Showing posts with label mastectomy. Show all posts
Showing posts with label mastectomy. Show all posts

Thursday, May 10, 2018








Five years ago, Ms. Angelina Jolie elected to proceed with prophylactic double mastectomy after undergoing genetic screening and learning that she had a significantly elevated risk of developing breast cancer due to mutation of the BRCA1 gene. As a member of her surgical team, I was deeply moved by her courage and benevolence as Ms. Jolie shared with the world her journey through mastectomy, breast reconstruction and recovery.
Today, her story continues to inspire increasing numbers of high-risk women to undergo genetic screening. A greater number of women are now aware of the concept of preventative mastectomy and reconstruction. The media has dubbed this the "Angelina Jolie effect." To me, it is an ongoing source of inspiration and an example of how one woman has made such a tremendously positive impact upon the lives of others.
I have personally seen women whose lives were likely saved as a result of the public awareness that has resulted from the "Angelina Jolie effect."
During the past five years, breast cancer risk assessment has continued to evolve. Today we understand that BRCA mutations are only two of many mutations that significantly elevate breast cancer risk. Multi-gene panels now assess for a variety of mutations – including those affecting the CHEK2, PALB2, PTEN and TP53 genes, as well as many others. Identification of these gene mutations help to assess breast cancer risk during a woman's lifetime.
We now recognize a number of factors in one's personal and family history that might make genetic testing advisable. These include:
  • Personal history of breast cancer, including bilateral breast cancer or diagnosis of triple negative breast cancer by age 60
  • Personal history of ovarian cancer
  • Family history of breast cancer before age 50 in two or more close relatives, including a mother, sister or daughter
  • Close relatives of Eastern European Jewish ancestry who have a history of breast, ovarian or pancreatic cancer
  • A close male relative with breast cancer
Breast cancer risk drops by approximately 90% among women who undergo prophylactic mastectomy. However, it is important to consider both the major and very personal nature of this decision. Undergoing a preventative mastectomy isn't right for every high-risk woman. Factors such as her estimated lifetime breast cancer risk, her willingness to tolerate that risk and her overall health must be considered.
Once the decision to undergo prophylactic mastectomy is made, the reconstructive options must be considered. As a plastic surgeon, I believe that it is very important to address with the patient the approaches that include the use of implants, as well as one's own tissues, to create the new breast.
Each patient is unique, and a personalized plan must be developed. In order to arrive at this plan, patient preferences, body type, lifestyle and overall health should all be taken into account.
During the process, it is essential that every patient take the time to develop a support team in which she is comfortable and confident. This team may include both general and plastic surgeons, medical and radiation oncologists, an internist, a geneticist and others. While the patient is the captain of her team, it is the privilege of each member of her team to strongly stand with her in helping to minimize long-term risk, maintain or achieve good health and restore wholeness.

Sunday, November 2, 2014








The Angelina Effect: More Women Looking Into Genetic Testing
Since Angelina Jolie's decision to have a double mastectomy to prevent breast cancer, the number of women looking into genetic testing more than doubled. Doreen Gentzler reports.



Tuesday, June 10, 2014


An excellent, comprehensive interview by the Evening Standard and includes Angelina's acknowledgement of Maleficent's rape scene.



Updated: 09:46, 10 June 2014
 
As heads of Governments, NGOs, lawyers and doctors converge on the ExCel Centre today for an extraordinary summit, the Hollywood actress and campaigner Angelina Jolie arrives just in time to provide the fairy dust.

Humanity can bear only so much policy – it deserves some beauty and charisma to sugar the pill.  No one should doubt the star’s clout or commitment. When Jolie speaks, heads of state listen. She is a powerful voice on behalf of victims of war, particularly women. Her statement today is that the summit must answer the grievances of girls kidnapped in Nigeria, wives stoned in Pakistan and women raped in many war zones.

“This sends a big message round the world, you see how women are treated as second class citizens and abused. This is to say: ‘No, you can’t and we will, in an organised fashion, come after you.’”
For Jolie, 39, this is personal. “I will work on this for as long as I am alive. For as long as it takes.”
It is thanks to a remarkable partnership between the actress and the British Foreign Secretary William Hague that the issue of rape in war zones has such prominence. For students of politics and leadership, the method is almost as interesting as the topic.

Politicians alone – with their poor standing on social media and their narrow processes cannot “shift the dial” on social change. But social change cannot happen without them. Legislation matters, Governments must be involved as well as “the people”. The summit today could be a template for how to tackle the big global issues.

Jolie is convinced that this coalition of players is the way to crack social injustice. “If this works, it can spill out into all the other crimes against humanity. I think this kind of summit is the only way to address these issues in a comprehensive fashion to get change and make a difference.”

She is shrewd enough to understand the value of her power base. I ask her if she is likely to move into conventional politics and she says, politely: “If I felt I could effect change, I would certainly consider it.” But isn’t she in a more powerful position as a globally known actress and humanitarian? “It is certainly more unusual. It is interesting to be able to work with all sides in all ways and to work as a citizen of the world. I wouldn’t want that taken away.”

I note that Hillary Clinton’s autobiography – seen as presaging a presidential bid – is published today. Is Jolie backing her, or contemplating a role in her administration? She answers deliberately: “I shall be following every candidate.”

By working with whoever is in power, Jolie can makes things happen. She is a beauteous version of Henry Kissinger, a superb negotiator in designer clothing.

We meet in a central London hotel, where Jolie has hardly had time to unpack before the summit. This is trivial hardship compared to last time we met, in March 2013, on an RAF flight to the Democratic Republic of Congo. Jolie joined William Hague to meet survivors of war rape and to flesh out a solution with the Governments of Congo and Rwanda. It was only after the trip that the media learned the actress had also undergone a preventative double mastectomy.

I recall the unmade roads, and shuddering helicopters and asked what on earth made her do the trip at that time.

Her preternaturally grey eyes fasten on me in surprise. “Honestly? There was no way I wasn’t going to be on that trip and certainly when you think of what those women suffer it was the least I could do."

She pauses: “And in a way, it helped to heal me because any pain or discomfort or concern I had became secondary in comparison. You would be ashamed if you did complain about it.”

