The 'prophylactic' removal of women's breasts due to BRCA1/BRCA2 status has become a disturbingly popular trend, and increasingly it is being celebrated in the mainstream media and medical establishments as a reasonable choice. But does the scientific evidence itself refute this approach?
Angelina Jolie's recent announcement in a New York Times op-ed that she had a 'prophylactic' double mastectomy due to her BRCA1/BRCA2 status has disturbing implications, some of which we covered late last year in connection with Allyn Rose, the 24-year old Miss America contestant who announced she would be undergoing a double mastectomy to "prevent" breast cancer.
Beyond the fact that as high-profile celebrities their decisions will affect millions of women's perception of the procedure, likely making them more accepting of the concept, their decisions also reflect profound misconceptions about gene-mediated disease risk embedded deeply within popular consciousness, from which prevailing medical opinion is hardly immune.
First, there is a common misconception about the role that the so-called breast cancer susceptibility genes, BRCA1 and BRCA2, play in breast cancer disease risk and prognosis. BRCA mutations vary widely by ethnicity and are exceedingly rare in the general population, which is why, as NBCNews.com recently reported, "The U.S. Preventive Services Task Force recommends that only women with a strong family history even think about getting a BRCA genetic test –which is only 2 percent of U.S. women." But even in those in which a BRCA mutation is identified, the genes, in and of themselves, do not alone make the disease.
Despite the commonplace refusal of so-called 'evidence-based medicine' to acknowledge the actual evidence of genetics, we moved into a Post-Genomic era over a decade ago following the completion of first draft of the entire human genome in 2000. At that moment, the central dogma of molecular biology – that our DNA controls protein expression, and therefore disease risk – was disproved. Our genome was found to contain roughly 20,000 genetic instructions – not even enough to account for the 100,000 proteins in the human body!
As a result, we must now accept that factors beyond the control of the gene, known as epigenetic factors, and largely determined by a combination of nutrition, psychospiritual states that feed back into our physiology, lifestyle factors, and environmental exposures, constitute as high as 95% of what determines any disease risk. In fact, even the psychological trauma associated with being diagnosed with cancer can drive malignancy via adrenaline-mediated multi-drug resistance,[i] and according to a recent NEJM study, lead up to a 26-fold increased risk of heart-related deaths in the seven days following diagnosis.[ii]
Given this fact, Jolie's decision to have a bilateral mastectomy in order to excise from her body the breast tissue that contains BRCA1/BRCA2 genes which are known to interfere with the repair of radiation-induced DNA damage, rather than focusing on reducing or eliminating all future radiation exposure from her breasts, or incorporating hundreds of nutritional components experimentally confirmed to protect against radiation and associated genotoxic insults to the breast, reflects a iron clad faith in the inevitability of gene-driven cancer vis-à-vis a fundamentally powerless subject, versus trust in the body's ability to prevent and heal all disease, assuming it has the right conditions.
Another common misconception is that you either have, or don't have the "BRACA genes," as if they were monolithic entities, ascertained with the black and white certainty of a pregnancy test. It is a little known fact that thousands of "mutations" in the BRCA1 and BRCA2 genes have already been identified and characterized on a molecular level, adding much more complexity to the picture than the present level of medical knowledge can claim to convert into compelling statistical risk calculations and actionable treatment recommendations.
These mutations are technically known as gene polymorphisms which are naturally occurring variations of a gene present in more than 1% of the populations. It will come to many as a surprise to learn that some of these so-called "mutations" actually REDUCE the risk of breast cancer. BRCA1 variation K1 183R is related inversely to cancer risk, leading the authors of a review on the topic titled, "The case against BRCA1 and 2 testing," to conclude: "It seems that some polymorphisms may actually have a protective effect."[iii] Moreover, research exists showing that BRCA2 mutation carriers and non-carriers have similar breast cancer-specific rates of breast-cancer specific death,[iv] and that although BRCA positive patients have more frequently negative prognostic factors, their prognosis appears to be equal to or better than in patients with normal, also known as wild-type, BRCA.[v]
Another concerning blind spot in the framing of Jolie's decision is that approximately 70,000 breast cancers (31% of annual breast cancers diagnoses) are misdiagnosed by the vast breast cancer 'awareness' and treatment complex each year.[vi] These are not just so-called "zero stage" breast cancers such as Ductal Carcinoma In Situ (DCIS), which arguably should be reclassified as non-cancerous normal variations in breast morphology, but 50% are known as early-stage "invasive" breast cancers [view NEJM study video analysis here].
