Beyond Angelina Jolie: 5 Surprising Facts You Didn’t Know About the Breast Cancer Gene

The Hollywood actress, humanitarian, and mom of six announced she had a preventive mastectomy to reduce her risk of genetic breast cancer. Here's what you may not know about BRCA genes and what goes into the decisions Jolie and thousands of other women need to make every year.

By Lauren Gelman

Beyond Angelina Jolie: 5 Surprising Facts You Didn’t Know About the Breast Cancer Gene
Actress and humanitarian Angelina Jolie rocked the Internet and the medical community today with a New York Times op-ed in which she described how she’d tested positive for a faulty BRCA1 gene and decided to have a preventive double mastectomy. Jolie went through the procedure to reduce her personal risks of breast cancer (from 87 percent to under 5 percent) and ovarian cancer, from which her mother died from in 2007 at age 56.

“I choose not to keep my story private because there are many women who do not know that they might be living under the shadow of cancer,” she wrote. “It is my hope that they, too, will be able to get gene tested, and that if they have a high risk they, too, will know that they have strong options.”

While many patients and experts in breast cancer community are praising Jolie for her brave decision to go public and help raise awareness with her very personal health decision, it’s important to understand just why it was right for her—and why it may or may not be right for others.

1. Most cases of breast cancer are completely random—not due to BRCA genetic mutations.

BRCA1 and BRCA2 genes are types of tumor suppressors. When they function normally, they help prevent uncontrolled cell growth that can lead to malignant tumors. When the BRCA genes have faulty mutations, it can lead to the development of hereditary breast and ovarian cancer, according to HealthDay News.

Genetic mutations make up just 5 to 8 percent of all cases of breast cancer, Nancy Snyderman, MD, NBC’s chief medical editor, told Today. The overwhelming majority of people with breast cancer do not have BRCA mutations. “This was not a random test [for Jolie],” Snyderman said. The actress chose to be tested because her mother was diagnosed with ovarian cancer at a young age.

2. Most women don’t need—and shouldn’t get—genetic testing

Wondering whether you should be tested for mutated BRCA genes? Only women who have an increased risk due to certain patterns of family cancer benefit from testing.

The University of Texas MD Anderson Cancer Center says that it’s important to focus on the right relatives before jumping to conclusions about your family’s cancer history. It recommends the following criteria:

• Look at the health history of first-degree relatives (parents, siblings, children) and second-degree relatives (grandparents, aunts, uncles, nieces, nephews).

• You may want to consider getting tested for BRCA genes if one or more (on the same side of the family) were diagnosed with the same kind of cancer (two breast cancers, two ovarian cancers, for example), a BRCA1 or BRCA2 mutation, breast or ovarian cancer before age 50, both breast and ovarian cancer, or male breast cancer.

• People who are of Ashkenazi (Eastern European) Jewish descent and have one or more relatives who fit the the diagnoses above may have high risk of having a BRCA mutation.

The BRCA mutations are detected with a blood test through a lab that specializes in the screening and results can take a few weeks.

3. Not everyone with faulty BRCA genes will develop cancer.

Defective BRCA genes do raise the risk of breast and ovarian cancer dramatically, as Angelina Jolie’s doctor advised. According to HealthDay News, about 60 percent of women with these genetic mutations will be diagnosed with breast cancer; a woman with a BRCA1 or BRCA2 mutation is about five times more likely to develop breast cancer than a woman without it.

That’s why some experts believe that the decision to prophylactically remove both breasts, as Jolie did, as well as your ovaries, is a smart one for someone who tests positive for these mutations. Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City, told HealthDay News that a double mastectomy “the best option for someone who is BRCA-positive.”

But not everyone who tests positive for BRCA mutations has the same exact elevated risk of breast and ovarian cancer. As it explains on the Dr. Susan Love Research Foundation site, researchers used to believe that anyone with the BRCA1 mutation had an 80 percent risk of developing breast cancer in their lifetime, “but this was based on studies of families with a lot of breast and ovarian cancer. Additional studies done on women who had the genetic mutation, but had fewer relatives who had had breast cancer found that their risk was commensurately lower—more like a 37 to 60 percent chance.”

