The whole world knows about actress Angelina Jolie’s decision to have an elective double mastectomy. She didn’t choose the surgery because she has cancer — she was cancer-free. She chose it because she carries the BRCA1 gene, a “flawed” gene that sharply increases her risk of developing breast and ovarian cancer.
But having both breasts removed when you don’t have cancer is a drastic step, to say the least. Did she do the right thing? Let’s take a look. . .
Continued below. . .
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Ms. Jolie has seen firsthand how cancer can ravage the body and bring suffering to a whole family. Her mother battled breast cancer and ultimately died of ovarian cancer at age 56. By that point, she’d been struggling against the disease for a decade. Ms. Jolie’s maternal grandmother was also diagnosed with ovarian cancer.
Quick facts on breast cancer
Before we get into whether her decision was smart or crazy, let’s talk more about the BRCA1 gene. The term “BRCA” comes from the first two letters of each of the words “breast” and “cancer.” If you develop breast cancer, normal BRCA genes help you fight it. But when the BRCA gene is mutated, it can’t do its job, and cancer risk sharply increases.
Prior to surgery, and by her doctor’s estimate, Jolie’s risk of breast cancer was an alarming 87 percent. Her risk of ovarian cancer landed at 50 percent.
Some of my readers may be surprised, but on the whole, I think Ms. Jolie made a reasonable decision. It wasn’t the only thing she could have done, but it was not a “crazy” thing to do. I would choose a policy of regular monitoring for cancer, plus a healthy diet and the supplements we talk about all the time in this newsletter and in our books. Early detection IS possible and surgery comes into play only when you actually have cancer. But I understand a person can become panicky when faced with the kind of odds she faced. Men with small, nearly harmless prostate tumors are the same way. Most of them want the whole thing cut out NOW!
Though only a tiny fraction of breast cancer diagnoses stem from the BRCA1 gene mutation, if you happen to be one of the unlucky women who have it, you face a 65 percent risk of breast cancer and a 39 percent chance of getting ovarian cancer. Those are averages. Ms. Jolie’s risk was boosted by the fact that her mother and grandmother were cancer victims.
The breast cancer odds are more than five times worse for women with the gene mutation than for those without. For the latter, the risk of breast cancer is only 12 percent and the risk of ovarian cancer is less than 1 percent. I don’t mean to belittle the risk for any woman, but as you can see it’s much worse for women with the gene mutation.
Men can inherit the BRCA1 mutation as well, bringing their own breast cancer risk up to 8 percent.
The general risk of having a BRCA mutation is 1 in 500 people. If you’re of Ashkenazi Jewish heritage, risk rises to 1 in 40.
Jolie’s choice was to minimize her risk. I can’t imagine what a hard decision it must have been. After three months of intensive medical procedures that included removing the tissue in both her breasts, her chances of developing breast cancer have dropped from a high of 87 to a low of 5 percent. She paid her dues and got the reduction in risk she was seeking. As I said, it’s a reasonable choice.
Mastectomies don’t really mean medical progress…
The big risk in Ms. Jolie’s public announcement is that other women will draw the wrong conclusions. Some worry that she’s opened the gates to a new trend in mastectomies that are medically unnecessary.
It’s no secret that the past several years have unleashed a virtual epidemic in preventive mastectomies for women with one cancerous breast who decide to remove the healthy breast as a precaution. These women, by and large, do not carry the genetic mutations that elevate their risk. That means their odds for cancer developing in their remaining breast are quite low.
Preventive mastectomies make sense for women with the same high-level risk of cancer Jolie faced. But very few women share that risk. For women without the gene mutation, I’m prepared to say without a doubt that removing a healthy breast is unnecessary and unwise, even if the other breast has cancer.
The trend toward mastectomies is even more frustrating given that lumpectomies for actually existing cancer have been proven just as effective as mastectomies. In a lumpectomy, only the tumor and nearby tissue are removed, not the entire breast. And, yes, that’s all you need. The statistics indicate you gain nothing by “radical mastectomy,” i.e. removal of the whole breast.