How many of these women, having received a mammography-detected diagnosis of breast cancer and then a follow up BRCA test, believed that the gene must have therefore "caused" the "cancer"? The popularization of this crude way of understanding natural, sometimes self-limiting variations in breast morphology as cases of "breast cancer" is itself a malignancy that should be prevented and treated with healthy doses of the very 'evidence' that the so-called 'evidence-based' medical system claims to possess as a differentiating factor from other, more ancient, plant- and nutrition-based medical traditions.
Last November, an article published in NEJM found that 1.3 million US women were overdiagnosed and overtreated for so-called "breast cancer" in the past 30 years. These were screen-detected abnormal breast findings that would never have progressed to cause harm in the women in which they were diagnosed. These women, while essentially iatrogenic victims of medicine, being given standard treatment options, including mastectomy, lumpectomy, radiation, chemotherapy, were considered statistically as "survivors" whose lives were saved by the medical establishment, and these cases further inflated the statistics to make it appear that conventional treatment interventions are far more effective than they actually are.
Given these facts, Jolie's decision conceals a dark side that she, like millions of other American women, are completely unaware of. For example, look at the soaring stock response of Myriad Genetics, the patent-holders of the human genes BRCA1/BRCA2, soon after Jolie's announcement in this Yahoo Finance article published today: Myriad Genetics Shares Climb After Angelina Jolie Has Mastectomy.
The Utah-based company, contrary to popular opinion, owns patents on your BRCA genes (men have them too). And not only that, as a recent Slate article explains:
[Myriad Genetics] claims to own the rights to any test for the presence of the two critical genes associated with breast cancer, and it has ruthlessly enforced that right, though their test is inferior to one that Yale University was willing to provide at much lower cost. The consequences have been tragic: Thorough, affordable testing that identifies high-risk patients saves lives. Blocking such testing costs lives. Myriad is a true example of an American corporation for which profit trumps all other values, including the value of human life itself.Given the fact that powerful, profit-driven corporations stand to reap profound financial benefit from the propagation of an oversimplified gene-driven theory of breast cancer susceptibility, we must be cautious in jumping on the mainstream media and medical bandwagon by viewing Jolie's increasingly popular decision uncritically. Consider also that women who undergo these mastectomies often opt for breast implants which themselves have been linked to cancer, as we discussed in our article from last year, "Implanted: The Myth of the Cancer-Free Breast Implant," and which only recently were linked to more aggressive breast cancer, and lower breast cancer survival rates.
What we want is the truth when it comes to understanding breast cancer risk, its natural history, and what preventive and therapeutic steps should be employed to reduce its progression and associated suffering. Unfortunately, however, the breast cancer industry's influence stretches from academia to government, from KFC buckets of fried chicken to Smith & Wesson's pink ribbon-branded fire arms. All the more important to read between the lines, and remember that we alone are responsible for educating ourselves, so that a truly informed choice is made possible.
Please use our breast cancer health guide for direct access to the peer-reviewed and published research on natural and integrative breast health interventions: Health Guide: Breast Cancer
[i] GreenMedinfo.com, Stress Hormones Found To Make Cancer Resistant To Treatment
[ii] GreenMedInfo.com, Research: Some Diagnoses Can Kill You Quicker Than The Cancer
[iii] Cheryl Lin, Tina Sasaki, Aaron Strumwasser, Alden Harken. The case against BRCA 1 and 2 testing. Surgery. 2011 Jun ;149(6):731-4. PMID: 21621683
[iv] Mario Budroni, Rosaria Cesaraccio, Vincenzo Coviello, Ornelia Sechi, Daniela Pirino, Antonio Cossu, Francesco Tanda, Marina Pisano, Grazia Palomba, Giuseppe Palmieri. Role of BRCA2 mutation status on overall survival among breast cancer patients from Sardinia. BMC Cancer. 2009 ;9:62. Epub 2009 Feb 20. PMID: 19232099
[v] Andrea Veronesi, Clelia de Giacomi, Maria D Magri, Davide Lombardi, Martina Zanetti, Cristina Scuderi, Riccardo Dolcetti, Alessandra Viel, Diana Crivellari, Ettore Bidoli, Mauro Boiocchi. Familial breast cancer: characteristics and outcome of BRCA 1-2 positive and negative cases. BMC Cancer. 2005 ;5:70. Epub 2005 Jul 4. PMID: 15996267
[vi] New England Journal of Medicine, Effect of Three Decades of Screening Mammography on Breast-Cancer Incidence