The ‘Angelina Jolie Effect’ and Preventative Mastectomy

At a recent Conference on Breast Surgery in Melbourne, risk reducing mastectomy was discussed in terms of the Angelina Jolie factor.

In May 2013, the New York Times published the fact that Angelina Jolie had made the decision to have a preventative double mastectomy.  Angelina Jolie said “tell other women that the decision to have a mastectomy was not easy.  But it is one I am very happy that I made”.  She further stated that “I did not feel any less of a woman.  I feel empowered that I made a strong choice that in no way diminishes my femininity”.

Angelina Jolie said that her mother had fought cancer for almost a decade and died at the age of 56. Angelina carried a faulty BRACA1 gene, which sharply increased her risk of developing breast cancer and ovarian cancer. Her doctors estimated that she had an 87% risk of breast cancer and a 50% risk of ovarian cancer. Angelina accepted her reality and decided to be proactive and to minimise the risk as much as she could. She started with her breasts as her risk of breast cancer was higher than her risk of ovarian cancer and the surgery was more complex.

Angelina Jolie said that “today it is possible to find out through a blood test whether you are highly susceptible to breast and ovarian cancer, and then take action”. Angelina underwent a nipple sparing mastectomy and breast reconstruction using an implant. Her chance of developing breast cancer dropped from 87% to under 5%.

Following the report in the New York Times, breast surgeons around the world have noticed an increase in the number of women requesting genetic testing and information regarding risk-reducing surgery, which now includes such advanced procedures as Nipple Sparing Mastectomy with immediate “direct to implant” reconstruction. These women do not have breast cancer and therefore the surgical procedure can be a lot more conservative than when performing a mastectomy for a patient with diagnosed breast cancer.