The Angelina Factor

Brave New World

Saturday, May 25, 2013
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Last week, Angelina Jolie’s remarkable self-portrait created an unmistakably clear image of three dramatic shifts in our approach to breast cancer:

First, our understanding of genetics and our ability to personalize care now heavily influences breast cancer management.

Second, we have moved beyond the goal of early detection and are now invested in strategies for primary prevention – intervention before breast cancer occurs.

Third, advancements in surgical techniques have provided women options for multidisciplinary care and breast reconstruction that (paraphrasing her words) do not diminish a woman’s sense of femininity.

Fred Kass, M.D.
Click to enlarge photo

Paul Wellman (file)

Fred Kass, M.D.

Genetics: We are slowly growing the number of communities in which certified cancer-genetics counselors are available to guide patients and their families. In California, certified programs are available in six regions: in the San Francisco, Los Angeles, and San Diego metropolitan areas, in Fresno, in Sacramento, and here in Santa Barbara.

What should bring patients and their families to seek genetic counseling?

•Multiple relatives with breast cancer

•A personal or family history of breast cancer prior to age 50

• A personal or family history of ovarian cancer

• A special subtype of breast cancer: “triple negative”

• Breast cancer in a male relative

• Breast cancer in a family of Eastern European Jewish ancestry

Primary Prevention: For more than a decade, we have known that medications given to high-risk women can decrease the risk of developing breast cancer. The first such trial demonstrated that tamoxifen could cut in half the likelihood of developing breast cancer. Subsequently, the STAR trial showed that raloxifene (Evista) could achieve similar results, potentially with fewer side effects.

For the highest risk women – women like Angelina Jolie, who carry the burden of a breast-cancer genetic mutation – the option of prophylactic surgery with effective reconstruction is now an option, with a 95% likelihood of preventing the disease. Women considering this option must have available to them a multidisciplinary team of physicians, genetics experts, counselors, navigators, and other community cancer programs, like those available here in Santa Barbara, to insure that their decisions are well grounded in all of the presently available medical knowledge.

Multidisciplinary Team and Innovations in Reconstruction: Physicians specializing in breast cancer staff the Santa Barbara Breast Cancer Alliance. This group has won national recognition as a certified breast center – offering the full spectrum of surgical, reconstructive, radiation and medical breast-cancer therapies. In partnership with the Alliance, the Cancer Center of Santa Barbara employs three breast-cancer navigators and a social services staff dedicated to easing the path of women through the maze of choices now confronting them and their families.

The genetic risk carried by Angelina Jolie is responsible for only 5% of breast cancer. About four out of every five breast cancers are unrelated to family history. To that end, our efforts must be directed toward some of the root causes of this cancer, which strikes one in eight women during their lifetime. We need to look more closely at diet, exercise, and other lifestyle choices. We need to more closely identify the steps all women can take to reduce their risk and to lead healthier, productive lives.

Fred Kass, MD, is a doctor of hematology/medical oncology and the medical director of research and wellness for the Cancer Center of Santa Barbara, with Sansum Clinic.


Independent Discussion Guidelines

I'm sorry, but some day people are going to look back on the idea of preemptively removing healthy body parts in order to "prevent" cancer and say: "What the hell were they thinking?"

spiritwalker (anonymous profile)
May 25, 2013 at 12:32 a.m. (Suggest removal)

right cancer is genetic, thats why its frequency has gone up 150% in the last fifty years. angelina jolie is a chain smoker, dont hear much about that eh? let me go make an appointment to have my brain removed. and check out the trillions of dollars the cancer industry will make off this bull.

redbunz (anonymous profile)
May 25, 2013 at 10:04 a.m. (Suggest removal)

Who are you gonna believe, a licensed physician or two anonymous jag offs?

Ken_Volok (anonymous profile)
May 25, 2013 at 12:46 p.m. (Suggest removal)

"let me go make an appointment to have my brain removed."
-- redbunz

Somehow, I doubt they'd find anything.

The last paragraph says only some cancers are related to genetic issues.

In Jolie's case, she has a mutation in her BRCA1 gene. Women with that genetic defect have an 80% chance of getting breast cancer.

