A Voice in the Breast Cancer Community

The “Angelina Jolie effect” and the rise of unnecessary double mastectomies

In breast cancer treatment, harsher does not mean more effective. Unfortunately, increasing numbers of women believe that because mastectomies are radical, they are more likely to succeed in saving lives. As a result, many women diagnosed with early-stage breast cancer are having unnecessary mastectomies.1

A big part of this fear-driven misconception stems from the media—and from Hollywood. In 2013, Angelina Jolie wrote an op-ed in The New York Times about her decision to have both of her breasts removed in order to reduce her risk of getting breast cancer.

Jolie had not yet been diagnosed with cancer, but she carried a genetic mutation in the BRCA1 gene that made her likely to get cancer in the future, and she had lost her mother, aunt, and grandmother to the disease. Jolie chose to undergo a preventative double mastectomy. As part of her surgery, she also had her breasts cosmetically reconstructed.

After Jolie went public with her decision to have both of her breasts removed, cancer centers nationwide noticed a significant uptick in requests for double mastectomies. They began to call it the “Angelina Jolie effect.”

While Jolie’s double mastectomy might have had the biggest impact on public consciousness, it wasn’t the first time that the media had fixated on mastectomy as a treatment for cancer. In fact, the media had been focused on high-profile mastectomies all throughout the prior decade.1

The University of Michigan Comprehensive Cancer Center reports that media coverage of breast cancer has been biased consistently toward cases where double mastectomy was the chosen treatment.1 Of the 17 celebrities who publicly disclosed their struggles with breast cancer between 2000 and 2012, four opted for a double mastectomy. In media coverage of their diagnoses, this treatment decision was mentioned 45 percent of the time.

However, of the other 10 celebrities who did not opt for double mastectomies but still required surgery, choosing to have breast-conserving surgery, only 26 percent of media reports included information about their treatment decisions. This bias in reporting has resulted in a skewed perception of treatment options.
During the study period, requests for double mastectomies at the University of Michigan Comprehensive Cancer Center increased by 475 percent, from 4 percent of cases in 2000 to 19 percent of cases in 2011. Nationwide, clinics were seeing women come in—without doing genetic screening or treatment counseling—and immediately asking to have “what Angelina Jolie had done.”2

Study lead Dr. Michael Sabel concluded that biased media coverage was leading women to believe that a double mastectomy was the best treatment for breast cancer. Instead of exploring other options that, in many cases, would have been more medically appropriate, they came to his clinic set on having a double mastectomy.2

While a mastectomy is an appropriate choice for some women—for instance, those who have BRCA gene mutations that increase their chances of cancer or a strong family history of breast cancer—it is too extreme for most women with early-stage breast cancer, and it can result in longer hospital stays and longer recovery times than necessary, according to the American Medical Association.3

Furthermore, in the case of early-stage breast cancer, radical intervention doesn’t mean more effective intervention. Research from the American Medical Association showed that the survival rate for early-stage breast cancer is just as high with breast-conserving surgery (lumpectomy) followed by radiation therapy as it is for a mastectomy.3 And by avoiding a mastectomy, women can get back to their lives faster, while still feeling confident in their treatment.

Finally, in certain cases, double mastectomies can increase a woman’s risk of death. If a woman has a chronic disease, like obesity or high blood pressure, she faces a greater risk of mortality by choosing a mastectomy over a lumpectomy paired with radiation therapy, since a mastectomy is a more extensive surgery and comes with a higher probability of surgical complications.4

Ultimately, women need to consult with their physicians about their options after they’ve been diagnosed with breast cancer. If the cancer is still in an early stage, there are a number of treatments that are less invasive but still highly effective—for instance, a lumpectomy followed by Breast Microseed Treatment® has a 97.4 percent five-year overall survival rate.

In some ways, Angelina Jolie is an amazing role model for women with cancer. She was willing to speak publicly about a disease that can be filled with both terror and shame for many women. Women should all follow her example by being proactive about their breast health.

That said, the “Angelina Jolie effect” has also done harm to women’s health. Women need to know that a mastectomy isn’t the only choice, or the best choice, for treating all types of breast cancer. For women with early-stage breast cancer, a lumpectomy paired with follow-up radiation like Breast Microseed Treatment is effective, faster, and less risky—-allowing women to reclaim their normal lives.

References:

1. Doheny K. Celebrity cases may help spur rise in double mastectomies. HealthDay. April 22, 2016. https://consumer.healthday.com/cancer-information-5/breast-cancer-news-94/celebrity-coverage-may-partly-explain-increase-in-double-mastectomies-study-710208.html.
Accessed October 26, 2016.

2. Harris N-E. The Angelina Jolie effect: surge in women patients requesting double mastectomies, even when they don’t carry BRCA1 gene. Medical Daily. October 3, 2013. http://www.medicaldaily.com/angelina-jolie-effect-surge-women-patients-requesting-double-mastectomies-even-when-they-dont-carry.
Accessed October 26, 2016.

3. “More women are having double mastectomy, but survival rates are same as lumpectomy plus radiation.” Breastcancer.org website. http://www.breastcancer.org/research-news/more-double-mx-but-survival-same-as-lx.
Accessed October 26, 2016.

4. Neighmond, Patti. “Mastectomy no better than lumpectomy for early breast cancer.” National Public Radio website. Published December 10, 2015. http://www.npr.org/sections/health-shots/2015/12/10/459207948/mastectomy-no-better-than-lumpectomy-for-early-breast-cancer
Accessed October 26, 2016.


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