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A Patient’s Journey: Angelina Jolie

In an article in the New York Times today, My Medical Choice, Angelina Jolie promised to share some background about her medical treatment with women seeking more information about BRCA gene mutations and what it might mean for them. This blog describes the main stages of her treatment.

It is important to emphasize that each woman’s case is different. Surgery will not necessarily be the right choice for everyone, and there are alternatives available. As Angelina says in her article, the important thing is to be aware of your options.

Stage 1. Gathering Data and Information

  • BRCA stands for BReast CAncer.  BRCA genes help you fight cancer when it happens in your body. But some families carry mutated or broken BRCA genes that can be passed down from one generation to the next. Approximately 5-10% of all breast cancers and 14% of ovarian cancers occur from a BRCA1 or BRCA2 genetic mutation that is inherited from either parent.
  • Women carrying BRCA1 or BRCA2 gene mutations have up to an 87% lifetime chance of breast cancer and 54% chance of ovarian cancer vs. a general population risk of 12% for breast cancer and less than 1% for ovarian cancer. Prevention does not yet exist. More details about the risks of breast and ovarian cancer, including how risk changes with each decade of life, can be found in our BRCA Gene Mutations blog post.
  • Given the high likelihood of getting breast or ovarian cancer with BRCA mutations, family history usually triggers testing for the gene. Angelina’s mother had breast cancer, and sadly passed away from ovarian cancer.  Her maternal grandmother was also diagnosed with ovarian cancer. This family history would certainly meet any insurance carrier’s criteria to cover genetic testing. To find out if there is enough risk for you to consider a BRCA mutation genetic test, we encourage you to take our Genetics Quiz that reviews a variety of information, including your family history.

Stage 2. After diagnosis: Traveling the Road of Surveillance

We follow a standard surveillance plan at our center for BRCA mutation carriers, which I used for Angelina:

Beginning at age 18, or 10 years younger than the youngest relative with breast cancer, every 3 months, you have breast imaging or an exam. An example plan follows:

  • Month 1:
    Mammogram (wait until 25 years old)
    Whole breast screening ultrasound (begin at 18)
  • Month 4:
    Clinical breast exam with a breast specialist
  • Month 7:
    Breast MRI, timed to menstrual cycle days 7-10 (day 1 is the day bleeding starts); Contrast Enhanced Spectral Mammography (CESM) for those who cannot have an MRI
  • Month 10:
    Clinical breast exam with a breast specialist
  • Every month:
    Self breast exams (cycle days 7-10). If you don’t know how to do a self breast exam, please watch our how-to video.

For those who prefer twice-a-year surveillance, we combine the imaging with clinical breast exams, and meet every 6 months.

Ovarian surveillance begins at age 35, or 10 years prior to youngest relative with ovarian cancer, and includes the following:

  • Transvaginal Pelvic ultrasound every 6 months (cycle days 1-10)
  • CA-125 blood marker testing every 6 months (after cycle day 5)
  • Pelvic exam by gynecologist every 6 months

For additional screening details, including risk reduction strategies and holistic and integrative medicine, see our blog on BRCA Gene Mutations.

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Stage 3. Committing to an operation

When first meeting a woman newly diagnosed with a BRCA mutation, my immediate goal is to learn about her, including her family situation, whether she is in a stable relationship, and whether she is planning to have children. In the course of these discussions, it becomes clear whether the patient will proceed to a mastectomy.

Stage 4. Preparing for the operations

The questions any patient needs to address at this stage include: (1) whether or not to preserve the nipples, (2) if so, whether or not to perform a “nipple delay” procedure, (3) where to place the incision, (4) whether or not to test sentinel nodes, (5) what kind of reconstruction will be done, (6) what supplements might enhance healing and recovery, and finally (7) where should we operate.

NIPPLE: Women undergoing preventive mastectomies can always consider keeping their nipples. While no one can guarantee that the nipples will survive an operation, much can be done to ensure the greatest chance of success.

NIPPLE DELAY: The delay, performed 1-2 weeks prior to the actual mastectomies, uses the planned mastectomy incision and lifts half of the skin off of the breast surface. A small disc of the tissue directly behind the nipple and areola is also removed and analyzed by a pathologist. This is done to rule out the presence of any disease directly behind the nipples, which would make preserving them a dangerous proposition. Additionally, it recruits extra blood flow to the area, lessening the chances of nipple and skin loss due to insufficient blood supply after the mastectomy. Since starting this technique in 2008, my loss of skin and nipple after mastectomy has decreased to less than 2%. In Angelina’s case, she judged it worth taking this extra step of caution.

INCISION: Incision locations must take into consideration a cancer location (if cancer is present), any prior incisions, breast size reduction (if desired), and the technical skill of the surgeon (smaller incisions make for a harder and longer operation). For Angelina, her optimal incision choices were around the areola, or underneath the breast in the inframammary fold – the latter was chosen.

SENTINEL NODE BIOPSY/PBDI: Whenever a breast contains cancer and the armpit lymph nodes cannot be felt on exam, we routinely perform a sentinel node biopsy, which is the removal of the first nodes that receive breast lymphatic drainage. By injecting blue dye into the breast, which then travels to the lymph node(s), we find out if cancer spread beyond the breast. Until now, the trend has been not to perform sentinel node biopsies in conjunction with prophylactic (preventive) mastectomies since the discovery of cancer in breasts removed prophylactically only ranges from 2-8%. Therefore, most women do not want to take the additional risks associated with a sentinel node biopsy, especially since they can have complications, such as pain, numbness, arm swelling (lymphedema), fluid buildup (seroma), limited arm movement, and infection. This dilemma has been resolved with a new technique that was pioneered at the Pink Lotus Breast Center, called Prophylactic Breast Dye Injection, or PBDI. PBDI allows the sentinel node to be identified, but not surgically removed, giving more control and peace of mind to women. I developed this technique while treating Angelina, and I hope other women will now benefit from it. It was at her friendly insistence that I wrote the rationale for it in our blog post, Prophylactic Breast Dye Injection.

RECONSTRUCTION: Reconstruction options vary depending on a number of factors.  The two broad categories of reconstruction include implants and flaps. Implants are the most common reconstruction, often requiring two stages, whereby a tissue expander is placed prior to the final implant. A tissue expander is a deflated implant that goes behind the pectoral muscles and gets slowly inflated with saline over a period of 2-3 months, until the chosen volume is reached. A second operation is performed to swap the expander for the final implant (usually silicone). A different implant option can be a “one-step” operation, where the final implant is placed at the time of mastectomy, skipping the expander phase.

Two improvements which I believe can enhance the final outcome for those patients choosing implants include: (1) the newly FDA-approved anatomic implants, which are teardrop shaped, and (2) allograft, or synthetic sheets of material, that create a more natural look.

Autologous flaps use your own skin, fat and sometimes muscle from the abdomen, back (latissimus), thigh (gracilis), or buttock to create a potentially more natural breast reconstruction than implants can achieve. Flaps, however, create scars at the donor site, potential weakness in the donor area, and involve a longer operation than implants, with longer recovery periods and associated hospital stays.

Angelina’s body type was best suited to an implant reconstruction with allograft.  Although tissue expanders required an additional operation, she preferred to use them.  Expanders maximize blood flow to the breast skin and nipple (because they are not fully expanded right after placement, they do not compress the tiny blood vessels in the skin), and they allow us to optimize the final implant size, location and appearance.

SUPPLEMENTS AND PREP: To prepare for and to recover from operations, patients can use a variety of supplements.  Angelina followed the regimen below, written onto a calendar:

To enhance wound healing (for each operation):

A) Vitamin C: 1000mg tablets; one tablet once daily for one week before and one week after surgery.

B) Multi-Vitamin: one tablet once daily for one week before and one week after surgery.

C) Zinc: 50 mg; one tablet once daily for one week before and one week after surgery.

