.

But amid the accolades for the film star's courageous revelation, doctors and genetic counsellors were careful to note her medical situation -- an inherited genetic mutation putting her at high risk of breast and ovarian cancer -- was very specific, and that her course of action made sense for only a small category of women.

Breast cancer in Manitoba

In 2010, 848 women in Manitoba were diagnosed with breast cancer. That figure has changed little in the last decade.

Of all the cancers that afflicted women in 2010, breast cancer was by far the most common, making up 27 per cent of all cancers.

There were 192 deaths from breast cancer in 2010.

 

-- source: CancerCare Manitoba: Cancer in Manitoba, 2010 Annual Statistical Report

Still, they hailed her bravery and said she would surely help increase awareness -- and thus, perhaps, help save some lives.

"Having this conversation empowers us all," said Rebecca Nagy, a genetic counsellor who works frequently with women who test positive for a defective version of the BRCA1 gene, as Jolie did. "It's wonderful what she's done."

In an op-ed piece in the New York Times, Jolie, 37, began by speaking of her late mother, Marcheline Bertrand, who died of cancer at 56, before she was able to meet most of her grandchildren.

The actress revealed that beginning in February, she underwent three surgeries -- which she succeeded in keeping secret from the public -- in which her breasts were removed, and later replaced by implants.

"I wanted to write this to tell other women that the decision to have a mastectomy was not easy. But it is one I am very happy that I made," Jolie wrote. "My chances of developing breast cancer have dropped from 87 per cent to under five per cent. I can tell my children that they don't need to fear they will lose me to breast cancer."

The actress also hinted she might, at some point, have her ovaries removed, saying she had "started with the breasts" because her risk of breast cancer was higher than that for ovarian cancer. She did not say when she was diagnosed with the faulty gene.

While admiring Jolie's straightforwardness, cancer surgeons and others in the medical community were quick to point out hereditary cases of breast cancer account for only about five per cent to seven per cent of all cases diagnosed each year, and those connected to the BRCA1 and BRCA2 genes are an even smaller group.

And so, women shouldn't just run off and get tested for those genes, said Dr. Robert Shenk, medical director of the Breast Center at the University Hospitals Case Medical Center in Cleveland.

"My worry is that people will be inappropriately tested," said Shenk. Instead, he said, genetic counselling, including a close review of a patient's family history, is crucial.

Nagy, who is also president of the National Society of Genetic Counselors, agreed.

"The clues are in the family history. Has there been cancer in multiple generations? Are there clusters of cancers, like breast and ovarian, on the same side of the family? Has the cancer been diagnosed at an early age -- under 50?" she said.

 

-- The Associated Press

 

Republished from the Winnipeg Free Press print edition May 15, 2013 A4

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