When Angelina Jolie made the decision in 2013 to have a bilateral prophylactic mastectomy in order to reduce her risk of developing breast cancer, the Hollywood icon unknowingly started a trend. Dubbed the “Jolie Effect”, research has shown that in the years following the actress’ public decision to have the procedure, mastectomy rates nearly doubled.
After seeing an uptick in the years following Jolie’s decision, Lahey Hospital & Medical Center has started to see a decline in breast cancer patients opting for a prophylactic mastectomy.
According to Dr. Julie O’Brien, medical director of the Comprehensive Breast Health Center at Lahey Hospital, breast cancer patients used to reference Jolie when making the decision to have a prophylactic mastectomy. Jolie had a genetic mutation, BRCA1 that drastically increased her chances of developing breast and ovarian cancer. In fact, because of that mutation, Jolie had a 60-80 percent chance of developing breast cancer over her lifetime, compared to a less than 12 percent chance for a woman with no family history and no genetic mutation.
There are a number of reasons for the decline in mastectomy rates, according to Dr. O’Brien
At Lahey, for example, patients debating the procedure are encouraged to consult with Dr. Cary Meyer, a behavioral psychologist to discuss additional options. There’s also a focus on personalized care at Lahey that focuses on making the right decision for the patient. However, according to Dr. O’Brien, for breast cancer patients, a prophylactic mastectomy does not improve their overall chance of survival and it comes with its share of risks.
“It is important to note that Angelina Jolie did not have breast cancer. She had a genetic mutation in the BRCA1 gene which put her at a high risk for the future development of breast cancer,” Dr. O’Brien said. “Having the procedure can increase the chances of potential complications and there are also side effects to mastectomy from a physical and emotional standpoint. For example, patients have permanent numbness of the chest wall following the procedure.”
To help patients understand their lifetime risk of developing breast cancer, patients at any Lahey facility who are scheduled for a mammogram, take a risk assessment survey that helps determine what is their calculated risk for developing breast cancer and what is their risk for having a genetic mutation. According to Dr. O’Brien, determining a patient’s risk is much more informative, since only 5-10 percent of breast cancer diagnoses are secondary to a known genetic mutation, while 90-95 percent of breast cancer patients develop the disease from likely aging, hormone exposure, diet, or environmental exposures.
“We are focused on getting patients to understand their lifetime risk for developing breast cancer and from there, if necessary, evaluate patients in the breast center to discuss high risk breast cancer screening with bilateral breast MRI in combination with routine screening 3D mammography as well as referring patients to genetics for counseling and possible genetic testing,” Dr. O’Brien said. “Patients oftentimes rush into a decision after learning they have breast cancer because a breast cancer diagnosis is an emotionally charged diagnosis. However, the impacts from having a prophylactic surgery can be life altering and so the focus must be on educating patients of their options so that they may make an informed decision.”
For more information on Lahey Health’s breast health services, visit our website.