With her star power, Angelina Jolie turned the touchy subject of breast cancer and mastectomies into a household conversation Tuesday.
The Oscar-winning actress announced that she had a preventive double mastectomy. She had tested positive for carrying a gene mutation – called BRCA1 – that significantly increases her risk of breast cancer.
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The gene is a rarity, but if women have the harmful BRCA mutations, it can increase the odds of breast cancer by five times. In Canada, about one in 250 women carry the BRCA1 or BRCA2 mutation that puts them at an 80 per cent risk of breast cancer, according to Dr. Kelly Metcalfe, a University of Toronto professor and cancer prevention expert. “It’s significantly elevated compared to the average woman,” Metcalfe told Global News. A simple blood test could be critical in flagging a heightened risk of breast cancer, experts say. It could lead to proactive action for women and their families. “Having the knowledge is power. Once you know that you have the mutation and you know you have a certain risk, you can take steps proactively to find things quicker, at an earlier, more treatable stage. Or you can inform your family so they can take steps to protect themselves as well,” Dr. Stephanie Hines, of the Mayo Clinic’s Internal Medicine department, told reporters.
What is the BRCA mutation?
There are two types of BRCA – or breast cancer susceptibility gene. They’re called BRCA1 and BRCA2. The pair are tumour-suppressing genes, according to the National Cancer Institute. They’re meant to stabilize the cell’s DNA and prevent uncontrollable cell growth. But if they mutate, the BRCA genes can lead to breast cancer or ovarian cancer. How many women have these mutated genes in Canada and how does this increase their risk of cancer?
One in 250 women have the BRCA1 or BRCA2 genes in Canada. The average woman has an 11 per cent risk of breast cancer, Metcalfe said. But if a woman has one of these harmful genes, their risk increases by 80 per cent. They also face an elevated risk of ovarian cancer. The typical woman has a one per cent risk of ovarian cancer – with BRCA1, that risk jumps to 60 per cent. With BRCA2, the risk is 40 per cent. “Both men and women can have these mutations, it’s not sex specific for women,” Metcalfe warned. Are some groups more susceptible to having the genes?In the general Caucasian population, one in 250 people have BRCA1 or BRCA2. But it’s more common in women of Eastern European Jewish descent. In those cases, one in 50 women have the gene. One study found 2.3 per cent of women in that group had the mutations – that’s about five times higher than in the general population, the Associated Press reported.
Other ethnic groups, including the Norwegian, Dutch and Icelandic people, have slightly higher rates of these mutations. British Columbia health officials shed light on certain populations who have a higher chance of these gene changes here.
How can you find out if you have the BRCA1 or BRCA2 mutations? A simple blood test at your doctor’s office can help Canadians detect if they have either mutation. It could take weeks to receive your results, as the blood work is sent to a laboratory. About three to five per cent of women who develop breast cancer have the mutations, the Centers for Disease Control and Prevention says. The cost of genetic testing is covered in Canada — if the specific gene mutation is already confirmed in your family. If not a doctor can refer genetic counselling and testing — and if you meet certain criteria the test will be paid for by provincial health care. If you test positive for the gene and you chose a double mastectomy – the cost of that surgery is covered.
How many women have double mastectomies after learning they carry the genes? In Canada, about 30 per cent of women with the BRCA1 or 2 genes go on to have double mastectomies, Metcalfe said. She’s conducted international research to see if this is similar in other countries – mastectomies appear to be more common in the United States, but much less popular in Europe. “We’re not sure why these differences exist, it may be something cultural but it may be also related to the information given to women about cancer risk reduction options,” she said. Does the cancer risk lessen following a double mastectomy? Jolie said her risk of getting breast cancer decreased from 87 per cent to five per cent after undergoing a double mastectomy.
