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May We All Have The Option of Double Mastectomy

The views expressed are those of the author and are not necessarily those of Scientific American.

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Today, Angelina Jolie published an Op-Ed in the New York Times about her decision to get a double mastectomy (removal of breast tissue in both breasts) to reduce her risk of breast cancer. She has a genetic mutation in her BRCA1 gene, which her doctors said gave her an 87 percent chance of getting breast cancer and a 50 percent change of ovarian cancer in her lifetime.

In the future, may we all have the option to get a double mastectomy. Or, rather, its equivalent for whatever cancer each of us are genetically predisposed to.

1984 illustration of a total mastectomy by Donald Gates (National Cancer Institute)

Genetic testing for cancer has blown up in the past few years, but it’s still hard to know what to do with the results. So you find out you have a genetic mutation that gives you an increased chance of getting some type of cancer. What do you do now?

The answer, almost across the board, is that you wait. Armed with the knowledge that you are more likely to develop this cancer than the general population, you are more vigilant, get tested more frequently and prepare yourself to fight at the slightest sign of cancer. This is a great benefit. People who catch their cancer earlier have a better prognosis across the board.

Genetic testing doesn’t seem to increase people’s anxiety, so this solution must work well for most people. However, most known mutations associated with cancer only increase risk minutely or have ambiguous results; BRCA1 is a totally different ballgame. The average woman has a 12 percent chance of getting breast cancer in her lifetime, but for women with a mutation in BRCA1, that chance jumps as high as 90 percent.

With risks that high, most women with the mutation are just sitting and waiting for the day when they will get their diagnosis. For every BRCA1 woman it’s different—some handle it well and can live with the wait, while it’s excruciating for others. So it’s no wonder that some choose to take action and remove their breasts and/or ovaries. It’s a personal decision and not up for critical discussion.

It’s pretty amazing, actually, that this kind of preventative action—however drastic it may seem—can be taken at all. For most cancers, there isn’t a preemptive surgery available yet that will reduce your risk from 87 to 5 percent. The ability to make this choice—to have surgery or not—is itself empowering: it’s no longer a passive waiting game, but an an active defense.

In the future there may be direct preventative measures for other types of cancer. Some of these may also require major surgery; others may be simpler, like taking a daily pill. We don’t know what they look like yet—but, when we have true preventative measures for other cancers, we’ll be thankful to Angelina Jolie and Deborah Lindner and Nell Boeschenstein and so many other women who have talked publicly about their breast cancer surgeries and encouraged conversation around such a personal topic.

In each case, it will be a personal choice. May we all have such options in the future.

Image: 1984 illustration of a mastectomy by Donald Gates (National Cancer Institute)

Hannah Waters About the Author: Hannah Waters writes about natural history and the way people think about nature. She lives and works in Philadelphia, PA, but really on the internet. Follow on Twitter @hannahjwaters.

The views expressed are those of the author and are not necessarily those of Scientific American.

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  1. 1. rshoff 4:55 pm 05/14/2013

    This is an example of how accumulation of wealth is not only inequitable to begin with, but reverberates in all aspects of life. It would only be fair if it could be said that such accumulation where based on true contribution. But that cannot be said with any integrity. So, why do some women get to side step cancer while others are condemned? This question may be asked across the board for almost all serious medical issues.

    This post is specifically about treatment options for people with high-risk genetic mutations. It is in the benefit of insurance companies to cover pre-emptive surgeries for high-risk patients and I imagine they will start covering these surgeries. (Especially if they are part of the public dialogue! Thank you, Jolie.) Law requires that BRCA testing is covered, and some surgeries have been covered. (I don’t have detailed data, only anecdotes.) I really don’t know enough about insurance companies etc. to talk about cancer options broadly, far less all serious medical issues. -HW

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