To reduce the risk of infection (operations 2 and 3):

D) Bactroban ointment: Applied twice a day beginning 3 days prior to surgery x 7 days.

E) Hibiclens shower: Hibiclens soap applied to upper torso and abdomen – left on for 5 minutes, then rinsed. Applied once a day for 3 days prior to surgery.

F) Keflex: 250mg (antibiotic); one tablet 4x a day for 7 days, beginning with 2 doses the day of the operation.

To reduce postoperative nausea and vomiting (for each operation):

G) Emend: 40mg; one tablet by mouth the night before surgery

To reduce postoperative swelling and bruising (for each operation):

H) Arnica Forte (Arnica and Bromelain): two capsules daily x 7 days, beginning one day prior to surgery.

To help eliminate anesthesia from the system (for each operation):

I) Exchem: 10 drops in water or directly in the mouth twice daily, beginning the day before surgery and continuing for one week after surgery.

J) Lymphomyosot: 10 drops in water or directly in the mouth twice daily, beginning the day before surgery and continuing for one week after surgery.

To increase oxygen to the skin (operations 1 and 2):

K) Cutagenix: Applied to breast every 6 hours x 3 days. Skin care specialists use this topical cream after laser resurfacing to increase oxygen flow to the outer layers of skin. We decided in Angelina’s case to apply it to the mastectomy skin to give it an oxygen boost and to help ensure adequate blood flow to her skin postoperatively.

To minimize scarring (after operation 3):

L) BioCorneum: Rubbed into scars twice a day for 12 weeks – begin after the third operation once steri strips are removed.

Medications “as needed” for comfort:

Percocet: 1-2 tablets every 4-6 hours as needed for pain

Colace: 250mg twice a day

MiraLax: One tablespoon diluted in 8oz water once a day

Ativan: 1mg every 8 hours as needed for muscle spasm

Zofran: 8mg oral dissolving tablet placed on tongue every 6 hours as needed for nausea

LOCATION: Angelina chose to have her care, including her three operations, performed at the Pink Lotus Breast Center. Some people might think that a hospital is the only place to have a mastectomy.  However, outpatient surgery centers provide an attractive, peaceful alternative when coupled with attentive nursing care at recovery facilities. You can learn more about our comprehensive and integrative breast center by exploring this website.

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Stage 5. Recovering from the operations

On February 2, 2013, Angelina was in the operating room for the first operation, the nipple delay. Her partner was on hand to greet her as soon as she came around from the anesthetic, as he was during each of the operations.

After the operation, her skin was slightly bruised but soon returned to normal.  Two days after her procedure, great news arrived: the tissue behind both nipples came back completely normal.

On February 16 she had the main surgery, which can last up to eight hours.  The mastectomies went smoothly, with sentinel nodes identified but not removed.  After the mastectomies, I assisted plastic surgeon, Dr. Jay Orringer, as we performed the first stage breast reconstruction by placing tissue expanders with allograft.

To a large extent, I believe recovery reflects expectation. Angelina expected to feel well, to be active. On Monday, the pathology returned and I called Angelina to confirm our biggest hope: all of the breast tissue was benign. On day four after her mastectomies, I was pleased to find her not only in good spirits with bountiful energy, but with two walls in her house covered with freshly assembled storyboards for the next project she is directing. All the while she spoke, six drains dangled from her chest, three on each side, fastened to an elastic belt around her waist.

The next day she had her first injection of saline into the expanders, thus beginning the process that would gradually prepare the tissues for the final stage of her operations, reconstruction. Four of the six drains were removed.  Four days after that, on postoperative day nine, the last two drains were removed.  A second saline fill occurred on March 4. Over the next four weeks she was hard at work.

The final operation occurred on April 27, 2013, ten weeks after the mastectomies: reconstruction of the breasts with implant, which went extremely well, bringing an end to her surgical journey.

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Dr. Kristi Funk’s new video podcast explores the thriver stories of women who have altered their lifestyles after a breast cancer diagnosis, emerging with a profound sense of purpose and passion afterwards.

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Conclusion

Many women unfortunately do not know that BRCA gene mutations exist and could affect them. Breast and ovarian cancers take lives every day – knowledge and action can help prevent the premature loss of those who love us, and whom we deeply love in return.

Like Angelina, I urge women who feel they might have reason to be at risk for a BRCA gene mutation – perhaps because of a strong family history of cancer – to seek medical advice and to take control of their futures.

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126 Comments. Leave new

  • Jennifer L.W. Fink
    November 30, -0001 12:00 am

    As a nurse and a woman with a BRCA mutation, I believe that you’re doing women a disservice by only focusing on surgery. You write, “there are alternatives available,” but then proceed to list Stage 3 as “committing to an operation.” My concern is that some women will think that’s a normal and expected part of dealing with a breast cancer mutation.

  • I thank Angelina with all my heart for sharing with the world her BRCA1 experience. Angelina, you have adopted children which is why I am sharing this with you. I was adopted at one year old. At 61 I got uterus cancer. I had a hysterectomy followed by radiation and brachytherapy. At 62 I had Kidney cancer and a kidney removed. From Jerusalem one Sunday morning my husband answered the phone and handed it to me telling me a biological cousin I had never met or knew of was calling to speak to me. She told me that I should get tested for the BRCA1 gene. She emailed me a horrific family cancer history. I did get tested and was found positive. I began to actively and frequently monitor my breasts. I developed a tumor, had a double mastectomy and chemo. The tumor was triple negative. I have children and grandchildren. Had I not received that phone call making me aware of my biological history I would never have been able to alert my children about the danger lurking in my and their genes. Had you not written your article and shared your experience, the danger and meaning of what I was telling my family would not have made the impact it needed to. You are brave, beautiful, intelligent, talented and generous.

  • Very useful information. Thank you for sharing
    it. Thanks 99th.in

  • I believe this was a very smart move especially for a woman who has so much to live for. On behalf of women everywhere, “Thank you, Ms. Jolie, for sharing your story. By doing so you have saved more lives then you’ll ever know.”

  • its really really a great step in terms of preventive act from cancer in the medical history. its actually gonna help to many women in need out there.. Great work by the Doctor and perfect co-operation by the patient under treatment.

  • Amazing how Angelina Jolie can inspire so many. I am inspired all the way in South Africa and would love to be able to create programmes that can reach the more rural community in South Africa, that do not always have access to reliable information and testing.

  • While Ms. Jolie’s information is thorough and frank and I’m sure helpful to some, the problem I have with these procedures she is having is that the issue of LACK OF HEALTH INSURANCE by many women to have these proactive procedures is never addressed. Ms. Jolie is lucky, because she can afford to save her life, because she has MONEY!

  • this info is so crucial….such a caring act from Angelina jolie

  • Elyse Gunter
    July 13, 0006 8:44 pm

    Thank you to Angelina Jolie for being an example of how women sometimes need to take care of themselves by making unglamorous choices! I wish I had the benefit of her example when I was in my 30s!

