Last week, Angelina Jolie announced that she had a double mastectomy because of her increased risk for developing breast and/or ovarian cancer due to testing positive for the BRCA1 (breast cancer susceptibility gene 1) gene mutation -- her mother had ovarian cancer and is now deceased.
In addition to Angelina Jolie, Sharon Osbourne is another A-list celebrity who also elected to have prophylactic surgery with a double mastectomy due to an abnormal genetic finding. Will this soon be the celebrity trend?
Even though I believe this type of celebrity announcement is great for increasing awareness and education, it can also come across as an endorsement for mastectomies, when maybe that's not necessarily the case.
Someone who is high-risk has a big decision to make, and many to follow. How do they know they are high risk? Should they get tested? And if they do, then what? These questions, and many more, are vital to consider before making any final decisions about possible preventive measures.
This is where genetic counselors are vital. They are the professionals who would navigate someone through this process, making sure a patient being genetically tested for certain types of malignancy understands all aspects and gets the support they need.
Education, as I mentioned before, is essential. BRCA1 mutation does not guarantee a malignancy in life, but it can increase the risk, along with other factors such as family history, lifestyle, etc.
And just because someone who is discovered to have a BRCA1 mutation elects for a prophylactic double mastectomy and prophylactic salpingo-oophorectomy, does not mean they won’t develop some other malignancy related to this mutation. BRCA1 mutations have also been linked to melanoma, prostate, gastric, and pancreatic cancers. There is no current research that demonstrates what the decline is in these other cancers after a double mastectomy or salpingo-oophorectomy is performed, if any. More research is needed.
The key takeaway here is making sure patients understand all of the factors that go into such an important decision. Nurses are usually the ones on the front lines initiating these conversations -- this is why it's imperative that oncology nurses are informed when it comes to the issues surrounding genetics and counseling.
Have you recently referred or recommended a patient see a genetics counselor? If so, what did you learn? Any clinical pearls to share?