Pittsburgh doctor says Jolie's mastectomy decision may promote awareness

Medical technology makes it theoretically possible for any woman to do what Angelina Jolie did: take a blood test to determine whether she carries the gene that makes her highly susceptible to breast and ovarian cancer.

But should she?

That's a question that has arisen after Ms. Jolie, the actress and director, wrote an article this morning in the New York Times.

Ms. Jolie, knowing that her mother died young after a long fight with cancer, took a test that she wrote costs more than $3,000 in the United States to determine if she had the BRCA mutations. She discovered she carried the gene BRCA1 and decided to have a preventative double mastectomy and reconstructive surgery, dropping her chances of developing breast cancer from 87 percent to under 5 percent, she wrote.

Only women with certain risk factors should get the test for the genetic mutation, said Dr. Shivani Duggal, breast oncology surgeon in the Allegheny Health Network at Canonsburg General Hospital. Risk factors include having family members under the age of 50 with breast cancer, family members with ovarian and other types of cancer, a male family member with breast cancer and being of Ashkenazi Jewish ancestry.

The U.S. Preventative Services Task Force has also weighed in, recommending genetic testing for women with a family history, but recommending against testing for those without family risks.

For women such as Ms. Jolie, Dr. Duggal said their options include a bilateral mastectomy or active surveillance, which can mean being screened twice a year for breast cancer.

"In the appropriate patient population, it is a good choice," she said, referring to a woman who is very young, who has tested positive for the gene and who has the proper anatomy to support the nipple-sparing reconstruction Ms. Jolie had.

In recent years, she said, bilateral mastectomies have become more frequent, but she said she believes the increase is due not to genetic testing, but to patients becoming more educated and plastic surgeons becoming more proficient.

Dr. Duggal said she hopes people read Ms. Jolie's column as a message about the importance of breast health awareness.

"Overall, I think she did what she felt was best for herself and her family," she said. "I think she did the right thing for the right reasons, for her own personal reasons."

Ms. Jolie is not the first person to spread public awareness about her decision to have preventative breast surgery. In fact, WPXI anchor Peggy Finnegan went public with her decision to have a bilateral mastectomy and reconstructive surgery in 1994.

Dr. Duggal said the positive way Ms. Jolie portrayed her choices forms a message applicable to all women.

"I think it just helps to promote breast health awareness," she said.

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This story originally appeared in The Pittsburgh Press. To subscribe: http://press.post-gazette.com/ Kaitlynn Riely: kriely@post-gazette.com or 412-263-1707. First Published May 14, 2013 7:45 PM


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