Breast cancer thoughts on the Angelina Jolie story – Part 1

Breast cancer thoughts on the Angelina Jolie story – Part 1

Boy this headline caused an amazing amount of comments from around the world.  I wanted to wait until it had all calmed down before making my view public.

“It’s important to make it clear that a BRCA mutation is a special situation but few women fall into that category”
Dr. Monica Morrow, chief of the breast service at Sloan-Kettering.

“It is important to note that most research related to BRCA1 and BRCA2 has been done on large families with many individuals affected by cancer.  Estimates of breast and ovarian cancer risk associated with BRCA1 and BRCA2 mutations have been calculated from studies of these families.  Because family members share a proportion of their genes and, often, their environment, it is possible that the large number of cancer cases seen in these families may be due in part to other genetic or environmental factorsTherefore, risk estimates that are based on families with many affected members may not accurately reflect the levels of risk for BRCA1 and BRCA2 mutation carriers in the general population.  In addition, no data are available from long-term studies of the general population comparing cancer risk in women who have harmful BRCA1 or BRCA2 mutations with women who do not have such mutations.  Therefore, the percentages given above are estimates that may change as more data become available”
The National Cancer Institute (NCI) www.cancer.gov/cancertopics/factsheet/Risk/BRCA

“We need to be careful that one message does not apply to all.  Angelina’s situation is very unique.  People should not be quick to say ‘I should do like she did,’ because you may not be like her”
Dr. Isabelle Bedrosian, a surgical oncologist at M. D. Anderson Cancer Center in Houston.

In a 2011 published Journal of Clinical Oncology study covering 3,047 families from the Breast Cancer Family Registry, women with BRCA genes in their families were found to be at no higher breast cancer risk than average women. 

“…60% of women in their 40s who get yearly mammograms for 10 years will be told at some point that the test has found something suspicious requiring further tests.  And 35% will be told they need a breast biopsy.  In the end, about 0.5% of these women will have breast cancer.  And, many experts believe some of those would never have caused a problem if they hadn’t been diagnosed”
Otis Brawley, oncologist and chief medical officer for the American Cancer Society.

“The fact that breast cancer rates in eastern Africa are so much lower than in the UK is a stark reminder that every year in this country, thousands of women are diagnosed with a case of cancer that could have been prevented.  The fact that rates of breast cancer are much lower in other parts of the world highlights the fact that breast cancer is not inevitableThis means we need to do more to get across the message that just by making relatively simple changes to our lifestyle such as drinking less alcohol and maintaining a healthy weight; women can reduce their risk of breast cancer.  And it is not just breast cancer risk that is affected by what we eat and drink and how physically active we are.  Scientists estimate that about a third of the most common cancers in the UK could be prevented just through eating healthily, being physically active and maintaining a healthy weight
Dr Rachel Thompson, deputy head of science for the World Cancer Research Fund.

Firstly, I agree with Angelina being able to choose the options and process she has done.  It is her body and should she wish to perform radical surgery on the chance that she may one day get breast cancer (and the chance that the surgery will actually lower her risk of breast cancer), then I support her free choice.

Secondly, genetic breast cancer is around 1% of all breast cancer cases so her case is a very rare one indeed.  Even stranger, not only does she not have breast cancer, but she believes it is a strongly genetic illness and that cutting out part of her body will lower her risk of future cancers.  She is also having her ovaries chopped out even though she also does not have ovarian cancer.  She clearly believes (because she has been told I presume), that genetics are set, and you cannot control or change your genetic expression.  We know this is not the case.

Breast Cancer Risk
Over 40 years ago, the 70-page Cancer Review from the International ‘War on Cancer’ said “genetics determines about 2% to 3% of total cancer risk”.  Researchers have now been studying breast cancer for decades.  A small number of women inherit genes with mutations that make developing breast cancer much more likely.  For most women, though, it is what happens during their lifetimes (obesity, being overweight, fattening foods, lack of fruits and vegetables, alcohol, cigarettes, oral contraceptives and hormone replacement drugs) - not the genes they inherited, that contribute most to breast cancer.  The study titled “Breast Cancer and the Environment: A Life Course Approach” was produced by the Institute of Medicine, a panel of independent medical experts headed by Dr. Irva Hertz-Picciotto, chief of environmental and occupational health at the University of California, Davis.  The research found that “substances to which women voluntarily expose themselves every day - fattening foods, alcohol, cigarettes, meat, sugar etc - are the highest risk drivers for breast cancer” 

Breast cancer is mostly non-genetic
Breast cancer is sold to us from the perspective that it is genetic.  But 90% of cases appear in families that have no genetic history of breast cancer.  Why is it that in most Western countries we have 1 in 10 women with breast cancer and yet in other places around the world it is virtually non-existent?  Diet and lifestyle play a MASSIVE role in breast cancer creation, treatment and reversal. 

Most breast cancer is not a death sentence at all.

Part 2 tomorrow

Posted: Friday 31 May 2013

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