Brinkmann Gynaecology

Angelina Jolie, inherited cancer and the BRCA1 gene

Much has been made of the news of US actress Angelina Jolie’s decision to have a voluntary double mastectomy to reduce her chances of breast cancer.

She made this difficult decision after discovering she had inherited a faulty copy of the BRCA1 gene, which puts her at very high risk of developing breast or ovarian cancer.  It was this genetic flaw that lead to her mother’s death of ovarian cancer, aged 56.  According to the press, Miss Jolie may also choose to have a hysterectomy and oophorectomy (removal of the ovaries) to combat her raised odds of developing ovarian cancer, which stand at 50 per cent.

What is familial cancer?

Most cancers are sporadic and arise from genetic damage that accumulates over a person’s lifetime – the reason age is a big risk factor.  But a small amount of cancer is inherited, including cancers of the breast, ovary and endometrium through the BRCA1 and BRCA2 genes.  High risk families can be indentified through their family history allowing these women to choose how to manage their increased risk of developing the disease. 

How can risk be managed?

An important issue in inherited cancer is how to manage those who are identified as being at high risk.  Affected women should be encouraged to make informed choices based on what is right for them.  There are many factors that influence this decision with options available from intensive screening and surveillance (either with mammograms or MRI scans) to preventative surgery.  It is important to discuss options with a specialist to ensure the right choices are made based on individual circumstances.

Am I at risk?

You may have a higher than average risk of developing inherited cancer if a close relative or relatives have suffered from the disease (a close relative means a parent, brother or sister, child, grandparent, aunt or uncle, nephew or niece).  If you are concerned, consider if you have one of the following in your family:  

  • A mother or sister diagnosed with breast or ovarian cancer before the age of 40
  • 2 close relatives (either a mother, sister or daughter) from the same side of the family diagnosed with breast cancer
  • 3 close relatives diagnosed with breast cancer at any age
  • A father or brother diagnosed with breast cancer at any age
  • A mother or sister with breast cancer in both breasts – the first cancer diagnosed before the age of 50
  • 1 close relative (either a mother, sister or daughter) with ovarian cancer and 1 with breast cancer, diagnosed at any age

Affected relatives must be blood relatives and come from the same side of your family.  Risks are also higher among people of Ashkenazi Jewish descent.

Knowledge and action is key

It was thanks to her partner’s mother that Miss Jolie was tested for the BRCA1 gene.  As the founder of a children’s cancer unit in the US, she was aware of the possible inherited nature of breast and ovarian cancer and it was she who encouraged the actress go for a blood test.  It is worth reading Miss Jolie’s brave and thoughtful article in the New York Times on the influence and support of her family and doctors and how this encouraged her to make her own preventative choices.

If you have any questions or concerns about the disease, you can contact us for an appointment to discuss them – either by email or telephone at either Nuffield Chichester or Spire Portsmouth Hospitals.