This morning I read that Angelina Jolie announced she had recently undergone a double mastectomy based on her genetic risk for breast cancer. Talk about extreme prevention!

I have always liked Angelina as an actress and as a person. I respect her intelligence and her conviction for making the world a better place. So why would a 37 year-old seemingly healthy, vibrant woman elect something as radical as a double mastectomy as an act of prevention?

Angelina Jolie

Angelina is a carrier of BRCA1, a human caretaker gene expressed in the cells of breast and other tissue. It helps repair damaged DNA, or destroy cells if DNA cannot be repaired. It is essentially a tumour suppressor. If BRCA1 itself is damaged, the mutated DNA is not repaired properly and this increases risks for cancers.

It is thought to increase the risk of breast cancer by up to 80% and ovarian cancer by 50% in carriers. Undergoing a double mastectomy is thought to reduce BRCA1-related cancer risk by up to 90%.

Angelina’s mother died at 56 after a 10 year battle with ovarian cancer — something that must have weighed on her decision to proceed with the surgery. She apparently received extensive genetic counselling as part of making the decision she ultimately took.

While there are other options available to women found to be a BRCA1 carrier — screening every six months is the most common option — Angelina has certainly broken new ground by going public with this announcement. Women who elect the same procedure will likely feel more comfortable with their choice — they are in good company.

The tragedy in this is that we haven’t progressed far enough yet in cancer research to take a decision like this off the table. It has to be a tortuous decision to part with a healthy body part for the sake of preventing something that might happen — or might not.