• The Other Side of Angelina Jolie’s Double Mastectomy

    By Christiane Northrup, MD

    Many women became familiar with the breast cancer type 1 gene (BRCA1) when actress Angelina Jolie announced that she had undergone a double mastectomy as a preventative measure. The reasoning that Jolie shared with the media was focused on her risk—according to her medical professionals, Jolie’s variation on the BRCA1 gene gave her an 87 percent chance of developing breast cancer. So even though she did not have breast cancer, Jolie felt HER risk was too high to ignore this genetic predisposition and had the double mastectomy.

    I’m not writing to judge Angelina Jolie or the decision she made, which seems to have been the “right” choice for her. I’m writing because I know that having a preventative double mastectomy will not be the first choice for many women. And these women need to understand all sides of this issue before making a choice that’s right for them.

    First, it’s important for you to know that only about two percent (2%) of all breast cancers involve an inherited gene, either the BRCA1 or the BRCA2! The first has a higher risk than the second, and both genes are also associated with ovarian cancer. (BRCA1 is more common in Hispanic, African American, and Jewish women of Ashkenazi descent.) That said, if you have a strong history of breast or ovarian cancer, but test negative for either gene, your family history may be a bigger indicator of your breast cancer risk than the gene is.1 Jolie’s mother died in her fifties of ovarian cancer, and Jolie has a significant family history of breast and ovarian cancer—including an aunt who died from breast cancer shortly after her announcement.

    One aspect of the story that really got people’s attention was the statistic “87 percent risk.” That number sounds frightening, because it’s so specific! Jolie’s medical professionals didn’t cite an 85 or a 90 percent chance, or a range—they gave Jolie an 87 percent risk of developing cancer. Let’s look more closely at this, because it’s a great example of our misunderstanding of the genetic connection to disease.

    Jolie’s “number” is based on older estimates, which have been disputed by the National Institutes of Health. In fact, a 1997 study showed the risk of Jolie’s particular mutation to be closer to 56 percent. There are many factors that affect a woman’s chance of developing breast cancer—regardless of whether she has the BRCA1 or BRCA2 gene.

    •    In an blog called “What Doctors Didn’t Tell Angelina Jolie”2 journalist Lynn McTaggart points out, “New evidence shows that even a faulty BCRA1 gene, as Jolie has, may require epigenetic modification, or ‘silencing,’ before cancer progresses.”3 In layman’s terms, this means that a physiological change is required to activate the gene.

    •    Vitamin D levels play a huge role in protecting women from cancers of all kinds. We now know that the risk of breast cancer is cut in half in women with adequate levels of vitamin D. 4

    •    The nutrition a girl gets at critical times in her life, particularly as a fetus and during puberty, greatly influence the expression of genes like BRCA1.5

    •    Daily intake of fruits and vegetables also lowers your risk of breast cancer. Karolyn Gazella writes, “Specific to BRCA1 and BRCA2, a 2009 study featured in the journal Breast Cancer Research and Treatment demonstrated that women with the inherited mutation who ate more fruits and vegetables significantly reduced their risk of developing cancer compared to the women with the mutation who ate fewer fruits and vegetables.”6

    •    In a 2006 study also featured in Breast Cancer Research and Treatment, women who carried the mutation and had normal weight, and prevented weight gain as they aged, also had a much lower risk of developing cancer than women with the mutation who were overweight.

    •    Our families’ emotional legacies play a large role in all our health issues, and are hard to quantify in studies—although they absolutely are a factor.

    If you look at your family history and wonder whether you should have genetic testing, think hard about why you want to do so. The recent Supreme Court decision that denied a patent to the company that developed the breast cancer gene test has resulted in a flurry of other parties offering the test at a much lower cost. This is a double-edged sword for at-risk women unless they are fully informed about their true risks. Click here to read these risks.

    Before you have the testing, ask yourself the following: What would I do with the information? Would you be swayed by your doctor to get a preventative double mastectomy? Would you stop looking for ways to mitigate your risk? Would you let medical test results override your inner guidance?

    Whether the results are negative or positive, there are no guarantees. Regardless of what your choices are, or what your results may be, the most powerful thing you can do for your breast health is to cultivate a loving relationship with them, making breast-healthy lifestyle choices, and, if you are concerned, monitor their health with an attitude of self-love and self-care—not a “search and destroy mentality.” Acknowledge that your breasts—like every other part of your body—have the ability to become and stay healthy throughout your life.