EastBeach (anonymous profile)
May 25, 2013 at 1:06 p.m. (Suggest removal)

Are genetic tests available to people without health insurance? What about those with high deductibles who have to shell out $3000 for this particular test? Great that testing is available. Not so great that health care is not affordable.

mtndriver (anonymous profile)
May 26, 2013 at 10:38 a.m. (Suggest removal)

Absolutely correct mtndriver. But it's worse than that.

Myriad Genetics, the company that developed the BRCA1 test, claims they own the rights to the BRCA1 gene .. not just the test for the mutation! How can anyone own a patent on a human gene?

From a practical viewpoint, this is preventing Yale University from making available their BRCA1 test which is better and cheaper than Myriad's. And researchers who want to investigate other mutations of BRCA1 are prevented from doing so by Myriad's patent.

Fortunately, Myriad's patent is slated to be challenged in the Supreme Court. The outcome of this case will impact the future of medical research and how much the health care industry is allowed to have unfettered profit.

Now we can understand the real importance of Angelina Jolie's announcement:

EastBeach (anonymous profile)
May 26, 2013 at 12:12 p.m. (Suggest removal)

Myriad Genetics should be dissolved. No patents on natural occurring anythings should ever be given.
Edison lost control of motion pictures (thank God) because the Latham Loop is a natural phenom.

Ken_Volok (anonymous profile)
May 26, 2013 at 1:15 p.m. (Suggest removal)

Speaking of genetics, wasn't there an anti-Monsanto protest in town this weekend?

Ken_Volok (anonymous profile)
May 26, 2013 at 5:42 p.m. (Suggest removal)

Jagoffs? Look here, Vorlok, why the name calling? And an even bigger question, why do you have such a big problem with those who question "authority"?

And the biggest question of all, if "a licensed physician" were to recommend castration as a preemptive testicular cancer prevention "therapy', would you be first in line at surgery? (Actually, if you've already undergone such a procedure, that would explain quite a lot about the way you lash out at me.)

spiritwalker (anonymous profile)
May 26, 2013 at 9:30 p.m. (Suggest removal)

BTW, I completely forgot to mention that this whole thing is very likely nothing more than a publicity stunt on Ms. Jolie's part. (Think about it, she has way more than enough money for the best health monitoring and intervention available on this planet, why would she volunteer to mutilate herself for something that MIGHT happen some day? I sure wouldn't! And another thing to consider is that the surgery was supposedly done in such a way that it would be "difficult for an expert to tell" - how convenient!)

spiritwalker (anonymous profile)
May 26, 2013 at 9:57 p.m. (Suggest removal)

You are truly sick if you think Jolie needs publicity and would resort to such methods to get it.

Ken_Volok (anonymous profile)
May 26, 2013 at 10:16 p.m. (Suggest removal)

Is this a publicity stunt, her aunt succumbing to cancer:

Is there any human tragedy that is off limits to your ego?

Ken_Volok (anonymous profile)
May 26, 2013 at 10:23 p.m. (Suggest removal)

Oh, please! Is there ANYTHING "Brangelina" WOULDN"T do for publicity? Seriously, the "big story on CNN this morning was that Brad Pitt "thinks" he might have "face blindness" - 'prosopagnosia' - the inability to recognize faces - yeah, right! It's far more likely that ol' Brad is just such a narcissist that he simply couldn't be bothered to notice anybody's face! (And yes, Worlok, I brought this up just see what kind of hissy it'd provoke!)

And so what if her aunt got cancer? Her mom had terminal breast cancer - so what? Like I already said Ms. Jolie can afford constant medical monitoring and the best intervention money can buy, I just don't see the wisdom of slicing of body parts to prevent something that may NEVER happen!

spiritwalker (anonymous profile)
May 26, 2013 at 10:45 p.m. (Suggest removal)

So Brad Pitt decides what CNN presents to its viewers as news? When does he do this, between takes?

