Did Angelina Need to Remove Her Breasts? A Doctor's Advice

Actress Angelina Jolie made headlines recently when she made the decision to have a double mastectomy. Angelina Jolie does not have cancer. So why did she make such a drastic decision? And was it necessary? My medical opinion after the jump.

Angelina Jolie and Her Mother

What Was Wrong With Angelina?

Angelina Jolie does not have breast cancer. But she did discover that she has a genetic mutation that makes breast cancer a likely development down the line.

Angelina's genetic mutation involves her BRCA1 gene. A mutation on this gene means that most women have a 65% risk of developing breast cancer. Women without this mutation run roughly a 12% risk of developing breast cancer. Angelina Jolie's test put her personal odds at around 87%.

Mutations in the BRCA1 or the BRAC2 genes are highly hereditary. Angelina Jolie's mother Marcheline Bertrand was diagnosed with cancer at 47 and succumbed to the disease at 57 in 2007. Angelina's genetic makeup and her family history led her to make the decision to have a double mastectomy.

Should You Get Tested?

Most women will not and should not be tested for these mutations. The tests for BRCA1 and BRCA2 mutations are expensive -- around $3,000. And this mutation only affects around 750,000 women in the United States.

And not all segments of the population are equally at risk. The mutation is known to cause 5 - 10% of breast cancers among Caucasian women and women of Ashkenazi Jewish descent. The risk factors for women of other backgrounds is currently unknown.

So who should get tested? You run the risk of having a BRCA1 or BRCA2 mutation if you or a close family member developed breast or ovarian cancer before the age of 50. This is true for both men and women. Those without these risks do not need to spare the expense for this test unless their physician recommends it.

What Are the Consequences of a Double Mastectomy

A double mastectomy may sound like a simple fix, but it is a little more complicated than that. There are financial and health consequences associated with any surgery. And a double mastectomy is more than an overnight procedure.

Angelina went through three months of painful and expensive procedures before her ordeal was over. A procedure called "nipple delay" is required to increase the chances of saving the nipple through the surgery. The mastectomy itself takes 8 hours. After that surgery, the breasts must drain and recover while breast expanders hold the cavity open for implants. The implantation and reconstruction happen later.

As you can see, the decision to have a double mastectomy is not one that you should take lightly. The procedure is extensive and expensive. And each time you go in for a procedure, there are risks of complications.

Only women who's doctors deem this surgery medically necessary should undergo it. But while a medically unnecessary mastectomy is inadvisable, it is not a procedure that you need to fear. The women who do undergo the surgery have great recovery rates and beautiful natural-looking breasts.

Should You Consider A Double Mastectomy Anyway?

A double mastectomy is really only recommended for patients who's tests reveal that they are at high genetic risk for developing breast cancer. There is a trend now of women undergoing this difficult and invasive surgery unnecessarily. Often women with early-stage breast cancer in one breast will undergo a double-mastectomy to halt the disease. However, most physicians -- including this one -- do not recommend this invasive procedure.

Even with a BRCA1 or BRCA2 mutation, double mastectomy is not your only option. Often women choose to monitor their breasts closely with annual mammograms and M.R.I.s. Other women opt for certain medications that lower your risk of developing breast cancer. 

Is Angelina Jolie Immune to Cancer Now?

No. However, now that she has had a double mastectomy, she only has a 5% chance of developing cancer in her breasts which puts her well below the national average. Unfortunately, BRCA1 or BRCA2 mutations also put women at risk for breast cancer. Angelina's test revealed that she has a 50% chance of developing cancer in her ovaries. Angelina is considering having her ovaries removed at a later date. An ovariectomy is a much more complicated and lengthy procedure than a mastectomy.

Dr. Sharon Iglehart

Should Angelina Jolie have gotten a double mastectomy? Given her genetic and familial history, this may have been the right decision for her. However, this is not a good or medically advisable option for most women. If you are concerned about your breast health or your family history of breast cancer, make an appointment with your general practitioner. Together you will be able to make medically sound decisions about your future and your health.