Metcalfe said that the risk can be up to five per cent, but “even that is an overestimate.” She said doctors tell women the risk goes down to one per cent. What other options do women have? “The decision is very difficult to make, we were hearing this in our clinics all the time,” Metcalfe said. Right now, women can consider a double mastectomy, but they can also look into breast cancer screenings, from mammograms to MRIs, which can also pick up cancers at very early stages. “It’s a very personal decision. For some women, they know absolutely what they’re going to do but for most women, it’s a very difficult decision to make,” Metcalfe explained. She even created an aid to help women walk through the decision-making and weigh their options. She suggests that women look into their reconstructive options, meet with peers who have experienced different options and study photographs of post-mastectomies so they understand what their bodies could look like after
Your Mind, Boost Your Mood
Being diagnosed with breast cancer can make you feel scared, anxious, stressed, and sleepless. Besides the diagnosis itself, there’s uncertainty everywhere. Your mind is swimming with all kinds of questions: Which doctors will be on your team? What treatments will you get? What are the possible side effects? How do you tell your children, other family members, and coworkers? As a dual citizen, both doctor and patient myself, I have had the same fears and concerns as other women: About half of women diagnosed with breast cancer are distressed and feel anxious and depressed. Up to half of all cancer patients have sleep problems. For about a third of people undergoing or beyond treatment for cancer, these problems can stop them from being their best — lasting a short time or even years. Medicines such as antidepressants may offer some relief. Still, these medicines can have side effects and some may lessen the benefits of tamoxifen. Fortunately, there are ways to calm emotions and boost quality of life without medicine. One of the most effective ways to do this without medicine is to practice a type of meditation called Mindfulness-Based Stress Reduction.
What is mindfulness meditation?
There are many types of meditation, and all have one goal: getting yourself into a state called “mindfulness.” Mindfulness means you pay attention to each moment of your life without judging it. Mindfulness meditation aims to make you more aware of your feelings, thoughts, sensations, and behaviors as they happen. This way, you have a calmer, clearer mind that’s better able to experience joy and to accept and respond to stress. While it is based on some principles of Buddhism, meditation is not a religion.
Mindfulness-Based Stress Reduction is a form of mindfulness meditation. It’s designed to help people facing illness, pain, and other problems. It combines attention-focusing exercises such as becoming aware of your breathing, reviewing each part of your body to notice how it feels (called body scanning), and gentle yoga poses that are easy to learn. When you scan your body, you pay attention to sensations in of all parts of your body in sequence, from feet to head.
Mindfulness-Based Stress Reduction was developed in 1979 by Jon Kabat-Zinn, a professor at the University of Massachusetts Medical School. He is the founder of its Center for Mindfulness in Medicine, Health Care, and Society, which does research on Mindfulness-Based Stress Reduction and offers group classes on it. To get a feel for what Mindfulness-Based Stress Reduction is, you can listen to this short podcast.
The healing benefits of Mindfulness-Based Stress Reduction
In studies on how Mindfulness-Based Stress Reduction can help people with cancer, scientists usually compare people trained in Mindfulness-Based Stress Reduction to people who don’t meditate or who use another type of stress reduction.
Help for stress and mood changes:
A 2014 study compared 79 breast cancer survivors in a 6-week Mindfulness-Based Stress Reduction program to women getting standard breast cancer care. Six weeks after their meditation program, those women slept better and woke up less often than women getting standard care. How does it work?
How can something as simple as greater body awareness improve our mental health? It’s not completely clear, but we do know that emotions affect the body’s responses. Some scientists think practicing mindfulness affects how the brain works, possibly by strengthening nerve pathways in the parts that control certain behaviors.
When a person feels stress, activity in the part of the brain called the prefrontal cortex, which is responsible for conscious thinking and planning, decreases. At the same time, activity increases in other parts of the brain: the amygdala, hypothalamus, and anterior cingulate cortex, which are areas that quickly activate the body’s stress response.
Studies have suggested that mindfulness reverses these patterns during stress. Mindfulness increases prefrontal cortex activity, which can regulate and turn down your body’s stress response.
How to start It’s worth mentioning that a number of researchers have noticed that people enjoy doing Mindfulness-Based Stress Reduction and tend to stick with the program.
To get the best results from Mindfulness-Based Stress Reduction:
talk to your doctor before starting — together you can decide if it’s right for you check to see if your insurance company covers mindfulness meditation classes
some workplaces offer the training at low or no cost, so ask your employer or check this list if possible, find a class aimed at breast cancer survivors, called Mindfulness-Based Stress Reduction (BC); look for an instructor that’s experienced and certified
once you start, tell your treatment team that you’re practicing mindfulness meditation practice regularly (alone or with others) in a quiet, private setting; it can be done almost anywhere, such as while sitting in traffic or taking a walk
your doctor may ask you to track if and how well mindfulness meditation is working; try keeping a symptom log for several weeks or months, writing down each time you meditate and how you feel before, during, and after