Later, Jolie made another bold decision. She kept quiet about her operation in the field, but later wrote about it when securely and privately back in LA. Once again, she refused to claim special privilege.

“I do feel very human in my connection to others. I felt in that moment it was something I would have wanted other people to help me with.” She refers to her mother, who died of ovarian cancer at the age of 56: “To know I had this option and it could prevent me from dying young and leaving my children. It was something important to discuss and I have been so extremely grateful to women round the world who have in turn shared their stories.”

For some commentators, it was an awkward association. Here was a Hollywood woman voted the most beautiful in the world. How would it affect her image to have her breasts removed?

Jolie, whose humanitarian work has made her appreciative of unexpected goodness, says that she was “pleasantly surprised” by the general reaction of the public.

“I grew up in Hollywood, so I was expecting more of that silliness, I expected more surface judgement.”

In a way, her operation was central to the Jolie persona. She is both sex symbol and madonna. Her rebellious child star self has given way to a kind of overflowing maternal spirit, with unusual empathy.

She and her partner Brad Pitt have three children, adopted from Cambodia, Ethiopia and Vietnam, as well as three biological children.

Jolie, slender as grasses and with a Disney delineation of features, leans across the hotel sofa earnestly.

“Always since I can remember as a little girl, I felt that I wanted to adopt; as soon as I was aware that there were children in the world who needed families. It seemed a natural thing to do. It seemed so simple, if you were ready to be a mother and children needed a home.”

“But I think like most people I went through not being sure that I was good enough to be somebody’s mother. And especially I take very seriously bringing a child into my home that I did not give birth to. Maybe there is even an extra responsibility, a desire to earn this child. Then when I went to Cambodia, it was one of those strange moments when I just knew this is what was supposed to be.”

An armchair psychologist might link the reverence for the maternal impulse with Jolie’s loss of her own mother: “I had a great mother,” she says. “It is hard to think I could ever be as good as she was. Her whole life was motherhood. Like every mother you hope you are making the right choices but I love my kids so deeply.” She says that because her children are “home schooled” they accompany her on some trips and she hopes will inherit “a bigger picture of life”.

I had wondered if Jolie departmentalised her life into “Hollywood” and “the world” but it occurred to me that her humanitarian work finds unseen outlets. In her latest film, the Disney Maleficent, loosely based on Sleeping Beauty, she plays a fairy who falls in love with a human. He is ordered to kill her by the king, but instead strips her of her wings. She is desolate and bitter.

Was this a metaphor for rape? “You are the first person to ask,” she beams. “I was wondering who would figure it out. I am so happy that you have. We were all very conscious of it, it was in fact rape, it was clear. She was with a man, she is violated and of course it is a Disney story but she goes through a period of losing herself and her femininity and her motherly qualities, then she is able to remember them again, in her case, because of a child.”

Rape is not opaque in Jolie’s directorial debut, In the Land of Blood and Honey, being shown at the summit tomorrow, Wednesday. It is explicit and brutal. William Hague’s Bosnian special adviser, Arminka Helic, credits Jolie with an astonishing grasp of her country and the consequences of the war in the early 1990s.

By contrast, Jolie’s next film, which she has directed and is currently editing, is about the heroism of war. It is called Unbroken, and is the tale of an All American legend, Louis Zamperini, an Olympic winner, a World War II prisoner of war, a survivor, a Christian.

Was she deliberately scouting for a male role model? “Both my films have been war films. In extreme circumstances it brings out the worst and the best in human nature. In some ways, the films are not dissimilar. The unbroken strength of the human spirit, overcoming hate.”

Jolie says she intends to direct and write more and act less while continuing to “ fight the good fight” through her humanitarian work.

She is particularly interested in the balm of dignity given to victims of war. She describes a refugee asking her for soap. “ The woman explained to me how it hurt her not to be clean. That she wasn’t the woman I saw. She was so ashamed. And it is so painful for refugees not to be able to give their children what they ask for – I cannot imagine having to deny my children.”

Today, Jolie will be among political leaders and ordinary women who have survived unspeakable horrors. She will be equally at ease with government statistics and personal anecdotes. The wild, tattooed Hollywood child turned global humanitarian crosses all boundaries. She is a one-woman  soft power solution and William Hague’s chief weapon in executing change.


Read the post at eveningstandard




























Tuesday, February 11, 2014






latimes

Breast cancer and BRCA mutations: Removing healthy breast saves lives


By Karen Kaplan

February 12, 2014, 10:30 a.m.



Women considering a mastectomy after being diagnosed with breast cancer often face a difficult decision: whether to remove their healthy breast as well.
A new study should make it easier for some of these women to make up their minds. It concludes that patients with a dangerous mutation in their BRCA1 or BRCA2 gene were able to cut their risk of dying from breast cancer nearly in half by opting to remove both breasts.
The BRCA1 and BRCA2 genes contain instructions for producing tumor suppressor proteins, which repair damaged DNA and keep cells from turning cancerous. But certain mutations in these genes prevent those proteins from doing their job. As a result, a woman with one of those mutations is estimated to have a 60% to 70% chance of developing breast cancer at some point in her life. (For women without these mutations, the average lifetime risk of breast cancer is 12.4%, according to the National Cancer Institute.)
Studies have found that in the U.S. and Canada, about half of women with a BRCA mutation who develop cancer in one breast opt to remove the other breast as well, in a procedure called a contralateral mastectomy. But researchers had not been able to show that this logical-seeming strategy worked as planned.
RELATED: Foods that affect your risk of cancer
So a team of investigators from the two countries examined the medical records of 390 women who had been diagnosed with Stage 1 or Stage 2 breast cancer between 1977 and 2009. All of the women had a confirmed high-risk mutation in one of their BRCA genes, or they were from a family that was known to carry the mutation and were presumed to have it too.
Among these 390 patients, 44 decided to remove both breasts at the same time, even though one of the breasts was cancer-free. Among the 346 who initially had a single mastectomy, 137 — or 40% — later opted to remove their remaining breast even though it was cancer-free. In these cases, the average gap between the two procedures was 2.3 years. (The researchers hypothesized that these women didn’t remove their second breast right away because didn’t yet know that they had a BRCA mutation.)
In the first decade after their initial surgery, there was no real difference in survival rates for the patients who removed both breasts compared to the patients who removed one. But in the second decade, the benefits became clear: Women who went ahead and removed their healthy breast were 80% less likely to die of breast cancer than women who only removed one breast.
Over the entire 20-year period of the study, 31% of the women who had only a single mastectomy died of breast cancer. However, the women who removed both breasts were 48% less likely to die of the disease. The results were published online Tuesday by the British Medical Journal.
The researchers shared a theory about why it took so long for the benefits of a contralateral mastectomy to kick in. Among the 209 women who only had a single mastectomy, 70 of them later developed a new breast cancer in their remaining breast, and 61 of them died as a result. The researchers calculated that these second cancers were more than twice as deadly as the initial cancers. Those second breast cancers take many years to arise, the researchers wrote.
The researchers advised doctors to recommend a contralateral mastectomy to their patients with early-stage breast cancer if they have a BRCA mutation. Even patients who have already had a single mastectomy should be informed of the benefits of double mastectomy, they added.
In many ways, the dilemma faced by these cancer patients is similar to the one that led Angelina Jolie to have a double mastectomy before cancer arose in either breast, according to an editorial that accompanies the study written by Karin Michels, an epidemiologist at Harvard Medical School who studies how epigenetics influence the risk of breast cancer.
For breast cancer patients with BRCA mutations who are considering a contralateral mastectomy, there’s only one question that matters, Michels wrote: “Will this reduce my risk of dying from breast cancer?” The new study suggests the answer is yes.

