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One of the nation’s leading gynecologic oncologists, Dr. Beth Karlan, told The Hollywood Reporter Tuesday that Angelina Jolie’s public discussion of her double mastectomy has triggered an intense discussion of the medical options available to women carrying the genetic mutation that puts them at elevated risk for breast and ovarian cancer.
Karlan, who directs Cedars Sinai’s Division of Gynecologic Oncology and serves as associate director of the hospital’s Samuel Oschin Comprehensive Cancer Institute, said that, in the day after Jolie went public, she’s received many calls and emails from her patients with the BRCA genetic mutation, but who have been delaying surgery. “Seeing Angelina’s op-ed piece and knowing that surgery has not changed the fact that she is a beautiful woman has humanized the experience for people. She’s beautiful. She’s talented. She has a wonderful family. Everyone has to embrace the challenges in their lives and find the strength to make the best of them.
“I have patients who have tested positive for the gene and have not wanted to have definitive surgery,” Karlan said. “This isn’t wrong, but I think if we can prevent cancer, it’s even better than curing cancer. People don’t have to go through chemotherapy, radiation and the physical and emotional effects of cancer.”
Dr. Kristi Funk, who performed the surgery on Jolie at the Pink Lotus Breast Center — which she founded and directs — said her group, too, “applauds” the star’s “bold choices regarding her BRCA contagion, and we hope the awareness she is raising around the world will save countless lives.”
Jolie revealed Tuesday in a New York Times op-ed piece that she has undergone a proactive double mastectomy followed by reconstructive surgery after learning that she carries the BRCA 1 gene mutation. As result, she wrote, doctors counseled that she had an 87 percent chance of developing breast cancer and a better than 50 percent chance of suffering ovarian cancer. “Angelina Jolie is one of the most courageous people I know,” said former studio chief Sherry Lansing, a founder of the Entertainment Industry Foundation’s Stand Up to Cancer charitable program. “Her recent op-ed piece in the New York Times will raise awareness and save countless lives.”
Jolie is the most recent in a series of celebrities who have increased awareness of the BRCA gene issue by candidly discussing their own health situations. Last November, Sharon Osbourne revealed that she, too, had undergone a double mastectomy after learning she carries the mutated gene. Christina Applegate, who underwent a double mastectomy after she was diagnosed with BCRA-related breast cancer, even maintains a website — Right Action for Women — that encourages awareness of the problem.
The BRCA 1 and 2 genes may carry a genetic mutation that dramatically increases the risk of developing ovarian cancers and breast cancers in both men and women. Physicians generally recommend that individuals with close relatives who suffer those cancers before age 50 — Jolie’s mother died of ovarian cancer at 56 — undergo genetic screening. Jewish women of Ashkenazi descent also are thought to be more at risk than the general population. Karlan points out that most medical insurance plans now cover the screening.
“For decades now we have known that certain cancers cluster in certain families,” Karlan told THR. “There has been a lot of genetic research in the last 25 years to identify the genes that could be inherited and place people at risk for certain cancers. The risk of getting those cancers just as likely to come from father as it is the mother.”
Karlan said that when one of her patients tests positively for a mutation, she recommends a number of possibilities: Increased surveillance with breast MRIs and mammography for breast cancer screening in BRCA carriers; and CA 125 and transvaginal ultrasound for ovarian cancer screening. She is now studying the role of the HE4 tumor marker — with money from the National Cancer Institute – to determine if a better test for early ovarian cancer detection can be found. Doctors also have the ability to give patients preventative medications, including Tamoxifen for breast cancer risk reduction and birth control pills to prevent ovarian cancer. “It depends on the individual, her risks, and her life plans,” Karlan said.
“We want to find the cancers early because the screenings are not perfect,” she pointed out.
At this point in time, Karlan said, “the most effective prevention we have really is surgery for those who test positive.”
In addition to having double mastectomies, some patients opt to have their fallopian tubes and ovaries removed.
Karlan has been working on genetic research at Cedars since 1990, when she met Gilda Radner, a likely BRCA carrier. After Radner’s death from ovarian cancer, husband Gene Wilder gave the hospital permission to establish the Gilda Radner Hereditary Cancer Program. Karlan notes the tagline for Radner’s famous quote: “Don’t be afraid to look into it.”
“We have come a long way,” Karlan said. “We still don’t have the perfect answers. At least knowing about the risk allows you to make a difference. The knowledge can allow you to be empowered and not victimized by cancer.”
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