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    Angelina Jolie's Double Mastectomy: Q&A

    Do some experts think that performing a double mastectomy is too radical for those who test positive for BRCA mutations?

    I think most breast cancer experts would agree that the choice is really the patient's to make, and I really want to emphasize, it is a choice.

    Preventive mastectomy is one very excellent choice. But another choice women can consider when they know they carry a BRCA mutation is early detection. And that comes with more active screening.

    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.

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