LOS ANGELES – Angelina Jolie was “heroic” for undergoing a preventive double mastectomy, her fiance, Brad Pitt, said Tuesday after she wrote an op-ed piece revealing her decision and describing the mastectomy process, which began in February.
“Having witnessed this decision firsthand, I find Angie’s choice, as well as so many others like her, absolutely heroic,” he told the Weekly Standard in a statement, also thanking their medical team.
“All I want for is for her to have a long and healthy life, with myself and our children,” he said. “This is a happy day for our family.”
In not focusing on his wife alone, Pitt echoed Jolie’s intent to support other women who find themselves in the position of making the same decision.
“I choose not to keep my story private,” she wrote, “because there are many women who do not know that they might be living under the shadow of cancer. It is my hope that they, too, will be able to get gene tested, and that if they have a high risk they, too, will know that they have strong options.” In Jolie’s case, her “faulty” BRCA1 gene and history of a mother who died at age 56 of ovarian cancer made for quite a dark shadow.
Jolie praised Pitt in her Tuesday New York Times op-ed, which went public late Monday night.
“I am fortunate to have a partner, Brad Pitt, who is so loving and supportive. So to anyone who has a wife or girlfriend going through this, know that you are a very important part of the transition. Brad was at the Pink Lotus Breast Center, where I was treated, for every minute of the surgeries. We managed to find moments to laugh together. We knew this was the right thing to do for our family and that it would bring us closer. And it has.”
Her three months of medical procedures wrapped up April 27. Also on Tuesday, the American Cancer Society released a statement of its own urging awareness and caution regarding testing and prophylactic surgery.
“This does not mean every woman needs a blood test to determine their genetic risk for breast and / or ovarian cancer. What it does mean is women should know their cancer family history and discuss it with their regular provider. If appropriate, they should be referred to and have the opportunity to discuss their risk and their options with a genetic specialist,” said Dr. Otis W. Brawley, the organization’s chief medical officer.
Brawley noted that insurance plans created since the Affordable Care Act must cover testing and counseling, but not necessarily surgery.
“A woman with a mutation of known significance must consider her quantifiable risk in making the very personal decision to have her breasts and ovaries removed or pursuing other options, such as more extensive screening for breast and ovarian cancer. Experts recommend women proceed cautiously, and receive a second opinion before deciding to have this surgery.
“The American Cancer Society Board of Directors has stated that ‘only very strong clinical and/or pathologic indications warrant doing this type of preventive operation.’ Nonetheless, after careful consideration, this might be the right choice for some women.”
A look at the procedure:
Q: What kind of surgery did Jolie have?
A: Jolie had a preventive double mastectomy, meaning she chose to have both her breasts removed even though she had not been diagnosed with cancer.
Q: Why did she have the operation?
A: Jolie says that she inherited a faulty version of the BRCA1 gene. Doctors told her she had an 87 percent chance of getting breast cancer and a 50 percent risk of ovarian cancer. She said the surgery reduced her risk of breast cancer to below 5 percent.
Q: What did the procedure involve?
A: In double mastectomies, surgeons typically remove as much breast tissue as possible. In Jolie’s case, the doctors preserved the skin covering her breasts, inserting “fillers” for the breast tissue to keep the skin elastic for reconstruction. According to Jolie, she had implants put in nine weeks later.
Q: How many women have this faulty gene?
A: Only a small percentage of women inherit this same faulty gene, or a similar mutated version of a related gene, BRCA2. (The name stands for breast cancer susceptibility gene). These mutations are most commonly found in women of Eastern European Jewish descent; one study found 2.3 percent of women in that group had the mutations — about five times higher than in the general population. Other groups, including the Norwegian, Dutch and Icelandic, also have slightly higher rates of these mutations.
Q: How do these genes increase a woman’s risk of breast or ovarian cancer?
A: The average woman has a 12 percent risk of developing breast cancer sometime during her life. In comparison, women who have inherited a faulty BRCA gene are about five times more likely to get breast cancer. In the U.S., about 5 to 10 percent of breast cancers are thought to be linked to harmful BRCA genes. Women with these faulty genes may also have a 15 to 40 percent risk of developing ovarian cancer, compared to about a 1.4 lifetime risk for women without such mutations.
Q: How can women find out if they have these gene mutations?
A: A genetic test using a blood test can detect these genes. Those at higher risk are those with close family members diagnosed with breast or ovarian cancer at an early age. Jolie says that her mother fought cancer for nearly a decade before dying at age 56. Genetic counseling is usually recommended to discuss the test and the results. “This does not mean every woman needs a blood test,” Otis W. Brawley, chief medical officer of the American Cancer Society, said in a statement. “What it does mean is women should know their cancer family history” and discuss it with their doctor.
Q. What does the test cost?
A. The test can cost several thousand dollars. According to Myriad Genetics, the sole provider of such tests in the U.S., 95 percent of patients have insurance that covers the test and the average out-of-pocket cost is $100. Myriad has a patient assistance program for those who aren’t covered by insurance.
Q: What other options might Jolie have had?
A: Doctors would likely have suggested earlier screening tests, including mammograms or MRIs, but those would only help them spot breast cancer earlier, not prevent it. They might also consider using breast cancer drugs preventively, though tests of long-term use are still ongoing. Not everyone opts for surgery. “This is not a decision that people take lightly,” said Dr. Emma Pennery, clinical director at the British charity, Breast Cancer Care. “You cannot decide to have a double mastectomy next week.”
Q: How relevant is Jolie’s decision to other women?
A: For most women, genetics will not play a big part in whether or not they get breast cancer. “The majority of women considering their breast cancer risk should focus on things like a healthy lifestyle, eating a balanced diet, keeping a healthy weight and not drinking too much alcohol,” said Dr. Peter Johnson, chief clinician at Cancer Research U.K. About one-third of breast cancer cases in Britain are largely tied to modifiable lifestyle risk factors.
But for women with a similar genetic risk to Jolie, it’s possible her decision will prompt more procedures. “It’s a very empowering message that women are not helpless when faced with a genetic cancer risk,” Johnson said.
The Los Angeles Times and the Associated Press contributed to this report.