If you're interested in the latest scientific and medical studies, you like the things I write about. Follow me on Twitter and "like" Los Angeles Times Science & Health on Facebook.







nj.com

Angelina Jolie's approach to breast cancer gene may be best: researchers

By Kathleen O'Brien/The Star-Ledger

When actress Angelina Jolie announced last May she’d had a double mastectomy to dodge the risk of gene-related breast cancer, critics wondered if she’d overreacted.
Now, however, a study of the 20-year survival rate of women with the BRCA 1 or 2 gene confirms she may be right: Women with that mutation are more likely to survive early cancer if they have both breasts removed, not just the cancerous one.
Researchers in the United States and Canada looked at the records of women who had early-stage breast cancer from 1975 through 2009. Most of those women had a single mastectomy; only 15 percent chose to remove the other, unaffected breast.
The double-mastectomy group saw a 48 percent reduction in breast cancer deaths compared to the single mastectomy group.
Phrased another way, if 100 women were treated for early breast cancer by having double mastectomies, 87 would still be alive 20 years later. If they had a single mastectomy instead, 66 would be alive after that same time period.
The only cautionary note was about the size of the study: It was small, examining the survival experience of just 390 women. For that reason, researchers said further research was need to confirm their findings.
Their study was published today at bmj.com, formerly the British Medical Journal.
The unconfirmed nature of the study's findings makes it risky to read too much into them, noted Rochelle Shoretz, executive director of Sharsheret, the national support group for young Jewish women facing breast cancer. The group’s headquarters is in Teaneck.
While BRCA1 and 2 genetic mutations are present in one in an estimated 345 people, that number drops to 1 in 40 individuals of Ashkenazi Jewish background. The mutations decrease the body's ability to ward off breast cancer.
Young women considering bilateral mastectomies for prevention purposes face unique considerations, Shoretz said. “They include the impact of surgical decisions on sexuality, breastfeeding and body image,” she said.
The researchers recommended that a double mastectomy be offered to any young woman with early stage cancer and the genetic mutation in her family history. In addition, women whose cancer was treated with a single mastectomy should be advised of the possibility of having the second, or “contralateral” breast removed as well as a precaution.


Wednesday, January 22, 2014






The New York Times’s Most Visited Content of 2013

The New York Times today released its Most Visited lists for 2013. Categories include the most visited articles and blog posts, multimedia and interactives, and videos throughout NYTimes.com, our mobile site and our iOS apps. The most visited of all our content was the interactive “How Y’all, Youse and You Guys Talk” (December 21).
Other highlights include:
Please see NYTimes for the full breakdown:





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Monday, November 11, 2013

bits













November 11th, 2013
10:45 PM ET

Zoraida Sambolin on opening up about her breast cancer battle: "It was Angelina Jolie who gave me the courage"

On the heels of ABC News correspondent Amy Robach's revelation of her recent breast cancer diagnosis, on Monday evening "Piers Morgan Live" invited Dr. Kristi Funk and Zoraida Sambolin to offer their personal and professional perspectives.
"Prevention does not yet exist," said Funk, who is Angelina Jolie's doctor. "So early detection is our best defense against this disease, and our only chance at a cure."
Sambolin, a breast cancer survivor, said it was Jolie who gave her the courage to announce her own diagnosis:
"She allowed me to be able talk about this decision. I was really hesitant," admitted the co-anchor of CNN's Early Start. "She [Jolie] talked about sexuality, which really hit me hard, because I was struggling with that. I was embarrassed to be struggling with that, Piers, because I thought, 'my breasts, really, they shouldn't matter this much to me. I've had my kids, I've breast fed, they've served their function in life,' yet I really did struggle. And those words in particular really helped me talk about this. And it was really healing to be able to talk."
If you are in need of care, visit Dr. Funk's Pink Lotus Breast Center.
Watch the clip for more of Morgan's interview with Dr. Kristi Funk and Zoraida Sambolin, and for the next edition of "Piers Morgan Live," watch CNN every night at 9.






















