Surgeon details Angelina Jolie's mastectomies

Angelina Jolie was up and working with "bountiful energy" on her next film project just four days after having her double mastectomy, her surgeon said Tuesday.

Dr. Kristi Funk hailed the "bold" Oscar-winning actress's positive attitude as she underwent three operations - two in February and one in April - to remove tissue and reconstruct her breasts.

"To a large extent, I believe recovery reflects expectation. Angelina expected to feel well, to be active," she wrote in a blog posted the Pink Lotus Breast Center in Beverly Hills.

Brad Pitt, with whom she has six children, attended for all three operations, starting on February 2 with a "nipple delay" procedure which lessens the risk of losing the nipples.

"Her partner was on hand to greet her as soon as she came around from the anesthetic, as he was during each of the operations," said Funk.

The main surgery was on Saturday, February 16, and "went smoothly," she wrote. Two days later, good news: "The pathology returned and I called Angelina to confirm our biggest hope: all of the breast tissue was benign.

"On day four after her mastectomies, I was pleased to find her not only in good spirits with bountiful energy, but with two walls in her house covered with freshly assembled storyboards for the next project she is directing.

"All the while she spoke, six (surgical) drains dangled from her chest, three on each side, fastened to an elastic belt around her waist," she said.

The final operation was carried out on April 27, ten weeks after the mastectomies, reconstructing the breasts with implants, "which went extremely well, bringing an end to her surgical journey," she said.

The blog gave comprehensive details about the various surgical procedures and drugs involved in the double mastectomy, which Jolie revealed in an op ed article in The New York Times.

Speaking outside the Beverly Hills clinic earlier, Funk said she hoped Jolie's decision to have the operation - and to go public with it - would lead other at-risk women to take action.

"We hope that the awareness she is raising around the world will save countless lives," she said, adding that the clinic "applauds Angelina Jolie's bold choices regarding her BRCA mutation."

In the New York Times piece, the actress -- whose mother Marcheline Bertrand died of ovarian cancer at the age of 56 - encouraged other women to address threats to their health.

She said she was confirmed as having the "faulty" gene, BRCA1, that doctors said gave her a 87 percent risk of developing breast cancer and a 50 percent risk of ovarian cancer.

Surgery can dramatically reduce genetic cancer risk

Surgery can dramatically reduce genetic cancer risk

Women whose genes put them at a high risk of contracting breast cancer can dramatically reduce the danger by having a double mastectomy -- but not eliminate it altogether, experts say.

The issue has been thrown into the spotlight with Hollywood star Angelina Jolie's announcement that she had her breasts surgically removed after tests revealed she carried a genetic mutation that can lead to cancer.

Rocker Ozzy Osbourne's wife, Sharon, did the same last year.

About 0.2 percent of women carry a harmful mutation in the BRCA1 or BRCA2 gene that boosts their lifetime risk of contracting breast cancer to as much as 80 percent compared to about 10 percent for women without the gene.

"This is what many people would consider a sky-high risk," epidemiology professor Per Hall of Sweden's Karolinska Institutet told AFP.

"For the few women who are carriers (of the mutation) this is definitely a good option," he said of surgery.

Having a double mastectomy reduces a mutation-carrier's risk by about 90 percent to a level lower than that of women who don't carry the genetic flaw.

But it but can never eliminate the danger entirely.

"Even the most skilled surgeon will leave some tiny part of breast tissue behind," said Hall.

An estimated 458,000 women died of breast cancer -- the most common cancer type among women -- in 2008, according to the World Health Organisation (WHO).

Survival rates vary greatly, from 80 percent in the developed world to under 40 percent in poor countries that have fewer early-detection programmes.

The cost of genetic screening can be prohibitive -- ranging from several hundred to several thousand dollars, says the US-based National Cancer Institute.

On its website, the WHO says early detection remains the "cornerstone" of its cancer strategy as preemptively screening asymptomatic people was a "far more complex undertaking".

DNA, the blueprint for life, comprises four basic chemicals called A (adenine), C (cytosine), T (thymine) and G (guanine) strung together in different combinations along a double helix.

Sometimes a "spelling mistake" in the A, C, T, G combinations can cause problems in gene function.

But carrying a mutation does not necessarily mean a person will develop cancer -- factors like lifestyle also play a role.