Ken_Volok (anonymous profile)
May 26, 2013 at 11:01 p.m. (Suggest removal)

Wow, Molok, you really DO have a knack for moving the goal post, don't you? Seriously, you go from righteous indignation over the mere suggestion that this might be yet another (in a LONG history of outrageous behavior) publicity stunt for the ever attention starved hollywood couple, and then effortlessly segue into a strawman argument about who decides CNN's content.

The point was that BOTH Brad and Angelina are basically attention whores who'll do anything for ATTENTION! Get it?

Now, having said all that, I really have to ask what exactly what point you're trying to make except for the sake of arguing against me?

And you STILL haven't answered my question as to whether voluntary castration is in your future (and don't try to laugh it off, men carry the same "faulty" oncogene and apparently are already subjecting themselves to preemptive prostate mutilation). So I ask again, ARE YOU GOING TO MUTILATE YOURSELF? If not, why do you think this is an idea worth arguing about?

spiritwalker (anonymous profile)
May 26, 2013 at 11:32 p.m. (Suggest removal)

You're the one watching CNN Entertainment News, I'm not.

Ken_Volok (anonymous profile)
May 26, 2013 at 11:47 p.m. (Suggest removal)

And again, you want to make this a strawman argument - this time it's somehow morphed into an argument about what tv shows I supposedly watch - c'mon smart guy, answer the question: IF YOU THINK WHAT ANGELINA JOLIE DID WAS SUCH A GREAT THING, DO YOU PLAN TO HAVE THE MALE EQUVILANT OF THAT SURGERY?

spiritwalker (anonymous profile)
May 27, 2013 at midnight (Suggest removal)

Why do you care?

Ken_Volok (anonymous profile)
May 27, 2013 at 12:18 a.m. (Suggest removal)

Good, grief! You really are tedious! Go back to the very first comment (mine) in this thread and see that all I did was point out the folly of surgically removing body parts as a preemptive "treatment" for cancer.

Even someone with a double digit IQ should be able to see that if this "philosophy" were followed to its "logical" conclusion, we'd all be spayed or neutered quadruple amputees devoid of ANY extraneous flesh (after, all ANY gene could mutate at ANY time, why take chances?).

AS for why I specifically "care"? I think I've made my point abundantly clear - you have NO point (except to argue against me), so WHY DO YOU CARE?

spiritwalker (anonymous profile)
May 27, 2013 at 12:44 a.m. (Suggest removal)

If you take anything to "its logical conclusion" you're most likely taking it to the unrealistic extreme.

Ken_Volok (anonymous profile)
May 27, 2013 at 12:59 a.m. (Suggest removal)

That's why balance is important. It's good you question authority, not enough people do. But immediately assuming everything is a lie (even tho most of it is) you do yourself a disservice because one then never learns the truth, only what one believes.
No doubt you've heard the phrase "healthy skepticism". You are right to ask questions; you are wrong to assume you know all the answers.
I hope this is useful to you, it's not meant as an attack. When we only say "no" all we are is a contrarian, not a truth seeker which I think you'd like to be. Collect ALL the facts, THEN make your decisions about what is true and what isn't.

Ken_Volok (anonymous profile)
May 27, 2013 at 1:41 a.m. (Suggest removal)

Look, Angelina Jolie made her little "announcement" in an op-ed piece in the New York times on 5/14/13 - on 5/15/13 she had a big article in People Magazine - the magazine is finalized 3 weeks before it's released to the public, so obviously this was a planned PR stunt.

And never mind all the high philosophy, you're arguing just to argue and you know it. As for me "assuming I know all the answers", I do no such thing - as with the article concerning Tsarnaev brothers, all I did was point out the obvious. (And it IS obvious that preemptive surgery of this type really isn't necessary and certainly does NOT guarantee that she won't get breast cancer anyway. If she actually chain smokes cigarettes, she'd be much better served by quitting than having her breasts guillotined.)

spiritwalker (anonymous profile)
May 27, 2013 at 7:07 a.m. (Suggest removal)

To do what? Raise awareness of cnacer which we are only tangently talking about because you have an unhealthy hatred of "show folk" or something.
In addition, actors are only carted for publicity when they have a movie about to be released, until it's mostly parasites and stalkers following them around with cameras.
And you can ignore the "high philosophy" which was merely my attempt to give you the benefit of the doubt since I can only guess you must be about ten years old judging from your posts.
And the obvious regarding the Tsaranevs is again your head is up your piehole.

