Jolie’s breast cancer warning expected to help others

Even as Shannon West Redwine writhed in pain at Sunrise Hospital in September, she had a message: With a family history of breast cancer and/or ovarian cancer, genetic testing for relatives can mean the difference between life and death.

West Redwine’s tests for the genetic mutations that greatly increase the risk of the disease, the former Clark County homeless coordinator told the Review-Journal, came after she was diagnosed with breast cancer, too late for her to have a preventive double mastectomy. The breast cancer that metastasized to her bones would kill her two months later at age 45.

If a woman has either a defective BRCA1 or BRCA2 gene –– West Redwine had a mutated BRCA2 –– prophylactic surgery, according to researchers, can decrease a woman’s average 65 percent risk of developing breast cancer to about 5 percent.

“There is no doubt that Shannon would have applauded Angelina Jolie going public with her prophylactic double mastectomy,” said Dr. Heather Allen, the Comprehensive Cancer Centers of Nevada oncologist who used drugs to fight back West Redwine’s virulent breast cancer for five years. “She wanted people informed about options they had.”

In Tuesday’s New York Times, Jolie, an Oscar-winning actress whose mother died of ovarian cancer in 2007 after battling the disease for 10 years, wrote in an op-ed article that through blood testing she found out she carried a “faulty” gene, BRCA1, which doctors estimated gave her an 87 percent risk of breast cancer –– more than 20 percent higher than the average risk for someone with a defective gene –– and a 50 percent risk of ovarian cancer.

After her surgery, doctors say she has a 5 percent risk of developing breast cancer.

Most women have an average 12 percent risk of developing breast cancer.

“I choose not to keep my story private because there are many women who do not know that they may be living under the shadow of cancer,” Jolie wrote. “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.”

Defective versions of BRCA1 and BRCA2 genes are estimated to cause 5 percent to 10 percent of breast cancers and 10 percent to 15 percent of ovarian cancers among white women in the United States. While mutations are found in other racial and ethnic groups as well –– as MGM Grand concierge Seiko Ray, who is of Japanese heritage, can attest –– it is not known how common they are in those groups.

Ray was 27 when her obstetrician-gynecologist suggested three years ago, after reading her family history, that Ray go through genetic testing. She had relatives who died of ovarian and breast cancer.

It wasn’t until last year that Ray decided to get tested, however. Using her husband’s insurance for the $3,000 test, she learned she had a defective BRCA1 gene.

“I felt like I was a ticking time bomb,” she said.

After reading books and talking with doctors, including Dr. Souzan El-Eid, director of the Breast Care Center at Summerlin Hospital, she decided to have El-Eid perform a double mastectomy in March. Earlier she had her fallopian tubes, the slender ducts through which ova pass from the ovaries to the uterus in the female reproductive system, removed to help lower the risk of ovarian cancer.

She plans on having her ovaries removed in about four years. Researchers generally say it is considered safe to wait long enough to have children before having the ovaries removed, but the operation should be done by age 40.

“I didn’t want to get thrown into menopause right now,” said Ray, who is currently undergoing reconstructive breast surgery and has no plans to have children.

Jolie, 37, said that because her risk of breast cancer was greater than her chance of ovarian cancer, she decided to have her ovaries removed at a later date. She has undergone breast reconstruction and she said the results can be beautiful.

The actress, often known for her activism, noted that the cost of genetic testing “remains an obstacle for some women.”

Both Allen and another oncologist, Dr. Paul Michael, say that there are times when women face challenges with insurance companies over coverage of genetic testing.

“Most insurance will cover part of it,” Allen said. “But if they say a woman has to pick up 25 percent of the cost, that’s still a lot for many women.”

Las Vegas breast surgeon Dr. Theodore Potruch said he has been gratified to see the maker of the test, Myriad Genetics, pick up the tab for impoverished women who need the testing done.

BRCA1 and BRCA2 mutations can be passed through the mother’s or father’s side of the family and can affect the risk of both female and male cancers. People with a mutation, regardless of whether they develop cancer, have a 50/50 chance to pass the mutation on to the next generation, Allen stressed.

BRCA2 mutations increase the risk of male breast cancer and may also increase the risk of prostate cancer. Up to 40 percent of male breast cancers may be related to BRCA mutations, according to researchers. The lifetime risk of breast cancer is 1 in 1,000 for average men and 65 in 1,000 for men with a BRCA2 mutation.

“When there is a lot of cancer in a family, both females and males should be tested,” Allen said.

More than 450,000 people die each year across the globe from breast cancer, according to the World Health Organization, with 40,000 of them Americans.

Both Cindy Aguilar, 56, and Jayleen Low, 39, Southern Nevada women diagnosed with cancer found to be caused by defective genes, wish they could have been tested prior to lumps being found in one of their breasts. Each decided to have a double mastectomy after learning they had mutated BRCA genes.

“I wish I had never had to go through chemo and radiation,” Aguilar said. “I’m doing fine now, but I worry all the time that the cancer is going to come back. ... I think she’s (Jolie) going to convince a lot of women to get tested, and hopefully that’ll stop them from having to go through so much worry.”

Contact reporter Paul Harasim at pharasim@reviewjournal.com or 702-387-2908.