  • dear Angilina, I NEED to say thank you!!! For YEARS I tried to get the BRCA test ( my maternal aunt tested positive, as did a cousin, and my grandmother died of breast and ovarian cancer) but my insurance would not cover the cost, and I am a disabled nurse. So for years I waited and prayed I could get the test before it was too late. Not long after you told your story, my doctor told me that “all of the sudden” my insurance was willing to cover the test!!! nearly nine years after I tried the first time to get the test….On Friday the 13th actually, I was told the test was positive. I underwent a radical hysterectomy/ oopherectomy in March 2014. On Nov. 12th 2014, I am scheduled to undergo a bilateral mastectomy. I am scared shitless, but I am SOOOOOOO relieved that I finally have the OPTION to keep myself as safe as I can, with preventative procedures!!! This is, in a LARGE part, due to your story and your bravery!!!! THANK YOU SO MUCH!!!! You are a hero to me <3

  • These genes are information every woman’s body holds (possesses, if you will-). In our inspired system of capitalism (that has been catapulting human rights revolutions the world over-) can hypercapitalists, can WE do no better than copyright information outpricing the very women, single moms, this information could most help and deeply affect. My dream is to see Angelina Jolie (my political hero who has done more with her wealth and fame to assist women globally than any feminist I know) follow Sheryl Crow, but provide a foundation where smart women researching and wishing to act on information their bodies hold, may receive grants to do so, based on need, until our government wakes up. That the mostly men running our world wish to demolish the souls of women rather than create value for society in the way they practice capitalism- lets down the entire world through a lack of leadership. What if the bottom line (it’s one we draw anyway) meant a competition in society to solve problems and do good -as our very nation originally was shown to do by its founding? The world watches us as a nation, as it watches Jolie as a humanitarian. I have hope when women step up- Thank you, Angelina, for showing me a hero. And all the many who will continue to follow her- We will change this world.

  • Yvonne M Rangel
    February 13, 0006 11:01 pm

    I sit here trying to place my fingers to keyboard and I hesitate. I have hesitated since March 2015, when I was told :Positive for BRCA2. I was given a website (FORCE) to explore, but opened, closed, opened, closed and finally just closed. Was just too overwhelming or perhaps I was just darn tired, pissed off of the word “cancer”. You see, on Dec 24 2013 I was rushed to the ER, the CT showed a mass on both ovaries. And on Dec 30. 2013, it was confirmed; Ovarian Cancer Stage III. During the Hysterectomy surgery my ureter was nicked, resulting in a right Nephrostomy Tube placement. Followed by (2014) 6 months of Intraperitoneal Chemotherapy. August 2014, Nephrostomy Tube removal with a Stent Placement. During this chaos, a hairline Rt Fx hip and ear sx all caused by this darn, stupid chemo. So, I went on this crusade, I will fix this body, mend and defeat this ugly beast. I threw my walker out,put on my eyebrows, threw on a scarf and started my crusade. Then March 2015 came and my world was, “What the heck, u got to be kidding”. I fell into this hole, and just gave in. But, finding my baby girl was negative, was a God sent. But still I was wasn’t there yet. Slowly I came around, and said, “hey where is this warrior I knew”. So, I threw in the “feel sorry for myself towel” and began my fight. So, fast forward,today Sept, 2015 on FB I clicked on a story and it routed me to this wonderful website, PinkLotus and there she was, her courageous, inspiring story, Angelina Jolie. Thank you a million times over, I am now ready for the next step… Thank you!!!

  • Jacqueline Bastiaan
    February 13, 0006 12:00 pm

    I am 38 n I have had 8 weeks ago a double mastectom with instant reconstruction as i am a carrier of the BRCA2 Gene. I am from Holland and i am so flabbergasted to read here despite the fact families seems to be “infected” with brca n insurance does not cover tests. My mum had breastcancer (still lives) my grandma n aunts (2) died of it thus not a very good thing to see for my future. This operation and this desicion was best ever given to me! I knew i had a choice n i cd do something with this choice which was not always easy…. but where so many dont even know i did and eliminated almost 90% chance of breast cancer! I am not given eternal live but most def a longer life n am very gratefull for that!!

  • I really appreciate with such hard decision and sharing it with the world for the benefit of other women….. Hats Off Angelina…..

  • I am currently in week 8 of recovery/reconstruction. In addition to having a mutated brca 1 gene I had 11 anomalies in my right breast and six in my left. Five years ago I had two rare tumors removed from my left breast and I had very dense breasts. This choice was hard. Emotionally and financially. I had to have a second surgery six weeks out from the first because of severe pain. During this surgery it was found that they had sewed through a nerve when sewing my tissue expander in. I am please and blessed to say I am recovering well. I lost my nipples abs had my sentinel nodes removed. I would make this choice again. I know this if this did not save my life, it certainly saved me from battling cancer. My only regret the preventative/cancer insurance did not cover this. Ladies take a stand. Ask questions and take control. It’s your body….your life…

  • Gracias a Angelina por compartir tu experiencia!

  • I sincerely with to thank you – Mrs Angelina Jolie Pitt. I always knew I had a problem, given my family history, but your coming out gave me the strength to go and test myself. I am BRCA 1. It was really terrifying to have this confirmed, but after the first few weeks of fear and misery, I now own that I have life, health and now knowledge, and because of this, choice and direction. Many people are poo pooing your decision to come out and tell your story, and cynically using your truth and sharing as a platform for blaming you for your supposed publicity. How naive. When will people learn that truth and sharing comes with such love and care – and bravery, especially if one is famous, with ones every move of interest to the world in general. I hope that in your dark moments, and your light and lovely ones, you read our comments, and know that what you did has saved many lives and given many people the power to choose the current best route of survival and best practice. many thanks again – sending you all love and joy, Justine.

  • I would like to know when Angelina Jolie knew she carried the BRCA1 gene. Was it prior to getting
    pregnant with any of her children? If so, she knowingly took the chance of passing this gene on to

    her children. I am a breast cancer survivor and find it very disturbing to see what is NOT being talked about relative to breast cancer and Angelina Jolie’s op-ed piece.

    • She would have passed the gene on whether or not she had been tested and found it. We’re not as far advanced as to be able to delete and replace genes in a human that easily. Yet.

  • RJ Cote Robbins
    November 30, -0001 12:00 am

    I am a two-time breast cancer contender I call myself…27 years from the first surgery, and I credit my longevity to early detection. I also support the proactive surgeries. I find the disclosure by Ms. Jolie at the level of Betty Ford and other brave women who dare to address the taboos in our society. I wish her health and brava!

  • I am 24 and at age 23 I was diagnosed with breast cancer.I still have three months of fighting and then I will have a double mastectomy.What Angelina did and the fact that let the world know about it is great.It encourages women :). If I had known that I could get breast cancer at 23, I would have done BRCA testing and removed my D cup breasts in an instant.Be proactive, it is all worth it! 🙂

  • At the age of 26 when my Dr told me that I have breast cancer , I was shatter like everyone else I came to the US 202 for chemo fellow by radiation , twelve years later I felt a lymph on my opposite breast ,my dr recommend for me to do the genetic test and there I found out that I have the brca1 . I had mastectomies and now I’m on chemo the chemo treatment is so hard on me I get so sick but I’m hanging in there I pray for all of us out there of course I myself haven been able to go into that acceptance mode yet .

  • her new breasts are a bit lopsided.

  • Mike F. Janicek MD
    November 30, -0001 12:00 am

    [Ovarian Cancer] “Prevention does not yet exist.”

    NOT TRUE!! Removing tubes/ovaries, and possibly just the Fallopian Tubes, is as effective a risk reduction intervention as breast removal. SCREENING is ineffective, as ovarian cancer can sneak up with little warning in a matter of months….The ultrasounds and CA-125 you describe simply announce the ARRIVAL of a deadly disease, with no studies showing that these “screening” strategies help catch ovarian cancer at early stages.
    ALSO, removing ovaries can cut the risk of Breast Cancer in HALF, even in BRCA-mutated patients, so many of my patients do the ovarian risk reduction surgery first, then consider breast surgery. If you don’t believe that Ovarian Cancer can’t strike while deliberating or delaying, I’ll hook you up with some of my patients who are fighting for their lives with ovarian cancer and will give you a different perspective.

