Angelina Jolie Undergoes Bilateral Prophylactic Mastectomy with Discovery of Gene Mutation BRCA1

When Angelina Jolie recently found out that she was a carrier for the gene mutation BRCA1, she underwent bilateral prophylactic mastectomy, in which both of her breasts were removed.

This is called contralateral prophylactic mastectomy and it is on the rise in the U.S. Data from large cancer registry studies, for one example, have shown that the overall rate of CPM among women with stage I, II or III breast cancer significantly increased from 1.8 percent in 1998 to 4.5 percent in 2003. Looking only at patients treated with mastectomy, the CPM rate grew from 4.2 percent in 1998 to 11 percent in 2003.

However, health professionals caution that with the news of Jolie's decision, this procedure should only be done for the same reason as bilateral mastectomies-the presence of BRCA1 OF BRCA2.

Many studies show that most health professionals do not think it's necessary to undergo this procedure unless you are carrying the mutation. In other words, it will not necessarily be more beneficial for your health by elminating both breasts. 

Considered in the context of history, this is a jarring development. Back in the 1970s, women with breast cancer and their supporters pushed to have the option of breast conserving surgery (BCS or "lumpectomy") made available as an option to treat breast cancer.

They argued then that they should have access to a less invasive option than mastectomy (surgery to remove all breast tissue), particularly when randomized trials suggested the two treatments gave women the same chance of long-term survival. Yet in the United States we now find ourselves on the opposite end of the spectrum, with patients largely driving decisions -- electing to undergo this most extensive treatment option for breast cancer.

It would be almost unheard of for a woman without cancer to have a bilateral prophylactic mastectomy, as Jolie did, unless she had a genetic mutation.

As patients are worried about recurrence, some women who carry neither the BRCA1 or BRCA2 gene may have a second, healthy breast removed because they feel this will help prevent cancer. However, for most, this is not the case, and the risk of a new breast cancer in the nonaffected breast is less than 1 percent.