    [1] American College of Obstetrics & Gynecology, Committee on Genetics, 1996, Breast-Ovarian Cancer Screening, Committee decision no. 96, Washington, D.C.
    [2] McTaggart, L. What Doctors Didn’t Tell Angelina Jolie, May 31, 2013,
    [3] Birgisdottir, V. Epigenetic silencing and deletion of the BRCA1 gene in sporadic breast cancer, Breast Cancer Res, 2006, 8: R38.
    [4] National Human Genome Research Institute, Three Breast Cancer Gene Alterations in Jewish Community Carry Increased Cancer Risk, but Lower Than in Previous Studies, 1997.
    [5] De Assis S, Hilakivi-Clarke L. Timing of dietary estrogenic exposures and breast cancer risk, Ann N Y Acad Sci, 2006; 1089: 14–35.
    [6] Gazella, K. Angelina Jolie Missed an Important Opportunity, Psychology Today: The Healing Factor, May 16, 2013.

  • NHS Breast Screen Program Does Not Give Women Informed Choice, It Misinforms The Public, UK

    Academic Journal
    Main Category: Breast Cancer
    Article Date: 04 Sep 2011 – 9:00 PDT

    Peter C Gøtzsche and Karsten Juhl Jørgensen of the Nordic Cochrane Centre urge for “more honesty” from the NHS BSP (Breast Screening Programme). They believe that harm has been understated, and that information issued to the public has in general been unaffected by “repeated criticism and pivotal research” which has expressed reservations regarding screening benefits and registered considerable over-diagnosis.

    Their paper, “The Breast Screening Programme and Misinforming the Public”, is published in the Journal of the Royal Society of Medicine.

    The authors say:
    “Spokespeople for the Program have stuck to the beliefs about benefit that prevailed 25 years ago and continue to question the issue of over-diagnosis.

    Women therefore cannot make an informed choice whether to participate in screening based on the information the Program provides. This must be changed.”

    The report explains that information is largely embellished, regarding the lives that have been saved through the screening program.

    Professor Peter Gøtzsche, co-author of the paper and Director of the Nordic Cochrane Center, explains:
    “The claim that death rates have fallen ‘in part from earlier diagnosis associated with screening’ is astonishingly misleading.

    Deaths from breast cancer are falling because treatment is improving. There’s been a similar fall in the age-groups not invited to screening. In this respect, and many others, the Program persists in misinforming the public. It was forced to revise its leaflet inviting women for mammography but the new leaflet and their latest Annual Review continue to repeat incorrect mortality estimates.”

    The program estimates that one breast cancer death for every 400 women is prevented by being screened on a regular basis over a ten year period – arguing against this the authors say:
    “(the figure) is wrong by a factor of five. We have been unable to find any evidence for this estimate in reports from the Program or elsewhere. The 1993 meta-analysis of the Swedish trials reported that one breast cancer death was avoided for every 1000 invited women after ten years. The number is 2000 if we use the more realistic estimates of a 15% reduction in breast cancer mortality.”

    They also stress that contradictory information about over-diagnosis is being provided by the NHS BSP.
    “The (2010) Review has reverted to repeating the much too low estimate regarding over-diagnosis from the 2006 Review, but it is obscure as to where this figure comes from. The new leaflet never uses the term over-diagnosis, and although it talks a lot about ‘benefits’ it does not use the equivalent term ‘harms’ but just speaks about ‘downsides’, which is far less negative.”

    In the report they explain that “the only hint at over-diagnosis” in the invitation leaflet is the sentence ‘Screening can find cancers which are treated but which may not otherwise have been found during your lifetime’. They believed this is vague and readers may understand that screening can only be good, as it detects cancers which would otherwise be hard to find.

    The researchers tried out the sentence on a group of fourth year medical students – by this time in their training they still would now have had lectures about screening. They discovered almost half did not understand the sentence and one third believed it was bad for women to have these cancers detected.

    The researchers said:
    “There is no quantification of over-diagnosis in the leaflet and no estimate of the balance between benefit and harm.”

    The Programs 2010 Annual Review was criticized by the authors for using sentences, such as..:
    “If a breast cancer is found early, you are less likely
    to have a mastectomy.”

    ..claiming that the program encouraged belief that screening will reduce the chances of the women needing to have a mastectomy. The authors express:
    “But such claims are seriously misleading. Danish data has demonstrated that because of over-diagnosis, screening increases the use of mastectomies substantially.”

    Written by Grace Rattue