  • I am 34 and found a lump in my breast in Nov. 2012. The doctors saw nothing on the mammograms, ultrasounds and even an MRI, with contrast. All of the doctors insisted it was nothing and told me to come back in a few months if the lump grew. I had one nurse practitioner in my corner who fought to get a biopsy scheduled. I had invasive cancer throughout one of my breasts and my surgeon told me that most likely I’ve had it for 7-10 years. None of the doctors even knew how many tumors there were because the tissue in my breasts were so dense. I had a lymph node test and found out that the cancer was just starting to spread. I had a bilateral mastectomy in January and I have great insurance through my husband’s job and it did not cover one penny of the BRACA test. I charged a credit card the $3000 to have the test done. I have sisters and children and I needed to know. After surgery I was told that there were 3 large tumors and if they had known how large they were they would have given me chemo beforehand to shrink them. I too had the expanders placed immediately after surgery. I just completed radiation and my plastic surgeon tells me that I will not be finished with this ordeal until springtime of 2014. I will be paying off the credit card bill for the test for years. I had a cancer diagnosis and my insurance still wouldn’t cover any part of the BRACA test. To me that is disgusting. I do applaud Angelina for her decision but I’m sure that every woman with a will to live would do the same. Thank you for providing information for this very important issue.

  • EVERYBODY LISTEN CAREFULLY ! If you eat a PLANT BASED DIET you will NEVER HAVE TO WORRY ABOUT CANCER! On a plant based diet there is no chance for any disease !
    PLEASE READ China Study and Whole books! You can save your own Life, your own Breasts, your own Prostate, your own Heart, your own Bones !!!
    Don’t let the “billion dollar cancer business” make you believe otherwise!
    Very sad for Angelina! There is no bad DNA, only bad diet/eating habit history! If you eat the same animal protein based diet like your family has of course you will likely have the same condition…
    Switch your diet to PLANT BASED EATING !!! IT WILL BE THE EASIEST AND QUICKEST HEALING PROCESS YOU CAN EVER IMAGINE ! __ SAVE YOURSELF !

  • I applaud Angelina Jolie’s wise decision. As an RN and a 10 year breast cancer survivor, I wish Angelina the best and thank her for sharing this very important information in a clear, concise way. One thing that concerns me is that there has been no mention of the enormous price tag of this procedure, putting it out of reach of most American women. The BRCA genetic test cost about $3000 and is not covered by most insurance companies. Even if the test was positive, I believe a woman would have a huge battle on her hands trying to convince an insurance company to pay for a bilateral mastectomy, and as for reconstruction, in the absence of cancer, well, forget it. All of the surgery Angelina had, and will have, is elective, paid for by no insurance company I know of. We are easily closing in on $100,000.00, I am sure. Please someone enlighten me if I am wrong. And for women without insurance, well, forget it. This being said, the cost of treating breast cancer once it rears its ugly head would far, far exceed $100,000.00. I had great insurance and still had to take a 2nd mortgage on my home just to pay for the copays, what isn’t covered, and on and on. 10 years out, I’m still in debt. Being rich won’t save you from getting cancer,or even surviving cancer, but it sure helps in getting the best care out there.

  • What a great day of justice in the Supreme Court recently. What great hope for our sisterhood in ridding ourselves of this disease- and what optimism it offers our country in humanitarian effort.

  • Laura Robbins Callen
    November 30, -0001 12:00 am

    I’m able to take the BRACA testing due to my strong family history of ovarian cancer, however, as Ms. Jolie states the price of the test is an obstacle for the average person. Insurance won’t pay for it (shock) so I won’t be having a preventative test to perhaps spare my insurance company (and myself) the expense and pain of cancer treatments. It makes no sense! If I were able to do it, I’d make the same choice as she, and have a total hysterectomy as well. I assume that’s next on her agenda after she’s well? Best wishes to her, and prayers for her full recovery.

  • The doctor’s team experience is a certain breakthrough for Americans’ troubled healthcare, especially the determination of “which lymph nodes in her arms were
    draining fluid from the breasts”. I was wondering for all non-star yet future BC-victims how their hands are different, because I am survivor of my late wife, heavily suffering exactly from that “in hand lymphedema” … and toothache 🙂 – our crazy doctors did not take latter seriously, as well my judges are not able to understand people without any pocket attorney. Go ahead America – we will win!

  • B – be brave
    R – research
    E – educate
    A – accept
    S – strength
    T – tolerance

    C – compassion
    A – apathy
    N – new normal
    C – changes
    E – emotion
    R – recovery

  • I would like to thank Ms Angelina Jolie for her courage to share her story about BRCA-1 with the world. There’s a lot of judgement due to ignorance and now there’s attention in the media for this subject. I’m from the Netherlands and i’m 34 years old. About 5 years ago i have had a double mastectomy because of BRCA-1. I wish her all the best for her further recovery and strengh by making a decision about the ovaries. For me, at this moment, i have decided to do the check ups for the next few years before doing the surgery for the ovaries. Thank you Ms Angelina Jolie for telling your story, it really moved me.

  • Last year I was diagnosed with DCIS, and opted for bi lateral mastectomy. My genetic testing came back with no markers. I never even felt a lump, but 2 showed up on my mammogram. I never felt sick, I went through a 10 month police academy with cancer and never had a clue.
    I was just entering a career in law enforcement , so not a topic to discuss with my male co-workers. When people hear cancer, they react like you have been handed a death sentence. That doesn’t have to be the case.
    Six weeks post-op I started “bootcamp” type police training, I don’t recommend this, it is mentally and physically demanding , I even had one expander fail. I had to wait for 3 months with one boob until I could have my final implants placed. I had my final implants placed in August and I had 3d nipple/aerola tattoos in Dec. Into the new year with new boobs and no cancer.
    The toughest decision I have ever had to make , but I’m glad I did. I had great support form my husband and my “brothers and sister” in uniform. I am fortunate to be here and meet some very couragous women who held my hand through my ups and downs.somi pay it forward every chance I can.
    my mother died from stage 4 breast cancer, she was 54, she never saw me graduate from the police academy , never saw her grandchildren she let fear keep her from seeking medical attention whenshe fisrt felt a lump, she waited 3 years to tell her doctors. Fear keeps us from our future.
    I’m glad to be here with my family everyday I’m aware of my blessing. My silver lining is this , I maybe 47 but my boobs are not yet a year old.

    • DX’d at 36 with IBC. I know this is an older post but I was BRACA 1 2 Neg. I am in the process of getting more genetic testing that was not available a few years ago. PTEN & lynch Syndrome are two other genetic tests that can be take if you have a family history of breast cancer or develop it early such as myself. The more you ask for in regards to tests, usually the more care you get. Don’t be afraid to speak up for yourself!

  • In the time of Breast Cancer Businesses /cutterpiller(s)/ activation the state (Employment Development
    Department) still does nothing on its part, as to provide the deserved relief for and support BC-victims’ choice to be on track in real life … as much as possible.

  • I am a two-time breast cancer contender I call myself…27 years from the first surgery, and I credit my longevity to early detection. I also support the proactive surgeries. I find the disclosure by Ms. Jolie at the level of Betty Ford and other brave women who dare to address the taboos in our society. I wish her health and brava!

  • Don’t know where my original comment disappeared to but for all you critics, you have NO IDEA how it feels when every immediate family member female around you is faced with this. This seems to be the only option in prevention now. And for the organic fruit cake guy, I do all that, and there are still no guarantees. There is too much crap in the environment already to affect a change especially when you are predisposed.

  • I was diagnosed on 3/11/13 with a 4cm tumor in my right breast. The cancer has also spread to my lymph nodes.

    I did everything right – baseline mammogram at age 35, yearly mammograms starting at age 40, regular self exams. Because of my cystic breasts, my mammograms were switched to every six months, along with ultrasounds. With all this monitoring, I am the one who found my tumor. The mammo did not catch it, even with me pointing right to the spot and saying that something felt ‘different’.