Ken_Volok (anonymous profile)
May 27, 2013 at 11:34 a.m. (Suggest removal)

An unhealthy hatred of "show folk"? Exactly where you got that idea, I don't know, but the fact is that I DON'T have the energy to hate ANYONE! (including you, even though you've clearly gone out of your way to be a whiny little pain in the rear end - talk about someone acting like they're 10 years old! Just look at your first post - your response to perfectly valid points is "anonymous jagoffs"? Hello, Mr. Juvenile!)

And even though by now it's way beyond obvious that other than sophistry, you really have NOTHING to say, I again ask, WHAT IS YOUR POINT? That it's actually a GOOD idea to run out and excise body parts at great expense for no real reason? WHAT?

spiritwalker (anonymous profile)
May 27, 2013 at 12:11 p.m. (Suggest removal)

Are you circumcised spiritwalker?

Ken_Volok (anonymous profile)
May 27, 2013 at 12:17 p.m. (Suggest removal)

Are you mentally ill or something, Volok? What business is that of yours? And just what the hell does that question have to do with... ANYTHING?

(Seriously, if you're trying to wear me down, I'm going to just keep pointing out that you are increasingly off topic and must be desperate if you can't think of anything to do but pose inappropriate questions about circumcision - get a grip, man!)

spiritwalker (anonymous profile)
May 27, 2013 at 12:34 p.m. (Suggest removal)

Well you were really interested in my parts so I thought it was only fair to ask.

Ken_Volok (anonymous profile)
May 27, 2013 at 12:59 p.m. (Suggest removal)

You know, Volok, the more time I spend "talking" to you, the more convinced I become that you're not a real person at all - in fact, you really do seem like one of those artificial "persona" programs for use by internet disinfo specialists. (Or else, maybe you're just schizophrenic - which is it?)

And to set the record straight (for the umpteenth time), I was NEVER interested in your "parts", you came on strong with your whole "Angelina is SO brave" routine, and I merely asked if you were willing to undergo the equivalent male surgery. (So, in other words, even though you seem like you've already been castrated, I just wondered if it was on the table in a hypothetical sense.)

spiritwalker (anonymous profile)
May 27, 2013 at 5:26 p.m. (Suggest removal)

Ken Volok is currently out of service. Please see one of our other bots who will be more than happy to debunk you.

Ken_Volok (anonymous profile)
May 27, 2013 at 7:05 p.m. (Suggest removal)

Ooh, finally a chink in Ken-bots armor! (Thanks for the half hearted attempt at honesty, but the truth is that you couldn't "debunk" your way out of a wet paper bag!)

spiritwalker (anonymous profile)
May 27, 2013 at 7:50 p.m. (Suggest removal)

The whole house of cards is falling now.

Ken_Volok (anonymous profile)
May 27, 2013 at 8:02 p.m. (Suggest removal)

Her aunt just died of breast cancer. (

Was she a chain smoker?

billclausen (anonymous profile)
May 27, 2013 at 8:28 p.m. (Suggest removal)

Jolie's aunt just died of ovarian cancer. Not surprisingly, she had the same gene defect Angelina has:

Given her family history of cancer (mom + aunt) plus a positive result for the BRCA1 gene defect, the cards were seriously stacked against Angelina before her mastectomy.

Phophylactic mastectomy and removal of the fallopian tubes are some of the legitimate options available to those who carry defective BRCA1 or BRCA2 genes:

Remember, we're talking about the risk profile for women *with* the gene defect. It must be an enormously difficult decision to make for the patients and families involved.

EastBeach (anonymous profile)
May 27, 2013 at 9:39 p.m. (Suggest removal)

@spiritwalker, nobody is saying prophylactic surgeries like mastectomies are recommended for all women.

But for women with the BRCA1/2 gene mutations + a family history of cancer like Jolie, the odds against them are so high, it's a totally different story.

EastBeach (anonymous profile)
May 27, 2013 at 10:02 p.m. (Suggest removal)

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