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Angelina Jolie's Double Mastectomy: Q&A

What would that involve?

If a woman knows she has a BRCA mutation and does not want to have a mastectomy, a good alternative is to have a mammogram and a breast MRI every year.

You can do both at once or choose to alternate. [For my patients] I choose to alternate, doing one test every 6 months.

It's not as effective because by definition you are picking up cancer as it develops. But it is effective at picking up cancer at a very early stage.

If a woman has a preventive double mastectomy, what are the benefits and risks?

In women at higher risk -- those with BRCA mutations -- preventive surgery can reduce the risk of breast cancer by 90%. If the [increased] risk is 80% as it is for many BRCA carriers, this can reduce the risk of breast cancer by 90%.

In other words, this can reduce the risk to that lower than the general population. The risks [of the mastectomy] are not that great. Most women having preventive mastectomies are younger patients, and many choose to get reconstruction. A lot of the risk has to do with the implants, like implant complications, or other risks [linked with surgery] such as infections or bleeding.

Who should consider BRCA testing?

The women who should absolutely consider it are those who themselves have had a triple-negative breast cancer, the kind associated with BRCA mutations, at an early age, under 45, people who have had both ovarian and breast cancer in family members, and people who have breast cancer in the family and are of Ashkenazi Jewish descent.

What is involved in testing for BRCA mutations?

It is a simple blood test, or they can swab the inside of your cheek. The best way to get this test is to go for counseling from a genetic counselor. Have them talk to you about the possibility of testing positive. Women really need to be counseled about what this means, what the results mean, what their risk is, and then to make the decision about whether to get the test.

If you only get tested for the three most common mutations, results take about 2 weeks. The more comprehensive test, where they do gene sequencing, can take a month.

What is the cost and who pays?

The cost is about $3,000. The cost of testing is covered by many insurance companies [if you are deemed high risk].

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