Actress and activist Angelina Jolie has beauty, brains and bravura, on- and off-screen. Read about her decision to undergo genetic testing—and then a double mastectomy.
ANGELINA JOLIE WAS BORN WITH STAR POWER IN HER DNA
After all, she’s the daughter of Hollywood actress and producer Marcheline Bertrand and Oscarwinning actor Jon Voight. But enviable good looks and box office-busting acting chops weren’t all she inherited. Jolie, 38, also inherited a mutation of the BRCA1 gene, which dramatically increases the risk of developing breast and ovarian cancers. Her decision to seek genetic testing in January 2013—and undergo a double mastectomy a few months later—captured the attention of the public and media. Her decision was a personal one, but the actress, mother and human rights activist chose to go public to help other women understand their options.
Jolie first turned heads in the mid-1990s in several small films like Hackers (1995) and Foxfire (1996) before earning a Golden Globe and an Emmy nomination for her breakout role in HBO’s Gia, in which she played a drug-abusing model, when she was 23. Since then, the bombshell brunette has continued to shine on the silver screen. From her Golden Globe, Screen Actors Guild and Academy award-winning performance as a woman in a mental institution in Girl, Interrupted (1999) to her Academy Award nomination for her performance as a mother fighting to find her lost child in Changeling (2008) to her spellbinding role as suspected sleeper agent in Salt (2010), there’s a common thread in the boundary-breaking roles Jolie chooses and the actress herself. Off-screen, her work is equally impressive. She’s a human rights activist, a special envoy for the Office of the United Nations High Commissioner for Refugees and a philanthropist through her organization, The Maddox Jolie-Pitt Foundation, which aims to eradicate extreme rural poverty, protect natural resources and conserve wildlife.
But what Jolie lives for isn’t acting awards or accolades for her charity work—it’s her family. Engaged since April 2012 to Brad Pitt, her partner of more than eight years, the couple has an impressive brood of six—three adopted (Maddox, 12, Pax, 10, and Zahara, 9) and three natural (Shiloh, 7, and twins Knox and Vivienne, 5).
“We built a family,” Jolie told Marie Claire in a January 2012 interview. “[Brad] is not just the love of my life, he is my family.” It was her love and commitment to her family—and to being with them for as long as possible—that propelled her to undergo genetic testing and ultimately a double mastectomy in April 2013. Here, our experts discuss her bold decision and explain how genetic testing works, who should be tested, what the test could reveal and what your options are if you test positive.
QWHAT IS GENETIC TESTING, AND WHAT DOES IT REVEAL?
“Genetic testing is the process of screening blood or cheek cells for alterations in genes that can lead to health risks,” explains Barbara Biesecker, PhD, a spokeswoman for the National Institutes of Health National Human Genome Research Institute. It can be used to screen for diseases that could be passed on to children, to screen embryos for disease, to determine appropriate treatment options and even to make a concrete diagnosis in someone experiencing symptoms. Jolie was tested for mutations on the BRCA1 and BRCA2 genes, which are known tumor suppressors. “All of us carry these genes, but when there’s an abnormality in one of them, it significantly elevates our risk for breast and ovarian cancer,” Biesecker says. “It’s estimated that 1 in 500 women carries these mutated genes.“ Jolie, it turned out, is one of them.
9 THINGS You (Probably) Don’t Know About Angelina
1 ANGELINA ISN’T HER REAL NAME. She was originally named Angelica. Her father began calling her Angelina when she was about a year old.
2 SHE HAD A CLOSE CASTING CALL. She was considered for the role of Kelly Kapowski on Saved by the Bell.
3 SHE’S A JET-SETTER. Since 2001, Jolie has visited nearly 30 countries as a Goodwill Ambassador and a special envoy for the United Nations High Commissioner for Refugees.
4 SHE’S A PILOT. Jolie holds a private pilot certificate for single-engine, land-based aircraft.
5 SHE’S A NATURAL BLONDE. Her mother dyed her hair brown when she was 5, and she “decided to keep it that way.”
6 SHE DIDN’T ALWAYS WANT TO BE AN ACTRESS. Her childhood dream was to be a funeral director.
7 SHE HAS A CELEBRITY BESTIE. The actress regularly spends time with singer Gwen Stefani.
8 SHE LOVES REPTILES. Jolie has owned several, including two snakes.
9 She does her own stunts (sometimes). She suffered cuts and minor burns while filming 2001’s Lara Croft: Tomb Raider.
Your Family Tree May Hold the Key
Community Healthcare System’s High-Risk Breast Clinic is helping women understand and manage the risk for developing breast cancer. Although most breast cancers occur in women who do not have a strong family history, about 10 percent are traced to a genetic predisposition for the disease. Patients with a significant family history of breast cancer have a risk of carrying a specific genetic mutation and may benefit from a more specific method of estimating breast cancer probability called BRACAnalysis ®, available at the clinic through the medical geneticist.