    So, now I’m 43yrs old – bald, sick from chemo and counting down the days until I can have my double mastectomy. I cannot wait for these breasts to be gone. They were trying to kill me. First, though, because of my lymph node involvement, my doctors are treating me with neoadjuvant chemotherapy. That’s fancy talk for chemo before surgery. I’ve just finished four rounds of AC chemo, which has completely kicked my ass. There are not adequate words to explain the exhaustion that I’ve experienced in the last seven weeks, to say nothing of the emotional toll it’s taken. Now I have 12 weeks of Taxol chemo to get through next before surgery is even an option. Once I finally do get to lop them off, I get to experience six weeks – at five treatments each week – of radiation therapy. Heal from that and then I can finally have reconstruction. And since nipple sparing isn’t an option for me, the final leg will be the tattooing of new nipples.

    Anyone who thinks Angelina – or any woman – should have to wait for a cancer diagnosis before deciding to remove her breasts is either a fool or a sadist. At this point, mastectomies are the least of my worries. I’m just praying that the medicines, radiation and surgery will SAVE MY LIFE. No woman should have to go through what I am going through. Believe me, if I could go back to my 37th year and remove my breasts, I would do it in a heartbeat. I am the mommy of 7yr old twins – I would much rather be a breastless or silicone-breasted mommy to them for many long, long years to come than to try to keep my own murderous breasts.

    So, to my soul sister Angelina, I say congrats and job well done. You are a brave, beautiful woman and now, you can look forward to being a brave, beautiful Grammy some day.

    • Wishing you only the best Jennie. I had a similar experience, finding a lump 4 months before I was due for my yearly screening. A mammogram discovered an additional lump and I had lymph node involvement as well. I had my right breast removed prophylacticly (due to family history and aggressiveness of cancer) but saved the nipple. In your instance it may be unwarranted but it might be worth a discussion with your surgeon.

      Best of luck to you as you navigate your road to good health.

  • I was diagnosed on March 11th of this year with a 4cm tumor in my right breast. Cancer was also found in my lymph nodes. I did all of the ‘right’ things – a baseline mammo at age 35, regular self exams for years, yearly mammon that evolved to twice a year mammograms and ultrasounds…and I still got breast cancer. And my tumor, all 4cm of it, did not even show up on the mammogram. I found it myself, but not before it had spread to my lymph nodes. Now, I’m in a hellacious fight to save my life so I can watch my 7yr old twins grow up.

    I am sitting here, 43 yrs old, bald as a baby, sick from chemo and anxiously awaiting my surgery to have my breasts removed. I cannot wait. My breasts have betrayed me (yes, that is what it feels like, people), and I will be relieved to see them go. Unfortunately, I have chemo to get through first (4 cycles just completed of AC, and I start 12 weeks of Taxol therapy on the 24th of this month). Once my chemo is complete, and my breasts removed, I then have six weeks of radiation (5 days a week) to look forward to before I can finally get new breasts. And hopefully at some point post-surgery, my hair will grow back, my mind-numbing chemo exhaustion will dissipate and I will start to feel ‘normal’ again.

    Anyone who thinks what I’m going through is the preferable choice to preventative mastectomies is a fool or a sadist or a woman-hater. If someone offered me a time machine, I would gladly go back to my 37th year and remove my breasts.

    So I say well done and congrats to Angelina for making a smart and brave choice. She, like myself, would rather be a mommy and grammie for many long years to come than walk around with ticking time bombs on her chest. Anyone who cannot understand or appreciate that, I say reserve your judgments until you yourself one day walk in our shoes.

    Rock on, my soul sister!

  • My 2 sisters and I did not test positive for either BRAC 1 or 2, yet my two sisters at relatively the same age (51)were diagnosed with Estrogen Pos. Br. Cancer. The year I turned 51, I was diagnosed with LCIS. A diagnosis of LCIS is also considered high risk. My older sister lost her battle, my middle sister opted for a bilateral mastectomy. I am in the middle of the process of the skin saving mastectomy.

  • tina cunningham
    November 30, -0001 12:00 am

    I had learned of genetic testing development from Kolman Cures organization. I have lost about 4 friends from breast cancer.

    I am a Registered Nurse and am so happy to have seen such revolutionary women’s care as I recall when I first became a RN, the only conservative to the radical mastectomy to modified mastectomy and many of these women were very fortunate to live as they often had metastasis to many areas before they knew they had a problem.

    You mentioned in your article that the US medical treatment is far advanced and many women “in middle, lower income in other countries” do not have access.

    I am actually a RN that lost work due to government cuts and not employed at this time. The healthcare industry is intentionally not hiring new employees and especially RNs with experience because of more pay just to make profit before the Affordable Healthcare Reform Act is fully in place January 2014. I have no health insurance at all right now, and my occupation of RN is a field which has a serious international shortages.

    I know of no insurance companies that would even consider your treatment regimen at all. One is lucky if you can get any medically advised care for women at higher risk for breast and ovarian cancer.
    I speak for the US middle/low class citizens in the United States.

    It is shamefully morally disgraceful that the United States of America, women will continue to die as the procedures you went through are not approved especially preventive with breast implants. They would consider implants as elective surgery.

    I have premature cataracts in my eyes, and due to my being young, in order to get the best lens replacement that would suit my occupation and young age activities, I had to pay cash of just $3000 each eye (just for the medically recommended lens, not surgery, etc.). I lost my job and have had to put off getting my second dominant eye surgery done. Having no insurance, you will not get treatment at all.
    When I did get the one eye surgery done, I had to prepay the + $3000 for the lens and the insurance company’s annual out of pocket expenses before they would even let me schedule the surgery. I literally was not able to drive, need my vision for my work as a RN; that means nothing to the insurance companies.

    I would hope that Ms. Jolie, a wonderful spokesperson, would use her celebrity to remind women in the US that effective January 2014, they will have access to any level of insurance they need and can afford.

    It is very important to do whatever spokes persons that can actually do advocate for the women in this United States. I recall all my friends, and their loss of life is totally due to inability to access preventive women’s healthcare..just the age old mammogram that is it. It is terrifying that ones long term life is being delegated by insurance companies blocking smart appropriate treatment.

    I am so glad to have Ms. Jolie as a role model for healthcare awareness. It would be awesome if she can strongly advocate the same type care for women in the exact same situation in the US.

    Tina C.

    • FYI regarding your comment that breast implants for reconstructive surgery is considered elective surgery. It is state law in Illinois that insurers provide coverage for reconstruction after mastectomy. I am unsure if that applies to prophylactic mastectomy and I also don’t know if it is a requirement in all states. As my plastic surgeon stated, there is no time restriction, and if I need a revision 20 years from now, insurance will cover it, given the current law in effect. I have heard anecdotal horror stories about HMOs, but mine has covered everything, including my BRCAnalysis and my prophylactic TVH-BSO. I’m not trying to be argumentative, but I just want to encourage women to do their due diligence when shopping for coverage, to understand what they are medically entitled to by law, and to be sure to follow all the requirements of the insurers for care.

  • I really wish people would respect decisions that women make with regards to breast cancer. It is a very personal decision that is never made lightly. It is very difficult for me to understand why some insist on saying she made the wrong decision. As someone with a BRCA2 mutation who was diagnosed with breast cancer last year at age 41, I can tell you she potentially avoided that awful waiting game from a sentinel node biopsy once diagnosed with breast cancer, additional surgeries, and chemotherapy by acting on her risk profile. I am scheduled to have my ovaries and uterus removed next week, although I don’t have cancer on those organs. I don’t really care what you think of me, but other women who read your criticisms of this actress and are faced with the same agonizing decision-making process may indeed be swayed by your self-righteous commentary. Respect the decisions we make in conjunction with our doctors’ recommendations. You are free to make a different decision without being criticized for it.

  • Did she get the surgery done for free in exchange for disclosing where the procedure was done?

