With the recognition that 5 to 10 percent of cancers are due to inherited mutations, it is especially important that people work with their physicians to identify their cancer risk and, when appropriate, do gene testing to see if they have a mutation. Once any mutation is identified, the person who has the mutation can get advice on preventing the cancers associated with the mutation and can also start a program of screening, so that any cancers can be discovered at the earliest and most curable stages with the least amount of treatment.
Angelina Jolie is now my new hero and role model for gene testing and taking the necessary steps to control cancer risks. Here is why.
Many women in Angelina's family have died from cancer, breast and ovarian cancer. With the discovery of the BRCA1 and BRCA2 gene mutations that cause most inherited breast and ovarian cancer, Angelina had the courage to be tested herself. And as suspected, she had a severe mutation in her BRCA1 gene. According to what her doctors calculated, her chances of getting a breast cancer were 87 percent, and her chances of having ovarian cancer were also high.
Angelina won her first credit (from me) for publicly discussing her decision to have a bilateral breast removal (also called double mastectomy) with plastic surgery reconstruction so she could retain her feminine beauty and eliminate nearly all her breast cancer risk.
Yet that was not all she had to think about. Because her gene mutation also markedly raised her risk for ovarian or fallopian tube cancer, Angelina recently had to face another surgical decision. She now has won her second credit (from me) as a role model for having surgical removal of her tubes and ovaries to eliminate the risk of cancers in those organs, and then publicly discussing it again so women could have her experiences to share with their own doctors and ask the question, "What is my risk of breast or ovarian cancer and what should I do about it," like Angelina did.
Also importantly, Angelina has been emphasizing that the decisions she made about her own personal care, the operations, and her taking hormones were all choices she herself made after getting her physician's advice. There were many options, and her choices, she emphasized, might not be the same ones you would make in her situation. It is all a personal decision, and it reminds us of the importance of having your own doctor, getting complete advice, and then making your own choices. By stressing how individualized the advice and decision must be, Angelina has reminded us how important the patient-doctor relationship is to your care.
So after Angelina's two operations and multiple public discussions, what should you be considering? Here are my tips for inherited cancer risk assessment.
• If there is any history of any cancer in your family, be sure your primary doctor takes a detailed family history from you, including types of cancer, relationship to you, age at which the cancer was discovered, and if any relatives each may have had two different episodes of cancer. If you need a sample history form, you can find it in my book Surviving American Medicine.
• Make certain your doctor discusses this history with you and assesses your cancer risk of breast or ovarian cancer, of colorectal cancer, of prostate cancer, or other cancers in your family. If your doctor does not know how to calculate your risk, ask for a consultation with another physician (oncologist or geneticist).
• Ask if gene testing would be appropriate for you. Ask if prophylactic preventive surgery would be appropriate (like Angelina had, twice). Ask what other preventive measures would be appropriate (diet, medicines, exercise, or avoiding things like smoking or excessive drinking). And ask what screening tests are needed to find any cancers when they are smallest and at very early stage.
• Remember, you should take Angelina's story to heart now. She had the bravery to confront her suspicions herself and protect her life. You should as well.
Kudos to Angelina Jolie, and our thanks to her for keeping cancer prevention issues in the news to benefit all of us.