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Monday, October 14, 2013









abcnews

Jolie's Doctor Says Her Story Raises Awareness, Saves Lives

PHOTO: Actress Angelina Jolie attends the Women in the World Summit 2013
Angelina Jolie raised global awareness of breast cancer, genetic testing and pre-emptive medical procedures when she revealed her decision to have a double mastectomy five months ago. Now her surgeon says that by going public with her ordeal, the actress has saved lives.
"I'm seeing in my practice already women who are saying, 'I was inspired by that to get gene testing,'" said Dr. Jay Orringer, the Beverly Hills, Calif., surgeon who performed Jolie's breast reconstruction, in an interview with the New York Daily News this past weekend. "I think it's going to have a tremendously lasting impact."
The National Society of Genetic Counselors did indeed notice an immediate "Jolie Effect" as soon as the actress publicly revealed her medical situation.
On the day Jolie's op-ed about her decision and treatment appeared in The New York Times, visits to the society's "Find a Genetic Counselor" online tool jumped by 86 percent, according to the society, and the Preventive Mastectomy Fact Sheet, which typically receives fewer than 200 page views per day, according to the society, jumped to more than 69,000 page views.
Dr. Mehra Golshan, director of Breast Surgical Services at the Dana-Farber Cancer Institute and Brigham and Women's Hospital in Boston, said he agreed with Orringer that Jolie's story might help save lives by raising awareness of the disease, but he worries about a downside.
He said his practice had seen a 50 percent increase in requests for genetic counseling, which is positive, he said, but he believes patients sometimes act out of fear or before they have all the information they need to make informed choices.
"We have always gone through a complete family history with our breast cancer patients. The difference is now patients come in saying they want to be tested and meet with a reconstructive surgeon even before they go through an evaluation," Golshan said.
Golshan emphasized the importance of meeting with a genetic counselor to evaluate cancer risk before pushing forward with testing or treatment. He said he didn't recommend testing for people without a family history of breast or ovarian cancer. Because test results aren't always conclusive, they can lead to additional testing and the potential for unnecessary stress and cost, he said.
He also worried that instead of fighting to save their breasts as they did in the past, many women are choosing to remove them at the slightest hint of cancer, even if they don't carry one of the high-risk genetic mutations associated with a sharp increase in breast and ovarian cancer.
"We are now getting requests for contralateral prophylactic mastectomy surgery from patients who don't have a genetic predisposition for breast cancer and who won't necessarily benefit from breast removal," he said.
Women like Jolie, who have inherited a harmful mutation of either the BRACA1 or BRCA2 gene are about five times more likely than average to develop breast cancer, and up to 40 percent more likely to develop ovarian cancer, according to the National Cancer Institute. Experts increasingly believe that removing as much breast tissue as possible can be a lifesaving strategy.
In one recent study that followed nearly 2,500 women who carried one of the two dangerous gene variants, having a double mastectomy did appear to lower their risk of breast cancer. None of the women who opted to have their breasts or ovaries removed were diagnosed with breast cancer in the three decades they were followed, while 7 percent of those who chose not to have surgery were.
Golshan said, however, that only 5 percent to 10 percent of breast cancer patients fall into this high-risk category. For all other women, even those who've had breast cancer, surgery does not increase chances of survival and can lead to avoidable complications and health problems.
Dr. Stephen Grobmyer, the director of the Cleveland Clinic Breast Center, said he believed the Jolie Effect was responsible for the greater number of requests for genetic counseling and testing but not for the rise in pre-emptive mastectomies.
"The increased demand for surgery was not borne out of her editorial, and she was not the first to raise it. We've been talking about it for years," he said.
This appears to be true even for women without a high genetic risk. The Journal of Clinical Oncology reported an 188 percent jump in the surgery between 1998 and 2005 among women given a new diagnosis in one breast of ductal carcinoma in situ, or DCIS, the "stage zero" cancer. Among women with early-stage invasive disease, the rates soared more than 150 percent.
Grobmyer said he thought only good could come from Jolie being so up-front about her medical choices and that it was the responsibility of caregivers to steer their patients toward their own right medical choices.
"The most important thing Jolie has done is open the discussion and helped educate people about their family history of breast cancer," he said. "In that way, she probably is saving lives."
Join Dr. Richard Besser, ABC News' chief health and medical correspondent, for a tweet chat today at 1 p.m., ET on breast cancer prevention, diagnosis, treatment and survival.
While only a fraction of breast-cancer cases are linked to genetic mutations, there are many other risk factors associated with breast cancer, including age, environment and lifestyle. Besser will be joined by experts and those who've survived breast cancer to discuss these risks and what steps you can take to lower your chances of developing the disease.
Click here to find out how easy it is to join the conversation.









ETonline

Plastic Surgeon Lauds 'Remarkable' Angelina Jolie

By ROBERT PACE
October 14, 2013

The surgeon who performed Angelina Jolie's reconstructive surgery, Dr. Jay Orringer, gave ET his first TV interview about operating on the famed actress and his thoughts on her decision to reveal her surgery to the public.
"She's a remarkable individual. She made the brave choice to want to help others," Orringer told ET's Brooke Anderson.

PICS: Angelina's Most Unforgettable Moments
Jolie revealed in May that she underwent a preventative double mastectomy after discovering that she had a defective BRCA1 gene, which dramatically increased her risk for breast cancer.
Because of the reconstructive surgery she had soon after the double mastectomy procedure, she could have let the surgery slide under the radar, but instead decided to publicize the news in an op-ed, presumably to help bring awareness to breast cancer and gene testing.
"She's a...truly benevolent individual [who] I think really cares about other people," her reconstructive surgeon said about Jolie's bold choice to reveal her surgery. "...It made women think, 'Well, maybe I should be gene tested.' We're already seeing women come in and say, 'That saved my life!'"

RELATED: Celebs React To Angelina Jolie's Double Mastectomy
Watch the clip above to hear Dr. Orringer talk about Brad Pitt's support for Jolie during her surgery.
Dr. Orringer will be speaking at a fundraising event in Florida on Wednesday, Breast Reconstruction Awareness Day, to promote education awareness and access concerning post-mastectomy breast reconstruction.









NYDailyNews

EXCLUSIVE: Angelina Jolie's doctor says star's double mastectomy will have 'tremendously lasting impact' and save lives

Dr. Jay Orringer, a Beverly Hills plastic surgeon, tells The News that ever since Jolie revealed she had both of her breasts removed that many other women are getting proactive to find out their risk of getting breast cancer. 'I'm seeing in my practice already women who are saying, 'I was inspired by that to get gene testing,'' Orringer says.




 Dr. Jay Orringer recently performed reconstructive surgery on Angelina Jolie and says more women need to take a team approach to cancer care.

Angelina Jolie's double mastectomy "has already begun to save lives," the mega-star's plastic surgeon says, speaking out for the first time since the Oscar winner revealed her procedure five months ago.
“I’m seeing in my practice already women who are saying, ‘I was inspired by that to get gene testing,’” said Dr. Jay Orringer, the Beverly Hills surgeon who performed Jolie's reconstruction, in an exclusive interview with the Daily News. “I think it’s going to have a tremendously lasting impact.”
Angelina Jolie attends the world premiere of 'World War Z' in London in June.