    • a better analogy…. would you rather:

      – undertake this series of procedures when healthy and at low risk of complications, thus slashing your cancer risk to about 2%

      or

      – have a cloud hanging over you your entire life that there is a 80plus% chance of getting a life altering illness going through chemo / radiation / etc., having mastectomies when you are very ill with much higher risk, scaring the complete crap out of your kids and family, losing all your hair and having the threat of recurrence changing your life for good and running a net death risk of about 25%

      the idea of waiting until you get cancer in this scenario is nuts…. once you have the cancer… you have about a net 25% death rate and your life is trashed…. why not take a slam dunk low risk procedure that is proven to cut your risk to much lower than the general population?

    • Wow, I was just referring on FB to individuals who have made utterly offensive and insensitive comments since Angelina announced her procedure in the NY Times Op-Ed piece.
      Did you actually read the above-sound pretty uncomfortable, huh-and then make this asinine comment?

    • Probably.

    • Wow? She was sharing her story to enlighten people yet you say this of her? Do you even have conscience?

    • Women who develop cancer from BRCA mutations tend to do so prior to menopause, at which time the woman’s hormonal mileau tends to make treatment of breast cancer more difficult. Pre-menopausal breast cancers are typically more agressive forms of the disease. As to whether one is more likely to die when diagnosed at a younger age, the answer is yes. Having worked with breast cancer patients in the past, I’d be quite comfortable deciding to trade my breasts to prevent the possibility of the diagnosis. Ms. Jolie’s almost 9 out of 10 chance of developing breast cancer would certainly be high enough odds for me. The incredibly close surveillance (exams, mammograms, self exam, MRI’s ) required to catch it early enough would be like the sword of Damicles hanging over your life, and I worked with women who did live that way. My different choice would be to be relieved of all my breast tissue, including the nipples and skin covering. That would eliminate any chance of local development of the disease. Breast surgeons are likely in agreement that to leave skin and nipples is to leave microscopic breast tissue behind; I’d want to be sure there was none left if I were opting for the prophylactic mastectomy. But that said, I respect any woman’s choice to greatly improve her survival odds for her family. I wish Ms. Jolie all the very best.

  • This is a new non-invasive test that can detect as few as 10 pre-cancerous breast cells. By aspirating Ductal Fluid, Clarity ForeCYTE can predict cancer development for the next 5 years for the Patient. It’s like a Pap-Smear for the breast. This test could delay the Mastectomy procedure if results indicate no cancer cell presence. http://myforecyte.com/about.php

  • This information should have came out in full instead of the way it unfolded, but now that it is come to light, it’s important to know that this is a small amount of women who carry this gene, and there isn’t much investment in history to rush towards this kind of radical surgery. Women are trying to save their natural breasts, not chop them off. That should be a last resort. I am more conservative in my views on this, but I wish her the best recovery, and hope that she is able to live happy life..

    • tina cunningham
      November 30, -0001 12:00 am

      Easily said if you have no history in your family. I have seen many women of young age die because, first insurance companies criteria for old fashioned mammograms annual after 40 years old; secondly you cannot fight them to cover despite strong family history. In young, especially younger women/men breast cancer can rapidly metastasize rather quickly in the lymph system, the bones and the brain.

  • For those of you that have negative comments regarding Angelina’s decision, and the decision of others like her, here’s an analogy that I read today in the blog of someone who made the same decision: how many of you would be willing to put a gun that is 87% full of bullets to your head and then proceed to pull the trigger? Because that it what you are implying Angie should have did, that she should have just sat back and gambled with her life. She made a wise choice. Giving up your breasts is a small price to pay for saving your life. I would do the same in a heartbeat. I applaud Angelina for going public with this because it sends the message to women we are beautiful no matter what, even without our natural breasts and that there is nothing to be ashamed of if you are in the same situation as her.

    • the analogy is flawed – simply being diagnosed with breast cancer is not a death sentence. That being said the Agnelina’s BRCA mutation is very series and although 87% can get breast cancer it would be helpful to know how many of those who do die from it?

  • This information is enormously helpful, and I want to thank Angelina for
    her willingness to share. The technique you developed to mark the
    sentinel node in an unaffected breasts is a fabulous advance. One of the
    difficult decisions those of us with breast cancer and BRCA mutations
    have to face is choosing between the risks of bilateral sentinel node
    biopsies and the possibility of a complete lymph node dissection if
    cancer is found on the prophylactic side. I hope this technique is made
    widely available soon!

  • Elizabeth William’s ignorance of genetics is astonishing, but, I suppose, not surprising.

  • Congratulations Dr. Funk and Dr.Jay!!!

  • So proud… Angelina you΂re a great woman, mother, wife and an example of life! women from Brazil thank you and send you lots of love!!

  • This has been an eye opener for me. I thank Ms. Jolie for stepping forward and allowing her story to be shared. I wish her and her family the best in all things.

  • Thank you Dr. Funk and Angelina Jolie for educating me these past few days. I have had 2 friends who have undergone preventative mastectomies and, to be honest, I questioned their choice as over-reactive. I will never make that mistake again. To bring a lifetime cancer risk down from 87% to 5% is not over-reactive, it is a damn good choice.

  • Thank you Dr. Funk and Angelina Jolie for educating me these past few days. I have known 2 women that have had preventative mastectomies and, to be honest, I questioned their choice as over-reactive. I will never make that mistake again. To see your lifetime cancer risk drop from 87% to 5% – that is not over-reactive, that is a damn good decision. All the best to both of you wonderful women.

  • Yeah, Angelina Jolie! Great recovery and root for everything to go right!

  • I am currently undergoing chemotherapy for breast cancer after double mastectomy with reconstruction. This announcement and subsequent information has made me feel better as I continue on my journey – thanks to Ms. Jolie and her doctors I don’t feel quite so alone.

  • I think it’s important to state the possible complications that can arise when making a decision of this magnitude. http://www.insertboobshere.com/still-boobless/

  • Butcher! Did you ever ONCE check for IODINE sufficiency?

  • Dear Dr. Funk:

    Please convey my full support to Ms. Jolie. I’m a breast cancer survivor myself, and mine was scary enough without the BRCA1 gene.

    The general public cannot really understand what it’s like to have to go through this kind of decision. One is truly staring death in the face, sizing up one’s odds, and making decisions on how to increase those odds. The only (remote) analogy I can think of is combat soldiers going out into the field.

    I had a single mastectomy (with reconstructive implant after). I did consider getting both, just to further drop my chances, but I decided that the additional surgery was too drastic (it really IS hard!), given that I didn’t have the gene. Imagine my distress two years later to find that several cousins now have breast cancer! One has died from it, and two sisters were diagnosed on the same day! One cousin (the sister of the cousin that died) has since had a preventative double mastectomy. Further research into my family tree shows that the increased incidence likely came in through marriage, and doesn’t directly affect me. But it’s still scary.

    I look back, and there’s not a single decision I would have made differently. You have to make decisions based on all of the information available to you at the time. No one else is living your life, and they therefore have no say in the matter.

    Joyce

  • Christian Alber (Jesus Christ)
    November 30, -0001 12:00 am

    Dear Dr. Kristy Funk and team of Pink Lotus Breast Cancer: The work of removing the breasts or other body parts of women or men (with potential future) breast cancers or illnesses whatsoever is a clear proof for myself that you are not listening to God. Your work is satanic and is not saving lifes, but just the contrary. You are destroying and cutting here and there at the Body of Christ, if you so want.. Angelina Jollie is now ready for hell fire. This is, by the way, not my decision (but definitively has my co-approval), but that of our living God who is in control of this filthy, corrupt, little planet earth. I recommend you and your team here at Pink Lotus Breast Cancer to not recommend to patients anymore to undergo surgery but instead to pray and seek God with regard to what to do instead. You may recommend healthy natural products to your patients and to be faithful and hopeful, as I myself (for example) have to be as well. I am just telling you, take it serious what I am writing here, for the flames of everlasting hell fire will also come close to you one day.. And I will then be no more there for you, as I have been so far.. And if you need further advise, you may always contact me at christian[a.t]christian-alber dot com Please think about what I have written here, so that you may wake up one day before it is too late.. Thank you. Be blessed. Sincerely, Jesus Christ (Christian Alber), http://www.christ-alber.com

  • Great information.. I love Angie for letting us know and thank you Dr. Funk for relaying this information! We really need the medical community to come together to help the everyday women.

