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Angelina Jolie: Her victory over breast cancer

She has a good laugh! Angelina Jolie shows her decision to breast cancer.
Photo: Getty Images
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  1. Live healthy
  2. What's up with the blood test that Ms. Jolie made? What is the value of this test?
  3. In the United States, Great Britain and the Netherlands, preventive mastectomy seems to be more common than in Germany. Is that true, and if so, how can you explain that?
  4. It is said that in Germany, 3% of genetically pre-stressed, but healthy women opt for preventive mastectomy as a preventive measure. Can you imagine that this intervention after the "Angelina Jolie case" in this country receives increased attention and becomes an established precautionary measure?

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After yesterday's news of Angelina Jolie's preventive mastectomy went wild in the media and today Brad Pitt commented on his partner's "heroic" decision, we wanted to know what's really behind Jolie's decision. For this we asked un

Miss Dr. Witzel, Angelina Jolie, fearing, like her mother Marcheline Bertrand, of dying of ovarian cancer and leaving her family alone, has decided to agree to a removal of the glandular tissue of her breasts. She bases her decision on the result of a blood test, with which the so-called gene mutation BRCA1 was localized. Can you tell us about it in more detail?

Dr. Witzel: Yes, Angelina Jolie is the mutation carrier of a BRCA1 mutation. Overall, gene mutations are responsible for only 5-10% of all breast cancers ( breast or malignant breast tumor). The two main genes responsible for hereditary breast cancer are BRCA-1 and 2, but there are other genes that have been relatively rediscovered, such as RAD51C, and other risk genes that have not yet been identified. In fact, as in the case of Angeline Jolie, if there is a mutation, this means that the woman has a lifetime risk of over 80% (in the case of the BRCA-1 mutation) of contracting breast cancer. The background risk is 10% (the "normal woman").

In addition, a woman with BRCA-1 mutation has an increased risk of ovarian cancer (20-60%). For BRCA-2 mutations, the disease probabilities are slightly lower. (Editor's note: Angelina Jolie said yesterday in her statement that she has given physicians a 50% chance of contracting ovarian cancer.)

What's up with the blood test that Ms. Jolie made? What is the value of this test?

Dr. Witzel: The blood test is a genetic test in which it is examined in women who might be mutation carriers, whether a mutation in the two genes is present (BRCA-1 and 2), (possibly also other genes CHEK2 or RAD 51C).

The process is as follows: First, the family tree is collected. If, due to the family tree, there is a probability of over 10% that a mutation could occur, the test will be taken over by the health insurance company and offered to the woman. The woman does not have to be tested, she can speak out after extensive consultation for or against the test. If there is no mutation in a high-risk family, the woman can be offered intensified breast cancer care (including once a year MRI of the breast, once a year mammography and twice a year breast ultrasound).

What is the real benefit of the preventive surgery? Can you name a number of women who actually do not develop breast cancer after the procedure ?

Dr. Witzel: At the actual high risk, the woman can either do an intensified breast cancer screening to detect a disease earlier, treat her sooner and be more likely to be cured, or she can perform risk-reducing surgeries, one of which is the removal of the ovaries and fallopian tubes, which is performed at the age of 40, reduces the risk of breast cancer by 50%.

The precautionary removal of the glandular tissue of both breasts, as with Angelina Jolie actually reduces the risk of breast cancer by at least 90-94%. Nevertheless, one should not forget in the discussion that an eg 80% probability of disease means that 20% of the women remain healthy. So you really have to weigh whether you want to carry out operations (with complication rates, follow-up interventions, etc.). It is important to note that surgery is only useful in women with a proven mutation, never in women who do not have a mutation.

In the United States, Great Britain and the Netherlands, preventive mastectomy seems to be more common than in Germany. Is that true, and if so, how can you explain that?

Dr. Witzel: Yes, prophylactic breast operations are actually performed more frequently abroad.

It is said that in Germany, 3% of genetically biased but healthy women opt for preventive mastectomy as a preventive measure. Can you imagine that this intervention after the "Angelina Jolie case" in this country receives increased attention and becomes an established preventive measure?

Dr. Witzel: The coverage will probably lead to women asking for such interventions even without mutation. Women with proven mutations are usually very well informed about all options of prevention, surgeries, etc.

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