Tim P. Whitby/Getty Images

Angelina Jolie attends the world premiere of 'World War Z' in London in June.

RELATED: ANGELINA JOLIE’S DOC TO SPEAK ON BREAST RECONSTRUCTION

The mom of six — Hollywood's highest paid actress and a United Nations humanitarian — announced in May that she had endured three months of procedures to have both breasts removed because of her high genetic risk of breast cancer.
The June movie premiere was one of Jolie’s first public appearances after announcing she had a double mastectomy.

Stuart C. Wilson/Getty Images for Paramount Pictures International

The June movie premiere was one of Jolie’s first public appearances after announcing she had a double mastectomy.

"My chances of developing breast cancer have dropped from 87 percent to under 5 percent," Jolie wrote in a surprise op-ed published in The New York Times that applauded partner Brad Pitt's support. "I can tell my children that they don’t need to fear they will lose me to breast cancer."

Angelina Jolie (right) with  her mother Marcheline Bertrand in 2001.

FRED PROUSER/REUTERS

Angelina Jolie (right) with her mother Marcheline Bertrand in 2001.

"I choose not to keep my story private because there are many women who do not know that they might be living under the shadow of cancer," she continued. "It is my hope that they, too, will be able to get gene tested, and that if they have a high risk they, too, will know that they have strong options."
Jolie's “brave, benevolent” decision to share her journey means that other women are more educated than ever about their own mastectomy and reconstruction options, Orringer said.
Angelina Jolie arrives for the world premiere of partner Brad Pitt's film 'World War Z' in London. Jolie praised Pitt for his support in her surprise op-ed in The New York Times.

NEIL HALL/REUTERS

Angelina Jolie arrives for the world premiere of partner Brad Pitt's film 'World War Z' in London. Jolie praised Pitt for his support in her surprise op-ed in The New York Times.

RELATED: JOLIE'S MASTECTOMY REFLECTS BETTER BREAST RECONSTRUCTION OPTIONS

Another positive development: as of the last decade, doctors increasingly work in teams to help women navigate the growing range of treatment and reconstruction choices, he said.
Despite a rocky start to her year, Jolie (left) is currently working on directing 'Unbroken,' a film based on the life of Louis Zamperini, 96 (right), a former Olympic runner and World War II Air Force veteran.

Universal Pictures

Despite a rocky start to her year, Jolie (left) is currently working on directing 'Unbroken,' a film based on the life of Louis Zamperini, 96 (right), a former Olympic runner and World War II Air Force veteran.

"It’s an initially daunting task to hear the many options — one mastectomy, two mastectomies; reconstruction options including round implants, shaped implants, the use of one’s own tissues — but I see the team approach as the patient being the captain and we as health care providers are members of that team helping her to arrive at a decision with which she’s most comfortable,” Orringer said.

PHOTOS: ANGELINA JOLIE ATTENDS 'WORLD WAR Z' PREMIERE
Marcheline Bertrand died of breast cancer and was the inspiration for daughter Angelina Jolie to get a gene test to determine her risk level of becoming sick from the disease.

Jim Smeal/WireImage

Marcheline Bertrand died of breast cancer and was the inspiration for daughter Angelina Jolie to get a gene test to determine her risk level of becoming sick from the disease.

That education is empowering, said Orringer, who will speak to colleagues Wednesday in Florida as part of the American Society of Plastic Surgeons’ Breast Reconstruction Awareness (BRA) Day.
“Even a patient who decides that she desires to have breast conservation (instead of a mastectomy) needs to understand the pros and cons,” Orringer said. “For example when radiation is given as part of breast conservation, there is damage to the chest wall that is permanent in nature. That could have very significant implications on the quality of future reconstruction should it be needed (if the cancer returns).
Mary Byrnes (pictured), another of Orringer’s patients, was initially “scared to death” by the prospect of reconstructive surgery, but changed her mind after the doctor 'just listened to me and really paid attention to what I wanted.'

Carlos Delgado/for New York Daily News

Mary Byrnes (pictured), another of Orringer’s patients, was initially “scared to death” by the prospect of reconstructive surgery, but changed her mind after the doctor 'just listened to me and really paid attention to what I wanted.'

“So in making the decision on which way she wishes to go, in terms of breast conservation versus standard mastectomy or nipple-sparing mastectomy, the consultation early on with a plastic surgeon is very valuable.”
Dr. Jay Orringer consults with a patient at his office in Beverly Hills, Calif.

Handout

Dr. Jay Orringer consults with a patient at his office in Beverly Hills, Calif.

Jolie's choice was familiar to Mary Byrnes, another of Orringer’s patients, who was initially “scared to death” by the prospect of reconstructive surgery.
 
RELATED: ANGELINA JOLIE REVEALS SHE UNDERWENT PREVENTATIVE DOUBLE MASTECTOMY
tmiller@nydailynews.com
Read the rest at NYDailyNews




Daily Mail

Angelina's surgeon says her double mastectomy decision has saved dozens despite concerns procedure is unnecessary for many women

By Daily Mail Reporter
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Angelina Jolie shocked the world when she announced earlier this year that she underwent a double mastectomy. Now, her plastic surgeon is saying that her operation has saved dozens of other women's lives.
Dr. Jay Orringer, the plastic surgeon who performed Jolie's reconstructive surgery, said in an interview with The New York Daily News, that Jolie's choice inspired other women to undergo the procedure.
'I'm seeing in my practice already women who are saying, "I was inspired by that to get gene testing,' Orringer said. 'I think it's going to have a tremendously lasting impact.'
Angelina Jolie's plastic surgeon, Dr. Jay Orringer, pictured, said he felt Jolie's double mastectomy would have a 'tremendously lasting impact' on other patients
Angelina Jolie's plastic surgeon, Dr. Jay Orringer, pictured, said he felt Jolie's double mastectomy would have a 'tremendously lasting impact' on other patients

Jolie, seen here in this July 2013 file photo, was told by doctors had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer before undergoing a double mastectomy
Jolie, seen here in this July 2013 file photo, was told by doctors had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer before undergoing a double mastectomy
Orringer said breast cancer patients like Jolie now have the benefit of doctors working in teams to provide the best medical options for them
Orringer said breast cancer patients like Jolie now have the benefit of doctors working in teams to provide the best medical options for them


Orringer also told the paper that as part of breast cancer treatment, doctors work in teams more and more to help breast cancer patients with medical options.
'It’s an initially daunting task to hear the many options — one mastectomy, two mastectomies; reconstruction options including round implants, shaped implants, the use of one’s own tissues — but I see the team approach as the patient being the captain and we as health care providers are members of that team helping her to arrive at a decision with which she’s most comfortable,' Orringer said.
Orringer also warned the paper that 'Even a patient who decides that she desires to have breast conservation (instead of a mastectomy) needs to understand the pros and cons [...] when radiation is given as part of breast conservation, there is damage to the chest wall that is permanent in nature.'