I like the reaction of Dr. Susan Love, breast surgeon and author of Dr. Susan Love’s Breast Book. In an interview with The New York Times, she pointed out that Ms. Jolie was an unusual case. Said Love, “What I hope that people realize is that we really don’t have good prevention for breast cancer. When you have to cut off normal body parts to prevent a disease, that’s really pretty barbaric when you think about it.”1
If anything, we can hope that Ms. Jolie’s public disclosure will shed light on a topic that deserves more research. For now, the only definitive answer is drastic surgery.
It’s also important to know that preventive surgery isn’t the only option, even for those with BRCA1 mutations. Many doctors advocate mammograms and MRI scans, done alternately every six months. That way if cancer does surface, it’s found early … assuming the mammograms do their jobs, which is debatable.
Readers of this newsletter know all about the shortcomings and dangers of mammograms. Themorgraphy is a better, safer way to screen for breast cancer. See our previous Issues #218 and #239 for more information on the best ways to find breast cancer early.
You should also consider purchasing my Special Report Breast Cancer Cover-Up. This report was written to explain all your best options for detecting, preventing and treating breast cancer. Needless to say, the report focuses on alternatives, not mainstream treatments.
How to heal the “Whole Body” from surgery
Ms. Jolie’s advice is for all women, especially those with a family history of ovarian or breast cancer, to get a better understanding of their risk level. She advocates gene testing and preventive treatment. But she acknowledges that gene testing, which typically costs more than $3,000 in the U.S., is not an option for a great many women.
Many insurance carriers will cover genetic testing, but most of them require you to prove your risk through family history. If you’re unsure about your increased risk, take this free quiz on risk assessment from the Pink Lotus Breast Center—the same center where Ms. Jolie was treated.
She also acknowledged that many alternatives to surgery are in the works. On top of that, I was interested to learn that much of her own surgery played by an alternative rule book.
For starters, Ms. Jolie’s surgery was done on an outpatient basis at the family-owned, mostly female-run Pink Lotus Breast Center where they pride themselves on holistic care and wellness.
Following her surgeries, Ms. Jolie was placed on a variety of supplements. These included vitamin C, zinc, and multi-vitamins to improve healing at the site of each operation. A combination cream of arnica and bromelain, an enzyme extracted from pineapple stems, was used to help with post-operative swelling and bruising. The homeopathic remedies ExChem and Lymphomyosot were used to help eliminate anesthesia from her system.
In a situation like Ms. Jolie’s where risk was high and intervention was believed to be the best course, it’s nice to know she wasn’t sentenced to a coarse and impersonal hospital stay with a stack of prescription drugs. It’s proof that even in the event of extreme surgery, there are still ways to assist your body’s natural healing faculties.
Is it fair to patent a gene?
It’s possible that Ms. Jolie’s public disclosure will bring about a different kind of positive change. I’m not talking about more women choosing preventative surgery, but about a woman’s right to information and gene testing, even if she lacks the cash and her insurance doesn’t cover it.
As it turns out, a Utah company called Myriad Genetics currently owns the patent on the BRCA1 and BRCA2 genes. This company developed the BRCAnalysis test that screens women for the gene mutation. And as long as they own the patent, no other company can develop a similar test. That’s why the test costs $3,000.
The ACLU and the Public Patent Foundation have challenged Myriad’s right to patent these genes on the grounds that they’re preventing further studies and tests on the gene and delaying critical research. The landmark case will be decided before the Supreme Court in June.
Until then, Myriad argues that Medicare, Medicaid, and their own financial assistance program make testing available to what they consider “appropriate patients.” But the bottom line is this: they’ll retain control of the future of the BRCA genes, unless the Supreme Court decides otherwise.
