Many patients ask me what I think of Angelina Jolie’s decision to undergo risk-reducing mastectomy and removal of her ovaries.  In the situation of being diagnosed with a mutation in one of the two BRCA genes, there is a very high risk of breast and ovarian cancer in your lifetime and there is no doubt that undergoing surgery is the most effective way to reduce cancer risk, by 90% or more.  However, there are also less drastic measures that can reduce risk, such as taking medication to prevent breast cancer, which reduces the risk by 65-75% in BRCA mutation carriers.  Also, undergoing a preventative ovary surgery by age 35-40 not only reduces the risk of ovary cancer by >90%, it also decreases the risk of breast cancer by up to 65%.  The bottom line is that there are several reasonable options and women in this situation need to seek advice from medical experts to help make a choice that is right for them.  I also like to emphasize that these risks are specifically in the situation of known BRCA gene mutation carriers, not just those with a family history of breast or ovarian cancers.  The best thing to do if you have a family or personal history of breast and/or ovarian cancer is to talk to a physician or genetic counselor to see if genetic testing for a BRCA mutation is a good idea.



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