Orringer's patient wrote an op-ed in The New York Times in May, explaining her decision.
'My doctors estimated that I had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer, although the risk is different in the case of each woman,' she wrote.
Jolie's mother, Marcheline Bertrand, 56, died after a 10-year battle with ovarian cancer, The Hollywood Reporter notes.
Despite the increase of breast cancer awareness, others in the medical community, including Prof. Kefah Mokbel at the London Breast Institute, warn that some patients may request the surgery without any real benefit.
'It's obviously a great step forward that Angelina Jolie has increased awareness of breast cancer,' he told The Daily Mirror. He said he's seen many women request a preventative mastectomy 'who've been diagnosed but don't have a genetic predisposition so wouldn't benefit.'
Jolie, seen here with partner Brad Pitt in June 2013, underwent plastic surgery with Dr. Jay Orringer after her double mastectomy. Jolie's mother Marcheline Bertrand battled ovarian cancer for 10 years
Jolie, seen here with partner Brad Pitt in June 2013, underwent plastic surgery with Dr. Jay Orringer after her double mastectomy. Jolie's mother Marcheline Bertrand battled ovarian cancer for 10 years
In her op-ed Jolie wrote 'I can tell my children that they don¿t need to fear they will lose me to breast cancer' after having undergone the double mastectomy
In her op-ed Jolie wrote 'I can tell my children that they don¿t need to fear they will lose me to breast cancer' after having undergone the double mastectomy

Tuesday, September 24, 2013








yahoo shine

After Angelina Jolie announced that she’d had a mastectomy in an attempt to dodge cancer, calls from women wondering about the procedure rose sharply in the U.K., British breast cancer charities have reported.

The story, appearing in the Daily Mail on Wednesday, dubs the surge in queries the “Jolie effect,” noting that the number of calls to Cancer Research U.K.’s helpline have increased four-fold. Visits to the organization’s website made a similar jump following the celebrity’s revelation in May.

The 38-year-old's news that she’d tested positive for the BRCA-1 gene, which radically increases a woman's risk of developing breast or ovarian cancer, was made public via her New York Times Op-Ed piece “My Medical Choice.”

And, unsurprisingly, it’s had a similar influence on this side of the pond.

“The baseline of inquiries remains a little bit higher than it was pre-story,” Rebecca Nagy, cancer counselor and president of the National Society of Genetic Counselors, tells Yahoo Shine. She notes that, while the rise in interest over BRCA gene testing has waned a bit since May, its effect has generally been lasting.

“Some of my colleagues have noticed that the volume [of inquiries] spiked and has not gone down since,” Nagy says. “Others say it spiked and then went down. It seems to be dependent on location.” But in her own practice, she adds, “I have seen a continuation of more low-risk women coming in just to talk, and I don’t think they would’ve come in had that story not broken. They wanted to know their risk — even women who weren’t touched by cancer in their family. I found that interesting.” The disease does, however, run in Jolie's family. Both her mother and maternal aunt died of breast cancer.

A report from the National Cancer Institute, focusing on the days immediately following Jolie’s story, showed a marked increase in women searching for related information. On the day of her announcement, page views of the organization's website, Cancer.gov (in English and Spanish), were 54 percent higher than on the same day during the previous week. And the website’s Preventative Mastectomy FactSheet,  which normally receives less than 200 page views per day, skyrocketed to more than 69,000 on May 14.

Also, in just the two and a half days after Jolie's piece was published, the Cancer Information Service saw a tenfold jump in phone, email, and Web-chat inquiries.

“The news of Angelina Jolie’s preventative mastectomy drove one of the largest increases in engagement with NCI digital resources seen since measurement began,” stated the report, “Angelina Jolie’s Preventative Mastectomy: Impact on NCI Resources.”

In August, Myriad Genetics, which performs the majority of BRCA-gene tests in the country, noted the impact of Jolie’s announcement on its latest fiscal year. A report by the company called the period of time, which saw year-over-year growth of 51 percent, “stand-out.” It concluded that the Jolie effect would not likely last, though.

“While the company received a benefit from the recent celebrity publicity around breast cancer, the duration of this publicity benefit is likely to be short term,” the public fact sheet noted.

Read the rest at yahoo shine






CTV British Columbia
Published Tuesday, September 24, 2013 5:00PM PDT
Hollywood star power may be behind a recent spike in cancer screenings in British Columbia.
The BC Cancer Agency says the number of people coming in for genetic testing to find out about their cancer risk has increased dramatically in the months after Angelina Jolie shared news of her double mastectomy this spring.










Daily Mail

The Jolie effect: Number of women asking about mastectomies quadruples since actress revealed she had her breasts removed to reduce cancer risk

By Sophie Borland
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Breast cancer charities have reported a four-fold surge in women enquiring about having their breasts removed since Angelina Jolie announced she’d had the operation to lessen her risk of developing the disease.
Figures from Cancer Research UK show the numbers of calls to its helpline have increased four-fold while there has been a similar rise in visits to its website.

Read the rest at Daily Mail

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Friday, September 20, 2013



Town&Country


Of the hundreds of thousands of doctors working today, most toil in relative obscurity. Often, when one does achieve prominence, it's because of an important scientific discovery, like developing a new vaccine or cancer drug. Sometimes it's because he or she works for a venerable institution or is in charge of a major hospital. But every once in a while a doctor becomes famous—a celebrity, even—because of a patient she treats. That is certainly what happened to Kristi Funk, a 44-year-old breast cancer surgeon and a founder of the Pink Lotus Breast Center in Beverly Hills, on May 14 of this year. All it took was one sentence, published in an op-ed in the New York Times, to introduce her practice to the world: "Brad was at the Pink Lotus Breast Center, where I was treated, for every minute of the surgeries."