Risks can vary widely, and some patients may be more comfortable with watching and waiting than having surgery. Experts recommend anyone considering genetic testing for breast or ovarian cancer should work with a genetic counselor who can help weigh the complex upsides and downsides of testing and treatments.

4. The highest risk family member should get tested first.

According to the Atlantic Health System, if cancers run in your family, first test the family member with the highest risk of having a mutation. That might be someone who was already diagnosed with breast or ovarian cancer at a young age, usually before 40. The site’s editors explain: “Even if there is a mutation in the family, a woman with late-onset breast cancer (say, after age 65) may still develop that cancer by chance, rather than because of inheriting a mutation. Testing her might miss catching the mutation in the family.”

If the first person tested in a family hasn’t had cancer yet, the results may be less reliable. Negative results might still mean that others in the family carry the mutation.

There are also three different kinds of BRCA tests, depending on your risk factors for having the mutation. Read more about which may be right for you.

5. The test is expensive, but insurance may cover it.

For insurers to cover the test, which can cost from a few hundred to a few thousand dollars, you need to be at high risk for the mutation, according to Ob-Gyn Lauren Streicher, MD, author of The Essential Guide to Hysterectomy in EverydayHealth. If you are considering the tests, check to make sure you’re covered.

According to the Atlantic Health System, most insurance policies will cover testing if a BRCA mutation has already been detected in your family, or you have a personal or family history that suggest BRCA-related cancers.

Photo Credit: Ethan Miller/Getty Images

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  • Your Comments

    • Ruby

      There is too much credit being given to Angelina Jolie. Here’s why I have a big issue with this;

      1). This is something that most women knew nothing about before…I know I didn’t, my mother didn’t, and none of my female friends did either. AJ having it done, just brought this testing to the light, for women who had never heard of it. Any celebrity having it done would have had the same effect.

      2). AJ is a rich woman, and so was given the opportunity to have this testing, remove two perfectly healthy breasts, and rebuild them by the finest plastic surgeon, no doubt. Very costly.

      I guarantee that if I had this testing done and found out that I was at risk, there is no way my healthy breasts would be removed unless I paid big money for the procedure. So basically, if you’re rich, and have the money to play around with your body, good for you. The rest of us not so much.

      My sister-in-law had breast cancer, and had both breasts removed. It came back a year later in her spine. The doctor refused to do an MRI for 7 months, telling her that Canada’s healthcare did not want them doing unwarranted MRI’s. She died at 45, a little over a year later. If they didn’t want to do an MRI on a cancer patient, why the heck would they do a mastectomy on a healthy woman? They won’t. Unless you pay.

      Thank you Angelina Jolie, for pointing out just how privileged you are, to receive only the very best healthcare that the rest of us cannot afford.

      • Heather

        In the US, at least, most insurance companies won’t fight you on DNA testing if there is a family history. If you are positive for the gene you have your deductible, but otherwise the insurance company usually won’t fight you on it either, especially with the new laws about care with a preexisting condition. There was also a law made a while back that if an insurance company provides a mastectomy they must also provide reconstructive surgery. She definitely had privileges because of money and less need to worry about losing time at work, etc. but plenty of average women with mutations do this without losing all of their possessions. I am sorry that Canada’s health care did not supply the MRI for your sister in law, I had breast cancer spread to the spine in a woman in my family and she died very young, it is extremely unfortunate. Had she been at high risk, though, something preventative could have been done about it, Jolie took advantage of the few options she was given – an extremely probable cancer diagnosis or a surgery now to save pain and hardship later. There is nothing wrong with that, and she wasn’t given that opportunity ONLY because she has money.

    • http://www.befreebies.com/ BeFreebies.com

      Wow doctors used to be content removing women’s uteruses as a regular procedure good for whatever ailed them. Now apparently they want our breasts and our ovaries.