“Genetic testing may help some women learn whether or not they have an increased likelihood of developing breast cancer or whether inherited factors have contributed to their own or a family member’s cancer,” says Janice Zunich, MD, a medical geneticist on staff at the High-Risk Breast Clinic. Other services include clinical breast exams by a certified nurse practitioner, breast self-exams education and breast cancer risk, screening tests, a personalized surveillance plan and prevention strategies.
“I carry a ‘faulty’ gene, BRCA1, which sharply increases my risk of developing breast cancer and ovarian cancer,” she wrote in her New York Times op-ed, “My Medical Choice.” “My doctors estimated that I had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer.”
Q WHO SHOULD BE TESTED FOR BRCA1 AND BRCA2 MUTATIONS?
Women who have been diagnosed with early onset (premenopause) breast or ovarian cancer and those with multiple blood relatives who have had breast or ovarian cancer should be tested, Biesecker says. Jolie’s mother died of ovarian cancer at age 56 in 2007, and her aunt died of breast cancer at age 61 in 2013, making Jolie a prime candidate for testing. For women determined to be high risk by their healthcare provider, the test is considered preventive care and is covered under the Affordable Care Act—which means no out-of-pocket cost. For those who aren’t high risk or aren’t insured, the cost had been as high as $3,000—a point Jolie lamented in her article. “Thankfully, that cost has come down since the Supreme Court ruled that a gene can’t be patented,” Biesecker says. It is estimated that about 5 to 10 percent of all cancers are hereditary. A genetic counselor or a primary care physician can help you look at your family history and determine whether you should be tested.
Q WHAT ARE THE BENEFITS OF GETTING TESTED?
Undergoing genetic testing can be an emotional roller coaster, especially while you wait for results, but it’s worth it, says Ora K. Gordon, MD, a cancer geneticist and the co-author of Positive Results: Making the Best Decisions When You’re at High Risk for Breast or Ovarian Cancer. “If you already perceive yourself to be high risk, confi rmation can provide a sense of empowerment to change.” If your results are negative, you may want to consider further testing. “BRCA1 and BRCA2 are not the only hereditary genes that can increase breast cancer risk,” Gordon says. Genetic testing is also available for hereditary colon and related cancers, as well as other rare cancer syndromes, Biesecker adds. Since many of these cancers can be prevented, treated or circumvented if found early, testing positive allows you to seek out earlier, more frequent screenings, make lifestyle changes to reduce your risk or take more proactive measures—as Jolie did. “Almost universally, people are glad they know, whatever their results,” Gordon adds.
QIF I TEST POSITIVE, WHAT ARE MY OPTIONS?
Some women opt for more regular and careful screening for early detection, “which may also include taking medications like tamoxifen and birth control pills to reduce their risk of breast and ovarian cancer by as much as 50 percent,” Gordon says. Others, like Jolie, choose to undergo surgery to remove the ovaries or breast tissue before cancer has a chance to develop. “Removing the ovaries can cut your risk of breast cancer in half and nearly eliminate your risk of ovarian cancer,” Biesecker says. “I decided to … minimize the risk as much I could,” the actress wrote in her New York Times editorial. “I made a decision to have a preventive double mastectomy.” Jolie also plans to have her ovaries removed in the future, she told People magazine. “Preventive surgery is easier for women like Angelina who have found a partner and started a family already,” Gordon says. “Having a strong support system is hugely beneficial.” “I am fortunate to have a partner, Brad Pitt, who is so loving and supportive,” Jolie wrote in her editorial. “We knew this was the right thing to do for our family.”
Though she may have Hollywood magic in her bloodline, Jolie’s dynamite combination of beauty, brains, strength and heart has earned her millions of fans. With her breast reconstruction complete and two new movies Maleficent to be released later this year and Salt 2, due out in 2015 Jolie is looking forward to a healthy future with her family. And she’s proud of her decision to take that future into her own hands. “Life comes with many challenges,” reads her New York Times editorial. “The ones that should not scare us are the ones we can take on and take control of.”