When Angelina Jolie charted her course of action against the breast cancer cards she’d been dealt, she didn’t seek direction from an academic medical center.
Instead, she chose Pink Lotus, a “comprehensive and integrative breast center” in Beverly Hills when she decided on prophylactic double mastectomy — adding a prominent link to the facility’s website in her New York Times opinion piece and effectively giving it a glowing review.
But experts contacted by MedPage Today have few qualms with Jolie’s choice, arguing that she seems to have received top-notch care based on what she wrote in her editorial.
“Not everyone must be treated in an academic center,” Jennifer Litton, MD, of MD Anderson Cancer Center in Houston, told MedPage Today. “I think it is fantastic that Ms. Jolie … was, from what I have read in her op-ed, given good advice.”
Jolie wrote that her mother died after a 10-year-long battle with cancer and tests revealed that she has a BRCA 1 mutation.
Lynn Holt, MS, director of the genetic counseling program at the University of Alabama at Birmingham, said it’s ideal that women have access to services offered by the breast center.
Academic centers, however, are important originators of knowledge and practice-changing advances, Litton noted.
“Our role in a cancer institute such as MD Anderson is to not only give the highest level of care, but it is equally our job to pursue new knowledge that we can disseminate, not only to our patients but throughout our country and world,” she told MedPage Today.
Many physicians, however, were less comfortable with the marketing aspect of Jolie’s care. Pink Lotus is currently running a large ad on its homepage that promises full details of Jolie’s treatment and urges visitors to follow the center on Facebook and Twitter to get the story as soon as it posts.
Daniel Hayes, MD, of the University of Michigan Comprehensive Cancer Center, said he generally finds medical marketing “reprehensible,” but concedes he is “old school. Doctors didn’t advertise when I grew up. And I’ve gotten over it.”
Others are concerned about the deluge of questions they expect from female patients in the coming days and weeks. Litton said she’s already getting “bombarded with questions of people feeling they should get the [genetic] test.”
“My message is that not every woman needs this particular test, but they should review their family history of cancer with their healthcare provider,” she said.
Only about 5% to 10% of breast cancers that are diagnosed are caused by BRCA mutations; the majority are caused by other factors.
Certain characteristics do signal that women are at greater risk of being mutation carriers, such as a younger age at diagnosis, a strong family history, and certain ethnicities such as blacks and Ashkenazi Jewish patients.
Clinicians recommend a trained genetic counselor when patients do get screened for BRCA mutations, followed by a “balanced discussion” after the results, according to Deborah Axelrod, MD, of NYU Medical Center.
BRCA mutation carriers have an 80% to 90% lifetime risk of breast cancer, as well as a 40% to 50% lifetime risk of ovarian cancer.
The main options for the breast cancer risk are surveillance, preventive medical therapy with tamoxifen or other chemotherapeutic agents, or prophylactic double mastectomy — the most effective form of prevention, experts say, as Jolie chose.
When it comes to ovarian cancer risk, Axelrod said a screening program is less effective, as the disease is not easy to detect.
“Developing ovarian cancer can occur at any age with the BRCA mutation so even older women are recommended to consider removing their ovaries if they are positive for the BRCA mutation,” she said.
In her op-ed, which several medical experts described as “eloquent” and “personal,” Jolie wrote that she was tackling the breast cancer issue “first,” a potential indicator that she may be considering oophorectomy as well.
“The choice that Angelina made was the right one for her,” said Gary Lyman, MD, of Duke Cancer Institute, “and will hopefully inspire other women to have these important discussions and feel empowered to make their own right choice.”
-By Kristina Fiore, Staff Writer, MedPage Today May 15, 2013