Angelina Jolie Sparks Tough Choices Debate
UNIDENTIFIED FEMALE: It could be the most important thing that a woman ever does in her entire life in order to preserve her life.</s>MICHAELA PEREIRA, CNN ANCHOR: That was Angelina Jolie-Pitt's breast cancer surgeon, Dr. Christy Funk, discussing the actress' revelation that she has removed her ovaries and fallopian tubes. Jolie-Pitt opted for the preventative measure because she carries a mutation of the BRCA-1 gene, which increases a woman's chance of developing breast or ovarian cancer. Now her decision is really sparking an important conversation about women's health and some of those very difficult decisions. Want to turn to Dr. Seema Yasmin, a former CDC disease detective, now a staff writer for the "Dallas Morning News" and also with us our colleague, Elizabeth Cohen, CNN senior medical correspondent. Good morning, Ladies. Such an important conversations for us to have and I'm glad we're doing it. Dr. Yasmin, I think we should talk off the bat, talk about how common this BRCA gene is and even the cancers that Angelina Jolie is trying to avoid.</s>DR. SEEMA YASMIN, FORMER CDC DISEASE DETECTIVE: Well, we know breast cancer in itself could be quite common, affects one in eight women in the U.S., but this mutation, this faulty gene that puts women on much higher risk of getting breast and ovarian cancer. It's actually quite rare, Michaela, about 2 percent, maybe 3 percent to 4 percent of women will carry the kind of mutation that Angelina Jolie has that increases their risk many, many times compared to the general population.</s>PEREIRA: I think it's so interesting, what one writer has called this Angelina Jolie effect, Elizabeth. That it is seemingly has launched. We have a graphic here that sort of highlights what has happened since Angelina made her announcement back in 2013. The number of people that have gone in to get the BRCA gene testing done in America was about 350 per week after her announcement in 2013, up 40 percent to 500 women per week. It's so interesting to see the effect that this is having.</s>ELIZABETH COHEN, CNN SENIOR MEDICAL CORRESPONDENT: Right, it's very similar to actually years ago when Katie Couric got a colonoscopy, and then we saw other people following suit. So the doctors I've talked to, top experts in cancer and genetics, they're glad to see that more women are aware and are getting testing. But they are also saying look, only get the testing if you have a family history of breast and ovarian cancer. Not all of us need to run out. For example, myself, I don't have that history, I haven't been tested. You only want to get tested if you have the family history.</s>PEREIRA: Well, that's the thing that we should bring up, Dr. Yasmin, because you are concerned there's going to be a rush to overtreatment. We often see that knee-jerk reaction. It's one based in fear so we have to give a liberal dose of facts here.</s>YASMIN: Absolutely. Over-diagnosis is really, really important to talk about because it can lead to over-treatment. It's great that we have screening tests for things like breast cancer, but you want to be so careful that you're not diagnosing things so early on that wouldn't actually cause any symptoms, pain or even death and then you run the risk of putting women through surgery and treatment that they may not need and may be harmful to them.</s>PEREIRA: We look at the surgeries that Angelina Jolie has already had. She's had both breasts removed, her ovaries and fallopian tubes. Some people would think that maybe having her ovaries and fallopian tubes removed, it would be the most difficult decision. But I know you've written an op-ed, Elizabeth, that you don't necessarily think that's the case.</s>COHEN: No, the experts that I've talked to, Michaela, they said she was right on the mark. That this was not an extreme thing to do, it was a right thing to do. She has an incredibly high risk of getting breast cancer. So if we look at it this way, Michaela. Any woman without these terrible mutations has about a 12 percent chance of getting breast cancer in their lifetime. She has an 87 percent chance of getting breast cancer. So removing your breasts and removing your ovaries, they say, are a really good thing to do. Now it's interesting, the doctors said look, you don't have to remove your breasts, can you do MRIs frequently, that's an alternative. You don't have to remove them. But the removal of the ovaries, they said, is extremely important and should be done as soon as you're having children. If you're at a high risk like Angelina Jolie is. As a matter of fact, they wanted me to get the word out that they felt like she waited too long.</s>PEREIRA: Interesting.</s>COHEN: Yes, she waited too long. She was concerned about going into menopause because that's what happens when you remove your ovaries. As long as she was done having children, she should have done it, you know, very, very quickly and not waited several years.</s>PEREIRA: I really want to get to the point that Elizabeth brought up, Dr. Yasmin because I think this idea of putting a 39-year-old into menopause strikes fear in the bodies of most women. We know it's coming, can't avoid it. But this is a different kind of menopause, correct? Explain that to us.</s>YASMIN: It is a different kind of menopause, Michaela. It's very abrupt. Think about it happening to a woman in her 40s, maybe 50s, it happens over time. Women have the symptoms, they gradually become worse and they go into menopause. This is removing the ovaries, the organs that produce the hormones and overnight women sometimes will develop symptoms of menopause, it can happen a lot quicker.</s>PEREIRA: I'm really curious how you think this is now going to change the dialogue, Elizabeth, the final thoughts as we move forward with the revelation that she's made, a bold decision, a challenging decision at 39, she has many children. She has a partner. We know the testing was expensive. She is a woman of great means, do you think this is going to sort of change the dynamic and dialogue for us here in America?</s>YASMIN: You know, I think it will change the dialogue. I want to be clear, yes, she's very wealthy and has access to all sorts of things. But really this genetic counseling and the testing, the prices are coming down all the time, insurance does typically cover it if you have a family history so many of us do have access to the kinds of services that she got. Now what we don't always have access to is, you know, Angelina Jolie can pick up the phone and call anyone and get an opinion and talk to them. So we can't all do that. But we can follow her model. Think things through. Be an empowered patient. Talk to as many people as you can. Think through your decision and do it at what I liked about her op-ed piece, it showed that she wasn't emotional about how she directed this. Very pragmatic, thought it through and got good people on her side to help her think it through.</s>PEREIRA: We have good people on our side to help us, that's what we do have, our excellent medical team here at CNN, Dr. Yasmin, we appreciate your expertise as well. Elizabeth, thanks so much -- Chris.</s>CUOMO: All right, we'll take a quick break, Michaela, but we do have breaking news on Flight 9525. They just released more information about the victims on board and there were Americans. Stay with us.