Actress Angelina Jolie’s decision to undergo a radical mastectomy to minimize her risk of breast cancer from her inherited BRCA mutation aroused numerous views in Israel on Thursday.

Prof. Ephrat Levy-Lahad, director of the medical genetics department at Jerusalem’s Shaare Zedek Medical Center, commented on the story, “I think it is wonderful and courageous of her to be going public with her being a carrier and her decision to have a bilateral mastectomy for risk reduction. I am sure it will do a great deal to raise women’s awareness of being tested for cancer risk due to BRCA1 and BRCA2 mutations.”

“The fact that a beauty icon is willing to undergo bilateral mastectomy also legitimizes this choice, and shows that it is not a sign of reduced femininity, or a crazy thing to do,” said Levy-Lahad, who regularly counsels women with the mutations.

“That being said, it is important to remember that risk reduction mastectomy is a personal choice even for BRCA1 and BRCA2 carriers, and it is not an absolute medical indication. Yes, it does offer the greatest risk reduction, but, removal of the ovaries [oophorectomy] and fallopian tubes by age 40 reduces breast cancer risk in carriers by 50 percent – and this is a much simpler and internal procedure. Also, there are effective surveillance measures for early breast cancer detection, and breast cancer treatment is successful in most cases.”

The Shaare Zedek geneticist added that “although Jolie’s operation highlights breast-cancer risk reduction, the importance of ovary plus fallopian tube removal in carriers should be reemphasized. For carriers, riskreduction oophorectomy surveillance is necessary to prevent the high risk of ovarian cancer, which is a lethal disease that is with no effective early detection.”

Meanwhile, Dr. Shlomit Shadmon Sayag, an expert in women’s health and a member of the Family Physicians Association, also commented on the Jolie case.

“Research has shown that radical mastectomy and/or oophorectomy for women carrying the BRCA1/2 genetic mutation can reduce the risk of getting breast cancer by 50% to 85%. The recommendation is very significant for the women, as there is risk of a sharp reduction in such a woman’s female hormones and quick entry to menopause, with hot flashes, night sweating and sleeplessness. The effects on body image are smaller. But the decision to undergo surgery, even with restoration of the breasts, is very difficult,” said Sayag.

“One must have a long discussion with the woman, her partner and other family members to make the conscious decision.”

The family physician described a case, however, of a woman who did decide to undergo surgery and was very pleased with her choice. She underwent plastic surgery to restore the natural look of her body and was relieved of her terror of getting breast cancer.

“Congratulations to Angelina Jolie, who did it and turned into an ambassador for radical mastectomy to prevent the disease, thereby telling the whole world about what she did.”

Levy-Lahad was joined in her views by Prof. Mary- Claire King, a worldrenowned geneticist at the University of Washington and the discoverer of the BRCA1 gene mutation.

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