For Jolie, the surgery eliminated fear. "My chances of developing breast cancer have dropped from 87 percent to under 5 percent. I can tell my children that they don't need to fear they will lose me to breast cancer," she wrote. "The decision to have a mastectomy was not easy. But it is one I am very happy that I made.... I do not feel any less of a woman. I feel empowered that I made a strong choice that in no way diminishes my femininity."
Much of the work physicians may face in light of Jolie's story will involve providing information and alleviating the kind of anxiety Jolie described — time-consuming tasks, especially because many women tend to overestimate their risk, said Mary Jane Esplen, RN, PhD, head, Program of Psychosocial and Psychotherapy Research in Cancer Genetics at Toronto General Research Institute, in Canada.
Dr. Esplen has found psychosocial oncology counseling helpful for women who cannot always accept the facts when they are told that their risk is low.
"Risk perceptions are not always based on what we might refer to as rational knowledge," she said. "We saw that just giving information alone wasn't modifying their own internal sense of risk. It had to do with family history, sometimes there were losses in families and it had to do with grief, and it had to do with this imprint that's left with a family history and the experiences associated with that."
Referring patients to genetic counseling can also be effective in diffusing anxiety, said Dr. Madlensky, debunking the notion that such counselors are hard to find.
"One of the biggest myths is that its hard to get access to a cancer genetic specialist," she said, but that is not the case. The National Society of Genetic Counselors 2012 professional status survey found that wait times for the vast majority of its members were within a 2-week period, she noted.
Medscape Medical News © 2013
Send comments and news tips to firstname.lastname@example.org.
Cite this: Angelina Jolie's Mastectomy: BRCA Testing in the Spotlight - Medscape - May 16, 2013.