The Jolie Effect: Who Should Get a Preemptive Mastectomy?


When the New York Times famously published the Angelina Jolie-penned op-ed “My Medical Choice” on May 14, 2013, the actress/director/humanitarian’s admission that she underwent an elective double mastectomy came as a shock to many of her fans around the world. As Jolie told it, she underwent genetic testing for the BRCA1 gene following the untimely loss of her mother, Marcheline Bertrand, in 2007. Betrand passed at the age of 56 after battling ovarian cancer for a decade. In an effort to be proactive about her own health, Jolie opted to undergo genetic testing and then remove both breasts as well as her ovaries to reduce her risk of developing these cancers. But the move was met with some swift criticism from the medical community that, just because Jolie tested positive for the BRCA1 gene didn’t mean she would develop either of these cancers – even though Jolie admitted in her op-ed that her risk of breast cancer hovered at around 87 percent and ovarian cancer at about 50 percent.

Five years later, Jolie’s admission has launched what doctors are calling the “Jolie Effect,” a marked increase in elective mastectomy procedures around the globe following the New York Times op-ed. But are these procedures a good idea – and should you consider a similar procedure?

BRCA1 and Genetic Testing

The first thing you should know when it comes to any kind of cancer is that just because someone in your family has had it doesn’t mean you will automatically get it, too. You should also know that just because someone in your family has cancer does not mean they carry a cancer gene, or that you do. That being said, if someone related to you does develop a cancer such as breast or ovarian cancer, you may want to consider genetic testing for the BRCA1 gene.

The problem with this type of testing – which Jolie pointed out in her article – is that the testing is expensive. Most insurance plans don’t cover it, and it can cost upwards of $3,000 out-of-pocket. For those women who can afford it, it can offer great peace of mind. For those who cannot afford it, it can incite panic.

If you are one of the women fortunate enough to be able to undergo genetic testing, pay close attention to your risk percentages. Jolie mentioned her risk of developing breast cancer was estimated at 87 percent, so she elected to have her breasts removed and then reconstructed with breast implants first. She chose to tackle the removal of her ovaries second, because her risk was determined to be much lower, despite ovarian cancer taking the life of her mother.

While Jolie’s risk was quite high, much of the criticism she got for her candor about the procedure was that, despite that risk, there was no guarantee she would get cancer, so removing both healthy breasts seemed to some like a rash choice – but was it?

Throwing Out The Baby with the Bathwater?

While some people in the medical community believe Jolie was wrong to remove healthy organs to prevent something that may never occur, others lauded her choice to preemptively address something that could eventually take her life, leaving her children motherless. The piece clearly resonated with women, as requests for this type of procedure have doubled since its 2013 publishing. Studies in both New York and New South Wales, Australia, both showed a similar increase in requests for the procedure, proving the “Jolie Effect” is not just restricted to America.

So, is this type of procedure a good idea? Honestly, it’s up to you – the patient. If you have a strong family history of breast cancer or you have undergone genetic testing that has revealed you are a carrier of the BRCA1 gene and you feel your risk is unacceptable, then it is your choice to undergo an elective mastectomy and reconstruction procedure. If the procedure brings you peace of mind and improves your quality of life, then you should feel confident in your choice and proud of yourself for being proactive about your health.

If you would like to learn more about your breast reconstruction surgery options, please contact Dr. Chau’s office today and schedule a complimentary consultation. We can be reached at 888-966-9471.