The VOICE of Health

From Florida Hospital Apopka

There’s no arguing that celebrities can have an impact on our lives. They set trends, make headlines and sometimes, they even start conversations that influence public health decisions.

That’s exactly the case with actress Angelina Jolie, who announced in 2013 that she would undergo a preventive surgery to have both breasts removed. Though Jolie was not diagnosed with breast cancer, she tested positive for a genetic mutation that sharply raised her cancer risk.

A new study published in the journal Health Services Research found that since Jolie’s announcement, risk-reducing mastectomies nearly doubled. The study focused on New York State and New South Wales, Australia, finding similar results in both populations. In New York, for instance, bimonthly cases jumped from 3.3 to 6.3 per one million after Jolie’s announcement.

And Angelina Jolie isn’t the only celebrity who has helped raise health awareness for women. In 2005, Australian singer Kylie Minogue announced she had been diagnosed with breast cancer; in the years that followed, diagnostic breast imaging spiked among women aged 25 to 44.

“We are seeing a dramatic increase in the number of women who are asking about genetic testing for the BRCA mutation and preventive mastectomies,” says Dr. Olga Ivanov, breast surgeon at Florida Hospital Celebration Health.

“More awareness about genetic mutations and breast cancer, in general, can be a very good thing, but it’s important to be cautious when using information in the media to make your health decisions — the key takeaway is that we are not all like one celebrity; each individual has a different genetic make-up, set of risk factors and medical history to consider,” she adds.

In fact, Dr. Ivanov explains that only 0.2 to 0.3 percent of the U.S. population has the BRCA mutation. While this number is higher in people of certain ethnicities, such as in Jewish women and men of Eastern European descent, there is a relatively low number of women who are indicated for BRCA testing and at a heightened risk for breast cancer.

According to Dr. Ivanov, there are very specific risk factors for high-risk groups and automatic genetic testing for the BRCA gene mutation.

Some risk factors for BRCA testing include:

  • Having two first-degree relatives with a history breast cancer (mom, sister or daughter)
  • Having a family history of ovarian cancer
  • Breast cancer onset at age 50 and under
  • A family history of male breast cancer

Yet, even women with no history of breast cancer and red flags for the BRCA mutation still become worried. “If low-risk women are concerned about breast cancer and want these preventive measures, we educate them that genetic testing and preventive mastectomies would not be medically indicated.” In some cases, over-testing can do more harm than good, sparking increased testing from less reputable labs and even false positive results.

She further explains that even for women who have a history of breast cancer in one breast, the scientific data supports the conclusion that a preventive mastectomy of the other breast does not necessarily add years to their lifespan compared to implementing a regular screening protocol, provided they do not carry a genetic mutation that increases their risk.

“However, if a woman has had breast cancer and wants a preventive mastectomy, or is positive for the BRCA mutation with a very strong family history, it’s part of her taking control of her situation and I respect that by engaging in discussion so we can make a joint decision on the best course of treatment for the individual,” states Dr. Ivanov.

Breast imaging and mastectomies like Jolie’s do have a strong potential to save lives. According to the National Cancer Institute, preventive bilateral mastectomies can reduce the risk of developing breast cancer by at least 95 percent in women who have inherited certain gene mutations (including those in the BRCA1 and BRCA2 genes), and up to 90 percent in women with a strong family history of breast cancer. The important thing to note is that preventive mastectomies are not recommended for the majority of women.

Dr. Ivanov concludes, “If you are worried about breast cancer, the first and best source of information is your doctor (not a friend or news article), who can help assess your individual risks based on a host of factors and guide you in developing the best prevention plan for you.”

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