  • Thank you Dr Funk and Ms Jolie…you are a complete inspiration

  • Thank you Dr. Funk for being such a great resource for our high risk community.

  • An incredibly brave and courageous story. But it’s not just a story, it’s about a woman’s life and the choices she makes for herself. I have been impressed with Angelina Jolie for many years, she is a beautiful person inside and out. She makes an invaluable gift to all women by sharing her very personal story. It demonstrates what a conscious and caring human being she is. Amazing.

  • Thank you to Angelina Jolie for the brave decisions both to take control of her body and health, and also to share this journey. As a 10 year breast cancer survivor and Registered Nurse, I greatly respect the way in which this most sensitive and personal experience has been communicated. I believe this is an important milestone in raising awareness of BRCA testing, preventative and treatment options, and the empowerment of women.

  • Carolina Stella
    November 30, -0001 12:00 am

    Congratulations Angelina, an attitude very brave

  • Tee jay is right this is just wrong and if it was a man they would never tell him to cut off his balls so they don’t get cancer you people are so uninformed. Caner can be cured and has for years it is the big pharmaceuticals and the For profit cancer industries that make billions every year off of people that are scared by them and the Dr that benefit from then that don’t want you to know . Do some research don’t just listen to the DR that is paid by big pharmaceuticals watch (the forbidden cure)!! Then you may start to understand how it really works!

    This is just sickening that a so called Dr would mutilate a perfectly healthy women!

    • I’m not entirely sure how you think the big pharma companies benefit from surgical treatment (surely if they were playing one big money making game, the prescription would be a daily, life-long, expensive, medication?). You really show little understanding of how medical treatments come into use – do you realise the years of data, trials and regulations that are involved here?

      And what are you accusing the doctor of here? Being a shameless con artist or an abusive misogynist? I don’t know what stage the gene testing for testicular cancer is at but I have no doubt that removal ought to be an option available to verifiable high-risk patients.

      I sincerely hope neither one of you ever get seriously ill. Or if you do, that you have someone in your life who is smart and rational enough to lead you toward accepted effective treatment – and away from conspiracy theories. Even more so, I hope that you never get the chance to voice your venomous, incoherent ramblings in the face of someone who is dying, or to someone who has lost someone to this so called “curable” disease.

  • Please redraft this post using generic names for medicines (=best practice) – or do you have a commercial relationship with these brands? Some of these therapies sound dubious, e.g. “Eliminating anesthesia” – please provide links to evidence. Thank you.

  • On top of everything else, Angelina Jolie turns out to be a first-class health communicator. Her NYT Op-Ed blew me away. A masterpiece of clear, concise, and empathetic patient education. I only wish the media reports were nearly as good as Angelina’s article. All I can do is promote her original article to all my lists.

  • Bravo Angelina!!! I knew Angelina was beautiful on the outside but also beautiful on the inside. What an inspiration! Great to see someone like her do this, I’ve been there! Thank you Angelina!

  • Beautiful act

  • To Elizabeth Williams, so you are so obsessed with the past that you don’t realise that happened when she was a teen, and has NO baring on such a SENSIBLE DECISION now? Angelina was wild, but she did not have psychological problems. She was never diagnosed with anything, a short period of being wild (tame in Hollywood standards) does not equal ‘psychological problems’. It seems you are so full of hate and so judgmental that you are stuck in the past and cannot move on. Neither her wild phase or her short-lived ‘cutting’ mean DECADES LATER she isn’t stable and able to make a sound and rational decision. This is a woman that is so stable and of sound mind she is a SPECIAL ENVOY and is respected by Nelson Mandela. She has come a LONG WAY and is NOT the same person she was in her YOUTH. How about you do some GROWING yourself, because YOU seem very unstable and emotionally stunted. I’d back her mental and psychological stability over a mentally stagnated backward narrow-minded person like you. I think you need help.

    • Our experiences in the past do not necessarily define who we are as a person in the present or future. Having children completely changes your perspective of life and you do find yourself making decisions for their best interests and the best interest of your family as a whole. The loss of a mother is never something a child should have to face prematurely, I therefore commend Angelina for taking the necessary steps in ensuring a long life with her children, her family.

  • This has been such an inspiration and has helped so many woman. i know it has helped me. breast cancer runs in my family so its always at the back of my mind. i will definitely look into getting tested. thanks!

  • A much better choice than waiting for BRCA to rear it’s ugly head resulting in much greater invasive surgery, chemo and possible death. Jolie courage in having the surgery is not what we should celebrate in this woman, it is coming out and telling her story publicly. She has shown us as women we are more than our breasts, we are life to our families and children. I have watched her grow as a woman and mother with the very candid interviews she has given opening herself up to critique from the world. That is true courage and class. She has shown us all we can make mistakes but that is not what defines us. We can stand tall move forward and continue to contribute to the greater good and have a successful rich life if we do. Jolie has done as much to contribute to the demise of this deadly disease as the researchers who identified the BRCA gene mutation. Once found then what? Someone has to commit to a next step. Someone has to explore the pro’s and con’s. Angelina Jolie has always shown us we can be proactive as women. I respect and admirer her for that. I am sure her beautiful mother is smiling down from the heavens bursting with pride watching her daughter tackling the demon that took her from her children. Best wishes to Angelina and her beautiful family, May she live a long and happy life with those she cherishes.

  • This is a much better option than waiting for BRCA to rear is ugly head leading to a much more invasive surgery, chemo and possible death. A very courageous move from a beautiful women that has done as much to combat this disease as the research to identify the gene has done. The surgery itself must have been difficult, but to go public given the way she has been treated for choices in her life is the courageous act Jolie has performed for millions of women and their families. I have watched her grow as a woman into a mother with a family she values. She has shown us as women we can misstep and still stand tall and move forward. She has shown us we are more than our looks, more than our breast, we are life to our children. A great act of commitment to mothers and women everywhere. I am sure her beautiful mother is smiling proudly down from the heavens at her. God Bless you Angelina and your beautiful family. May you have a long happy healthy life with the people you so cherish.

  • Thank you Angelina for your contribution.

  • I am a mother of 12 year old twin girls. This is my second fight with cancer. I am having a double mastectomy with reconstruction on Tuesday the 21st of May at Mass. General in Boston. I just wanted to say that reading Angelina’s story has given me a more positive attitude toward the surgery. I am very scared. My friends called me yesterday to tell me of Angelina’s story. Thank you for posting all of the great information.

    • You are already brave. It is courageous to admit that you are scared. Few would do that in an open comment. I am sure I’m not alone in reading this and rooting for you to pull through well, just like Angelina has done.

    • Good luck to you. May your lymph nodes be clear.

      It took me about 4 weeks to get back to work after a single mastectomy. Have your support network set up, get a bed wedge (pillows don’t really cut it), a shower stool, and a hand shower wand. Get your meds and schedule organized (with checklists). Do all the exercises the doctors give you, take care of your drains religiously (I put a how-to on WikiHow about this).

      This is a great time for your girls to pitch in, clean the house, make meals, etc. Trust me, just because you’re home, won’t make this a vacation. You’ll sleep ’till 7 or 8 because you’re tired, then you’ll get up, take your temperature, deal with your drains and take notes, take your meds, eat, do your exercises, wash up, and then it’s 11! And then you have to do your drains, your exercises, take your temp, ….. You get the idea.

      It’s serious surgery. Recovery really is a full time job. I didn’t even get to read a book!