A study in 2005 concluded that a fifth of breast cancer deaths worldwide could be attributed to alcohol use, excessive weight and physical inactivity.

Delayed pregnancy and not breastfeeding are factors considered to increase one's chances of contracting breast cancer.

Age is a major factor -- most breast and ovarian cancers occur in women over 50, though women with the BRCA mutations often get ill at an earlier age.

Mutations in the BRCA (BReast CAncer susceptibility) genes, which normally act as tumour suppressors, also increase ovarian cancer risk.

Clinical geneticist Clare Turnbull at the Royal Marsden Hospital in London said women who carry the mutation are generally offered intensive MRI and mammogram screening so any cancer can be caught and treated early.

"That is one option, and for many women particularly young women, that's the option they choose," she told AFP.

"Other women feel that they would like to take a more interventional approach and try and reduce the likelihood of them getting cancer in the first place", such as a double mastectomy.

"It is not uncommon."

The London-based Breast Cancer Campaign said Jolie's openness would help raise crucial awareness of genetic breast cancer risk.

"Deciding whether to have preventative surgery is a heart rending decision for women like Angelina but we know it's a vital way of saving lives," the campaign's chief executive Delyth Morgan said.

"This is a stark reminder of how much more research we need to do to give women more knowledge, choice and life-saving options to reduce their risk."

Cancer campaigners urge caution

Cancer campaigners urge caution

Cancer campaigners cheered Angelina Jolie for going public Tuesday about her double mastectomy, but warned women against rushing out to be tested for the gene mutation that threatened her life.

Not only is the BRCA1 mutation rare in the overall female population, they said, but it is also expensive to test for at a US laboratory that controversially claims patent rights to the gene.

"We don't want everybody to go out and say, 'I want this test'," Otis Brawley, chief medical officer of the American Cancer Society, told AFP in a telephone interview.

"We want people to think about what their family history is, and to talk to their doctor" who might refer them to a genetic counselor to determine if testing is necessary, Brawley said.

"Women who have first-degree relatives -- that is a sister or a mother -- who had breast or ovarian cancer at a young age should especially have these conversations," he said.

"All women should not be tested for this gene. It is not that common," said Los Angeles-based surgeon, author, breast cancer researcher and leukemia survivor Susan Love.

"The people who should consider being tested are the ones who have had a lot of breast or ovarian cancer in their families," she told CNN.

In Jolie's case, the mother of the 37-year-old Oscar-winning actress and UN humanitarian activist -- star of such action films as "Salt" and "Lara Croft: Tomb Raider" -- died of ovarian cancer at the age of 56.

Writing on the op-ed page of The New York Times on the eve of the Cannes film festival, where she is a red-carpet favourite, Jolie said genetic tests had established that she was carrying a "faulty" gene known as BRCA1.

"She's very brave to speak out," said Katherine McLane, vice president for communications at Livestrong, the cancer charity founded by cyclist and cancer survivor Lance Armstrong before his fall from grace in a doping scandal.

But in a telephone interview with AFP, McLane voiced hope that Jolie's experience would also generate "more attention about affordable health care for all women."

In a little-noted part of her op-ed, Jolie, one of Hollywood's highest-paid stars, decried the fact that a BRCA1 test - which costs more than US$3,000 (S$3,729) in the United States - is out of reach for many women around the world.

Myriad Genetics is the only US lab that offers the test, and it is at the heart of a US Supreme Court battle over its claim of patent rights to BRCA1 and BRCA2. A ruling is expected in June.

On the NASDAQ stock market Tuesday, shares in Myriad Genetics leaped four per cent on news of Jolie's article to US$34.45, its best level since mid-2009, before easing back.

"We strongly believe appropriate use of many of our diagnostic tests can help reduce illness, hospitalizations and other costly interventions, and potentially lower health care costs," Myriad Genetics said in a statement.

It declined to say whether it was the lab that tested Jolie. Several facilities in Europe offer the same test, according to the American Civil Liberties Union, which is challenging Myriad Genetics' patent claim in court.

Overall, cancer death rates in the United States have been declining among both men and women since the early 1990s, according to the National Cancer Institute, a US government agency.

But while 12 per cent of all US women will develop breast cancer at some point, the chances are five times greater for the few with a BRCA1 or BRCA2 mutation, it says on its website (

Both mutations can also turn up in men, ramping up their risk of breast, pancreatic, testicular and prostate cancer.