It’s not a one-size-fits-all problem
At the end of her op-ed piece in The New York Times, Ms. Jolie stated, “Life comes with many challenges. The ones that should not scare us are the ones we can take on and take control of.”2
What’s important is to know your options. Surgery will not be the right choice for everyone, and each woman’s case is unique. Considering she had the gene mutation, I believe Jolie made a reasonable choice, but it’s not the only choice. Another woman might have chosen frequent screening, a healthy eating plan and supplements — and then surgery only if and when cancer cells actually appeared. And as I said above, I’m opposed to such surgery for women who don’t have the mutation.
Ms. Jolie’s choice should not highlight preventive surgery as the single best option for avoiding breast cancer. Rather, her message lies in the power of genetic counseling and informed decisions. Instead of asking questions about surgery, first focus on asking questions about your family history.
As Dr. Isabelle Bedrosian, a surgical oncologist at M. D. Anderson Cancer Center in Houston, told The New York Times, “We need to be careful that one message does not apply to all. Angelina’s situation is very unusual. People should not be quick to say ‘I should do like she did,’ because you may not be like her.”1
Meanwhile, it’s summertime and we’re all spending more time in the sun. Does it really cause cancer? You might be surprised by the news in our last issue. If you missed it, just scroll down and take a look now.
Sunshine and skin cancer: the real story
It turns out that a new type of nail polish may increase your risk of cancer. I’ll give you the details in a minute, but because we’re moving into summertime, let’s first take a look at one of the other things we do to make ourselves look good: getting some sun. . .
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You hear a lot of warnings that too much sun may give you skin cancer. Other than smoking, this is one of the few cancer prevention ideas mainstream medicine gets excited about.
It’s too bad they don’t use their resources and all those public service TV and radio commercials for something more worthwhile. The cancer danger from ultraviolet rays is pretty small.
The best evidence I’ve seen indicates that sunshine may cause mild, practically harmless basal cell carcinomas. Almost nobody ever dies of this type of skin cancer, although it can blemish the skin. The deadly type of skin cancer is melanoma and, surprisingly, the evidence isn’t conclusive on whether UV rays cause melanoma. In any case, very few people die of melanoma.
Now, I’m not saying go out and get as tanned as you want. Too much UV exposure does age the skin and most likely causes the mild form of skin cancer. What’s more, the damage from the tans and burns we get when we’re young doesn’t show up for decades. It’s a case of “enjoy now, pay a terrible price later.”
So assuming you don’t want dry, wrinkled skin and nasty little black lesions when you’re an old coot like me, you should keep your sun exposure brief and moderate. Boosting your vitamin D levels is the only real health reason to take in UV rays, and a little bit of exposure (well short of what it takes to give a white person a tan) is plenty for that purpose.
But there’s another danger here,
and it doesn’t come from the sun. . .
Conventional medicine’s “cure” for too much sun may be worse than the disease. Some researchers are just as concerned about sunscreens as a potential carcinogen as they are about UV rays.
I’ve been warning about this possibility for years. There have been few or no long-term studies on whether it’s safe to slather sunscreen chemicals all over our bodies. But people think, “Surely the government checks out all these products.” Right.
I see young parents covering infants and toddlers with sunscreen from head to toe. It’s scary.
Now there’s some evidence my hunch may be right. Cell toxicity studies conducted by researchers at Missouri University of Science and Technology suggest that a common sunscreen ingredient, zinc oxide, may be at the root of the problem.
Dr. Yinfa Ma, Curators’ Teaching Professor of chemistry, led research studies which found that exposing this ingredient to sunlight causes a chemical reaction that may release unstable molecules known as free radicals.
According to the study published in the Journal of Toxicology and Applied Pharmacology, as free radicals try to bond with other molecules, they cause cell damage that could increase the risk of skin cancer.
Dr. Ma’s team also theorized that the longer zinc oxide is exposed to sunlight, the greater damage it causes to human cells.
If this study is accurate, then using sunscreen to protect your body from UV rays could speed up the formation of cancer-causing free radicals.