Brad is Brad Pitt, and the patient—and the writer of the article—is Angelina Jolie. Funk performed a bilateral mastectomy on the 38-year-old actress, who had the procedure because she carries a rare mutation of one of the BRCA genes, which she inherited from her mother. The mutation substantially increases her risk of developing breast and ovarian cancer. Fewer than 1 percent of women have this genetic defect, which can make their risk of breast cancer as high as 85 percent and their risk of ovarian cancer more than 50 percent. Preventive, or prophylactic, removal of the breasts and ovaries reduces the risk a great deal.

Jolie's story generated rabid interest, as it combined a deadly and rare genetic defect with a potentially disfiguring surgery affecting the breasts of one of the world's leading sex symbols, one known as much for her private life as for her work as an activist. It was at some level also a glimpse into a kind of medical care that most people think is reserved for the rich. The test for the BRCA mutations, marketed exclusively by Myriad Genetics at the time Jolie had her operation, costs more than $3,000. The company behind it cultivates a glamorous image; during the world's largest cancer meeting this spring in Chicago, it held its reception at a Rolls-Royce dealership. (Myriad may face some competition soon, because of a Supreme Court decision that threatens some of its patents.)

As a lung physician and researcher at Memorial Sloan-Kettering in New York City, I was intrigued. When I visited the Pink Lotus clinic several weeks after Jolie's announcement, the practice was visibly overwhelmed. Dr. Funk's husband Andy, an entrepreneur and investor, has run the center since it opened, four years ago. Following the announcement, its 100 inbound phone lines were all in use. At one point patients—and the media—were being put on hold for more than an hour and a half. "And they were still happy when they finally got through," Andy insists. New patient appointments are being scheduled two to three months in advance, although the center continues to prioritize those who have a diagnosis of cancer and need treatment, usually fitting them in within a week.

I had flown to Beverly Hills worried I was about to walk into a Truman Show version of a doctor's office. I imagined a place that would downplay the seriousness of breast cancer, as if it were a minor inconvenience like a sprained ankle, rather than the killer it can be. Breast cancer ranks second only to lung cancer in the number of women in the U.S. killed each year, and more than 40,000 will succumb to it this year—more than 100 each day. But I had it completely wrong. Yes, everyone who works in the clinic wears black and pink scrubs, and a few too many items, down to the coffee cups, bear the clinic's logo. But as a whole the place is rather unassuming.

I met Kristi Funk in the middle of a busy day. Her blond hair was pulled back, not elaborately done up. Her surgical scrubs were a little rumpled. Her mind was on her next patient. She explained her strong work ethic and focus by quoting her longtime mentor, John Ryan, the former chief of surgery at Virginia Mason Medical Center in Seattle, where she trained: "You're doing one thing right now. One thing. Do it right." But I had yet to see her in action.

She met me early in the morning at the back entrance of the clinic, the one used by high-profile patients like Sheryl Crow, who is a breast cancer survivor, and Jolie. Inside was a young woman who had also tested positive for a BRCA mutation. "She's an Angelina patient," Funk says, meaning that she came to the doctor after reading about the Oscar winner's treatment. She was now scheduled to have the same sequence of procedures.

Funk then performed a nipple-sparing surgery on her, the first in a three-step process. This operation involves detaching the nipple from the breast tissue underneath it, which is removed during the next phase. She got the idea of adding this step from plastic surgeons, who routinely perform multistep procedures. It means more work than a routine prophylactic mastectomy, and it's not well reimbursed. But the cosmetic outcome is better for some women. Prophylactic mastectomies are on the rise, not only for women who have the potentially deadly mutation but for women who don't have it and are still worried about getting breast cancer. The latter is a trend that experts, including the renowned breast cancer authority and author Susan Love, find worrisome. Love places the blame, in part, on the medical profession. "We have little to offer young women to prevent the disease," she says.

Any doubts I had were unfounded. Funk's surgical expertise was apparent from the first moment, her hands moving in synchrony with her operating room nurse's, banter flying back and forth about kids (the Funks have triplet boys) and the latest episode of The Following. She moved around the table as she operated, setting up her body and her hands at different angles for each part of the procedure. Watching her reminded me of my medical training at Johns Hopkins, where I had been lectured over and over that getting yourself and the patient in the right position before performing a procedure was critical to avoiding complications.
Afterward we discussed the fame she has achieved as a result of being Jolie's surgeon. "The decision to go public came entirely from her," Funk says. "She and Brad hope their situation can resonate with other women. They are busy in their respective lives and could not be happier than to allow the word to travel farther and louder because I can be the voice. Whatever criticism there is that I am taking advantage of my clientele is overruled by the good that is done."

Funk says that Jolie's decision to come to her was made over a period of several years, during which time Jolie sought many options. In the end, all roads led her to Pink Lotus. Ryan, Funk's mentor, wasn't surprised. "When I heard the story the first thing I said to my wife was, 'I bet Kristi was her surgeon,' " he says, noting the reputation she has earned as a discreet and highly skilled doctor to the Hollywood set. Landing Jolie as a patient may have given rise to resentment from other breast cancer surgeons, who are generally among the most supportive in the medical ranks. Not a single colleague in the Los Angeles area called after the news broke. "People are funny," Funk says by way of explanation.

Starting her own breast cancer clinic in the middle of Los Angeles, a city crowded with healthcare providers, has proved challenging. Funk grew up in Pacific Palisades, a tomboy surrounded by brothers, an unknowing overachiever who didn't realize she was first in her high school class until Stanford asked for a ranking on its college application. She studied psychology there with plans of becoming an actress, but after spending several months at Oxford and volunteering in Africa, she says she realized that she "could have a broader reach and a higher impact" by pursuing medicine. She enrolled at a top-flight medical school, at the University of California at Davis, and followed with training at Virginia Mason.