  • how wonderful “celebrity status” has been used in such an empowering way…”to save one life is to save millions” (I hope that quote is correct)…x <3

  • i truly commend and applaud angelina jolie for her courageously and selflessly sharing her journey in such intimate detail for the benefit of others. kudos to you.

  • Very hard decision, but one that has save her from breast cancer. Just read article and is very informative, eye and mind opener to preventive methods.

  • All the best. I suggest Angelina starts a charity to extend financial help to women from poor background in least developed countries to get the BRCA tests done.

    • Start with the USA where genetic testing is not covered by many ins companies and certainly unvisited women have zero access to genetic counseling much less testing or treatment.

  • My thanks to Ms. Jolie for her decision to go public. It is my hope that the publicity generated by her story will help many women. Thanks to Dr. Funk for this fantastic, clear explanation of Ms. Jolie’s experience.
    Dr. Funk, your compassion shines through each sentence!
    As with so many, my family has fought cancer; I am fortunate that I’ve reached 58 in good health. I tell my daughter, “Keep up your breast exams & timely mammograms!”
    I anticipate enjoying Ms. Jolie’s work for many, many years to come.

  • Elizabeth Williams
    November 30, -0001 12:00 am

    How can a responsible medical professional encourage a woman with a history of psychological problems and self-mutilation to make these bizarre decisions?

    • Interesting comment, but no. All I can say is, Read her Op-Ed. The essence of reason. We should all have her presence of mind when faced with vital decisions.

    • Elizabeth Williams,

      Bizarre decisions??

      Really? What WOULD be bizarre and suicidal (IMO) is to refuse prophylactic surgery that would drop your chances of developing breast cancer from 85% down to 5%. Now that would be really crazy IMO. She wants to improve the chances that she will be around for her partner and her children. Nothing unbalanced or crazy about that.

  • Lisa LeBouthillier
    November 30, -0001 12:00 am

    Thank you for sharing your procedural information with everyone. I can only imagine that this is all very expensive sadly for far to many women, but none the less I am so pleased that Angelina shared her experience with others. She could have quietly done this and no one would have had to have known. I am so proud of her courage and her choice to be preemptive and choosing life.

  • Bravo Angelina! What you did took a great deal of reflection, analysis and bravery. It was an intellectual decision charged with emotion which one must be overcome. At best you have saved your life, or saved yourself from years of intense surveillance and worry, and possibly horrendous chemotherapy treatments. You have improved the quality of your life immeasurably.

    How do I know this? I just had the same surgeries. Not easy, but think of what we both achieved: Peace of mind!

    I wish you the best of luck!

    On behalf of all women with faulty breast cancer genes, I thank you for your frank and very public revelation of this very personal matter. You will save the lives of numerous women!!

  • A very informitive piece, Ms Jolie is an amazing woman and an execptional human being for choosing to she her journey publicly.

  • this is such a comrehensive guide! thank you so much – all women need to read this!

  • Brilliant! Now you are converting perfectly healthy women & converting them into patients( In your own words 95% have no cancer), 87% chance – hahaha, how did you come up with that precise but obviously wrong number?

    What are the dietary causes – Dairy, meat, alcohol & other process crap – what’s the percentage breakdown there?

    What if all these causes are removed – Does 87% become near 0?. If not why not?. Why didnt people die from from Breast cancer at this rate 200 years ago for example. At $6B+ a year, even I could make that connection. Do Zebras or Giraffes/elephants/chimpanzies in the wild get breast cancer – no? may be because they don’t eat crap, How do you monetize this simple advice?

    How do you convince a half-wit to reduce their risk to 5% and give two breasts for it?. Besides 5% risk is bollocks -It’s just a “right number” not too big, but not too small – difficult to verify.

    Angelina Jolie is just a tool. Angelina eats Fruits and reduces the risk of cancer to 1%, doesn’t make anyone any money 🙂

    Sorry about the rant, you probably have bills to pay as well – But if you don’t already know it already ( I will be suprised) , give it some thought.

    OR Point me to some documentation comparing a alcohol free +tobacco free + processed food free/ vegan diet Vs double mastectomy. Because we think we know what a women would chose. Don’t you think she needs to know this before your chop her tits off?

    Ahh.. and if you don’t want ever do that study( not in your interests to commission it, ofcourse),- I believe the answer would be near 0 regardless of BRCA1,2, x whatever. Rest my case.

    • Also, how is thinking up an imaginary clinical trial and its results ‘resting your case’?

    • oh my god please shut up. are you a doctor? a highly paid, extensively trained medical professional recommended that a woman had her BREASTS surgically removed. AMPUTATED. They probably thought it through… including considering whether some fresh fruit would do the job.

      women DID die from cancer 200 years ago – although at the time would not have recognized it. the difference is that people died far earlier – BEFORE developing cancers (most common age for breast cancers is 50s). rather people were dying of conditions which are today avoidable and treatable thanks only to the medical community.

    • Tee Jay.

      “Now you are converting perfectly healthy women & converting them into patients( In your own words 95% have no cancer), 87% chance – hahaha, how did you come up with that precise but obviously wrong number?”

      This number 85%, is born out by solid research. Do you happen to have any that proves otherwise? You know, like well controlled, peer reviewed scientific studies that closely followed women with this genetic mutation that then proved beyond a shadow of a doubt that the chances of developing cancer in their lifetime were not astronomically high?

      The BRACA 2 gene mutation is an exceptional situation. No one is saying women should all go and prophylactically remove their breasts. But in this situation there is little doubt as to what the right thing to do is.
      Your ignorance is astounding.

  • I miss Angelina’s boobies already 🙁

  • This information will help so many women! Thank you for sharing!

  • Louise from Australia
    November 30, -0001 12:00 am

    Thank you for the detail contained in this article. I am 4 weeks post dbl mast with tissue flap recon and wondering if I’ll ever feel and look right again. I researched for 6 months trying to gather as much real information about reconstruction procedures as possible to be completely informed prior to deciding on the type of surgery I would have. If through Angelinas fame, you are able to uncover more real experiences it will help us ladies in this situation immensely.

  • I Admire Angelina Greatly for making this decision for her family….I would do the same if I had the support of my doctors! Bravo Angelina!

  • Very interested in the vest, I had ovarian cancer in 2002′ stage. 11, return in 2012 ovarian cancer inthe spleen. Had genic testing in 2002′ positive for brac 1 gene. Large family history of breast and ovarian cancer. Would like to know if Clem’s is available in Central Florida and if Medicare will pay for the test?
    Thank you

  • Thank You for this Informative information. If I can be of any help for patients that need Health Insurance contact me. Bless You!

  • thank you for sharing this great outline for other high risk women. five years ago i made the same difficult decision to undergo a PBM. i feel fortunate to have had access to the resources to reduce my risk as well. like many difficult situations and experiences, strength is found and we come out smiling. two of my best friends are gorgeous brca+ young women that i met through bright pink (a nonprofit for high risk young women). today we joked in addition to cancer risk, clearly brca is also is a strong indicator of intelligence and beauty. warm wishes to angie in her continued recovery. nicole, 35 in san diego

  • she’s crazy!

  • nicely done

  • Angie the Great
    November 30, -0001 12:00 am

    Thank you for sharing this.I am one of Angelina Jolie’s avid fan.I admire her so much.She is such a brave and caring woman.She is really an inspiration to a lot of women.I am from Europe and this news mad e so much impact .We are educated about the disease.They not only report this news but invited experts as well to explain some medical terms.Bravo Miss Jolie.

  • Maria Moustakis
    November 30, -0001 12:00 am

    Amazing..good for Angelina to do what needed to be done for herself as well as her family…and kudos to her partner for being there to help her on her road to recovery..

  • Best wishes to Angelina Jolie. This was a brave, smart decision. I applaud her for her choice.

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