But the study authors caution against jumping to conclusions. Dr. Ma noted that this study was just a beginning and additional research is needed.
No doubt that’s true, but I haven’t used sunscreen for years (I don’t like the stuff anyway). I recommend avoiding it and taking the following steps instead:
- Cover your skin with light clothing (but not too light; the rays can penetrate extremely sheer material)
- Seek shady spots when you’re outdoors
- Get your exposure at times of day when the sun is not so intense (morning and evening); during the summer, 10 AM to 2 PM is generally the time when the sun is most intense and you can fry really fast
- Eat plenty of antioxidant-rich fruits and vegetables to help fight free radicals
- Apply skin care products enriched with green tea, vitamin C or other antioxidants to the outside of your skin. I’ve read that a mixture of vitamin C in water, applied to the skin, is a good sunscreen. I haven’t tried it.
These solutions may sound simple and “un-medical” — they don’t come out of pharmacy. But sometimes the most effective solutions don’t have to be complicated at all!
Now, about that cancer-causing nail polish. . .
At the 2012 Democratic National Convention, the First Lady sparked a fashion craze by wearing a unique shade of blue-gray gel nail polish.
Nail salons nationwide reported an uptick in clients searching for this long-lasting, chip resistant polish.
Because gel nail colors require a UV light source to dry and seal the color, they’re mainly applied by the pros. But some manufacturers have created home kits that include a mini UV lamp to help you achieve the same look at home.
Many women love these gel colors because some can last as long as three weeks! But that kind of durability makes it harder to remove the polish too.
You have to soak your nails in acetone for10 to 15 minutes to remove the polish. That sounds like a bad idea to me, right off the bat. The acetone can dry your nails… irritate the skin near your nails… and even escalate to form rashes or blisters on your skin!
An American Academy of Dermatology press statement cites one study in which dermatologists examined five women who complained of weak, brittle and thinning nails that they suspected were caused by gel manicures.
The dermatologists agreed that their problems were likely a result of the gel manicures.
What’s more, one of the women underwent two additional tests to measure the nail plate before and after one gel manicure. These tests confirmed that nail plate thinning occurred.
So what’s the cancer connection?
Gel nail polish may pose a cancer threat on two levels…
First of all, some of these polishes contain the chemical preservative butylated hydroxyanisol (BHA), which the National Institutes of Health (NIH) have found to be a consistent cause of tumors in laboratory animals.
Likewise, the International Agency for Research on Cancer classifies BHA as a possible human carcinogen.
Scientists are not sure how much exposure you would need for cancer to develop, but it’s wise to be cautious.
Not all gel polishes contain this chemical, so be sure to check the ingredient list on any bottle you plan to use.
The second potential cancer threat from gel manicures has to do with the application process. Remember that gel polish applications require a UV lamp to set. Does this UV exposure pose a cancer danger? At least one conventional expert thinks so. . .
Dr. Susan Taylor, dermatologist and clinical researcher, said that exposure to this UV light for just four to eight minutes every two weeks can wind up being a significant level of exposure.
I’m skeptical that the UV angle of this nail polish is much of a problem. Are women going to get melanoma lesions on their fingertips from a brief UV exposure? I suspect not. But, as I said before, it ages the skin and may also cause less deadly types of skin cancer. And who needs that?
Dr. Taylor has three recommendations for people who prefer gel manicures to traditional nail polish:
- Apply an SPF 30 or higher sunscreen directly to your hands and fingers after you wash them midway through the manicure. (Obviously, I don’t agree with her on this.)
- Cut the tips off a pair of cotton gloves and wear these while applying polish and during the time your fingers are under the UV light. This isn’t a bad idea.
- Find a manicurist that uses LED (light emitting diode) light to set the gel polish.
Like many beauty treatments (hair dyes, for example — see Issue #272) this one sounds like more risk than it’s worth. Your move. . .
Lee Euler, Publisher