Some doctors relish taking care of patients' chronic medical problems through relationships that span many years. Funk is not that type of doctor. She's a prototypical surgeon: a doer, someone instinctively ready to solve problems with her own hands. After her general surgery training she discovered her specialty when she was given the opportunity to become a director of the breast surgery program at Cedars-Sinai, in Los Angeles. The ability to focus on a single disease and achieve mastery of it suited her. The inspiration for Pink Lotus came, in part, after she saw the healthcare system routinely failing to support women after an abnormal mammogram or a positive test for a BRCA mutation. "Women are anxious, and no one talks to them," she says. "I'm a good listener, and I know how important it is to get people answers right away."

Andy Funk echoes the sentiment, with a businessman's spin. He says that Cedars-Sinai and other big hospitals in Los Angeles are not designed for the patients they serve. Specialist doctors each do their own thing, and patients bounce around among them, having to make their own appointments and even carry their own records from place to place. As a result, no one seems to have a plan, and nobody is in a particular rush to communicate with the patient. This rings true to me, after years of seeing patients so frustrated by the disarray in healthcare and the contradictory messages they get from doctors that they end up more worried about understanding the healthcare system than they are about the condition they're trying to get treated.

Pink Lotus has on-site most of what is needed to make an initial diagnosis after an abnormal mammogram, so women get answers—and one-on-one attention—within a few days. The Funks are building satellite locations for mammography around Los Angeles and have plans for comprehensive breast cancer care centers in other cities. They are also currently fielding inquiries from physicians at major cancer centers who are interested in practicing the kind of patient-centered medicine so many doctors would like to be able to deliver.

Making the business work is a challenge, particularly because Funk is committed to caring for any woman who wants to come in. The center takes Medicare, Medi-Cal (California's Medicaid program), and uninsured patients. The Funks have been working on a charity, Pink Lotus Petals, which will help women pay for care if they have abnormal mammograms but no insurance or can't cover the costs. Although the women don't have to go to Pink Lotus for that care, they can. They can also go to any other doctor who will accept the rates the charity will pay, which will be below those paid by the government. Funk says one of the roles of the various celebrities in her Rolodex will be to help raise money for this effort. Clearly this has already begun: The mammography services at Pink Lotus bear Crow's name, and Jolie has raised awareness to unprecedented levels.

Funk is taking it one day at a time. "There are big foundations focused on research and finding another magic drug. But women are dying all around them while they spend billions to find a very elusive cure. In my lifetime," she says, "there is something I can do about that."


Read the post original at Town&Country




Daily Mail

'It was entirely Angelina's idea to go public': Ms Jolie's mastectomy surgeon hits back at criticism that she's 'taking advantage' of clients flocking to her now-famous clinic

By Margot Peppers
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Angelina Jolie's breast cancer surgeon has hit back at critics who say she's 'taking advantage' of the clients who have been flocking to her now-famous clinic.
Kristi Funk, 44, told Town & Country that it was 'entirely' Ms Jolie's decision to 'go public' about the preventive double mastectomy she underwent at the Pink Lotus Breast Center, the clinic Dr Funk co-founded in Beverly Hills.
'She and Brad hope their situation can resonate with other women,' Dr Funk said of the actress. 'Whatever criticism there is that I am taking advantage of my clientele is overruled by the good that is done.'



Since May, when Ms Jolie told the New York Times she had her treatment at Pink Lotus, patients have been calling the clinic non-stop, booking appointments with Dr Funk up to three months in advance.
According to her husband Andy, who has run the center since it opened four years ago, it has become so popular that patients have been put on hold for more than 90 minutes.

You can read the rest at Daily Mail





NYMag






Today at 6:10 PM

Angelina Jolie’s Breast-Cancer Surgeon, Revealed


Dr. Kristi Funk is a 44-year-old breast-cancer surgeon who works at the Pink Lotus Breast Center in Beverly Hills, a clinic that she co-founded with her husband. Although she was not mentioned by name in Angelina Jolie's momentous New York Times op-ed, in which the actress described her own bilateral mastectomy, Dr. Funk's identity was hardly a secret, and she is profiled exclusively in this month's Town & Country magazine. (Frankly, it's surprising no one else got to her first. She's attractive, successful, and a mother of triplets — perfect magazine material.)
Pink Lotus was overrun by phone calls on the day that Jolie's article was published, and has since seen an influx of eager new patients who possess the same BRCA mutation that Jolie has (Dr. Funk calls them "Angelina patients"). But lest you think that it's some posh place that only treats the rich and famous, take comfort in Dr. Funk's normalcy, as reported by Dr. Peter Bach:
I met Kristi Funk in the middle of a busy day. Her blond hair was pulled back, not elaborately done up. Her surgical scrubs were a little rumpled. her mind was on her next patient. She explained her strong work ethic and focus by quoting her longtime mentor, John Ryan, the former chief of surgery at Virginia Mason medical Center in Seattle, where she trained: "You're doing one thing right now. One thing. Do it right."
Okay, fine, so it's a pretty posh spot, but not egregiously so:
I had flown to Beverly Hills worried I was about to walk into a Truman Show version of a doctor's office. I imagined a place that would downplay the seriousness of breast cancer, as if it were a minor inconvenience like a sprained ankle, rather than the killer it can be ... But I had it completely wrong. Yes, everyone who works in the clinic wears black and pink scrubs, and a few too many items, down to the coffee cups, bear the clinic's logo. But as a whole the place is rather unassuming.
Of course, you don't name a place "Pink Lotus" without immediately ordering a bunch of monogrammed mugs and Georgia O'Keeffe prints for the bathrooms. But anyway, just because Dr. Funk has treated wealthy women like Jolie and Sheryl Crow doesn't mean she's not interested in helping the poor and uninsured. In fact, the clinic accepts Medicare, Medi-Cal (California's version of Medicaid), and those without insurance altogether. She and her husband have also started a charity called Pink Lotus Petals (even better monograms!) that will help women pay for care if they need it.
It seems likely we'll hear more about Dr. Funk in the future — when someone is talented, photogenic, and tied to the Jolie-Pitts, fame seems inevitable. In choosing to become a face of preventative mastectomy surgery, perhaps Jolie purposely sought a doctor who would handle publicity with a similar sense of altruism.


Read the post original at NYMag