TIME health

Angelina Jolie Says She Had Her Ovaries Removed

Angelina Jolie arrives at the 20th annual Critics' Choice Movie Awards at the Hollywood Palladium on Jan. 15, 2015 in Los Angeles.
Matt Sayles—Invision/AP Angelina Jolie arrives at the 20th annual Critics' Choice Movie Awards at the Hollywood Palladium on Jan. 15, 2015 in Los Angeles.

"I feel feminine, and grounded in the choices I am making for myself and my family"

Angelina Jolie said Tuesday that she underwent preventative surgery to remove her ovaries and fallopian tubes, two years after she sparked a debate on women’s health by getting a preventative double mastectomy.

Writing in the New York Times, the Hollywood actress and U.N. envoy said her decision, made because she carries a mutation in the BRCA1 gene that gave her a 50% risk of developing ovarian cancer, was not an easy one.

“It is not easy to make these decisions,” she said. “But it is possible to take control and tackle head-on any health issue.”

The procedure forces a woman into menopause and Jolie will now take hormone replacements.

Jolie, 39, who wrote about her decision to have a double mastectomy after learning she had the gene mutation two years ago, said she wants to help provide information to women going through similar experiences.

“You can seek advice, learn about the options and make choices that are right for you,” she said.

Read more at the Times

Read next: Angelina Jolie: The World Must Do More for Syrian and Iraqi Refugees

Listen to the most important stories of the day.

TIME Cancer

Diagnosed With Breast Cancer? Get a Second Opinion

Ben Edwards—Getty Images

A new study reveals that pathologists don't always see a biopsy the same way

A new study shows that when it comes to diagnosing breast cancer, doctors do not always agree on what the biopsy slides reveal.

Every year, about 1.6 million women in the United States undergo a breast biopsy. In some cases, the biopsy results are obvious; a woman has breast cancer or she doesn’t. But other cases are more uncertain.

According to new research in the journal JAMA, when it comes to less obvious cases, the doctors making the call—pathologists—only agree with outside experts about 75% of the time.

In the study the researchers asked 115 U.S. pathologists to assess 240 breast cancer biopsy slides and make a diagnosis. Their responses were then compared to what a panel of three highly regarded experts determined to be the correct diagnosis.

Fortunately, when it came to diagnosing invasive cancer, there was broad consensus; the pathologists agreed with the panel 96% of the time. When it came to non-cancerous biopsies, the pathologists agreed 87% of the time, but 13% of the time they misdiagnosed.

When it came to more challenging cases—like atypia, where breast cancer cells are abnormal but not cancerous—the pathologists only agreed 48% of the time. In 17% of the cases, the pathologists diagnosed atypia when the expert panel did not, and 35% of the time the pathologists missed the diagnosis.

Another challenging diagnosis is ductal carcinoma in situ (DCIS), which happens when the cancer is inside the milk ducts but considered non-invasive. When it came to DCIS biopsies, pathologists agreed 84% of the time. Three percent of the time they diagnosed DCIS, and 13% of the time they missed it.

Though the study did not examine the clinical impact of incorrect diagnoses, the findings raise concern about cancer over-diagnosis and over-treatment, as well as missed opportunities to catch true cancer early.

“These findings are disconcerting but perhaps not altogether surprising,” write the authors of a corresponding editorial. (The editorial authors were not involved in the study.) In the real world, pathologists do have the opportunity to consult with others, they note. They conclude that the findings underline the value of having a second opinion in more ambiguous cases.

“The agreement on the diagnosis of invasive carcinoma was quite high, and that should be reassuring,” says Dr. Benjamin Calhoun of the anatomic pathology department at the Cleveland Clinic, who was also not involved in the study. He sees the results as an opportunity to improve continuing medical education for pathologists. “Instead of a lecture from an expert with a few carefully chosen representative images, pathologists need a more ‘hands-on’ experience,” he says, “and the opportunity to compare their diagnoses with an expert panel.”

For now, more research is needed to understand how such findings may be affecting patients.

TIME Cancer

Lung Cancer Now Kills More Women Than Breast Cancer in Developed Countries

The lingering effects of the tobacco epidemic are partly driving the shift

For years, breast cancer has been the leading cause of cancer death among women in developed countries, but according to a new report on the incidence of cancer worldwide from the American Cancer Society, lung cancer now surpasses it.

A combination of early breast cancer detection efforts and the lingering effects of the tobacco epidemic drove the shift, says lead report author Lindsey Torre, an American Cancer Society researcher. The study, which was published in CA: A Cancer Journal for Clinicians and used data from 2012, reported that lung cancer killed 209,000 women in developed countries in 2012, while 197,000 women died of breast cancer.

“We know now that in a lot of developed countries among women, smoking is on the decline,” says Torre, noting that new lung cancer infections today are the result of habits formed decades ago. “The good news is that we can probably expect to see these lung cancer mortality rates peak and start to decline as times go by.”

Read more: The Cancer Breakthrough With Big Implications

The report emphasized the growing incidence of cancer in the developing world. Lung cancer was the leading killer of men in developing countries and breast cancer the leading cause of death for women.

In part, these growing numbers can be attributed to an aging population, a trend that is affecting the world at large. And as the developing world continues to westernize, people in developing countries are increasingly likely to smoke, be overweight and rarely engage in psychical activity, Torre says.

“We’re seeing the burden of cancer shift to developing countries, so they’re taking on an increasing portion of the global cancer burden,” she says.

Cancer killed 8.2 million people worldwide and 1.6 million in the United States in 2012.

TIME diseases

U.S. Breast Cancer Deaths Fell Dramatically in the Past 20 Years

Getty Images

The 34% decline in deaths represents more than 200,000 lives saved

The past 20 years have seen a sharp drop in the number of deaths from breast cancer in the U.S., the latest government statistics indicate.

The number of deaths fell from 33 to 22 per 100,000 women between 1990 and 2011, USA Today reports. This decline — about 34% — represents more than 200,000 lives saved, the American Cancer Society said.

Experts say the downward trend, which they estimate has continued in the past four years as well, can be attributed to better treatment, rising awareness and more frequent checkups.

[USA Today]

TIME Cancer

Many Breast Cancer Patients Don’t Understand Their Condition, Study Says

The disparity is particularly pronounced for minority women

Many breast cancer patients don’t understand the details of their disease, according to a new study. While many believed they understood the grade, stage and type of tumor, only 20% to 58% identified those characteristics correctly.

The study, published Monday in the journal Cancer, found that minority women fared particularly poorly in identifying their tumor characteristics, a finding that remained true even as researchers controlled for factors like education. The lack of understanding about their own disease makes it difficult for patients to make informed medical decisions and to follow prescribed treatments, said study author and Harvard Medical School professor Rachel Freedman.

“Our results illustrate the lack of understanding many patients have about their cancers and have identified a critical need for improved patient education and provider awareness of this issue,” Freedman said.

TIME health

For Breast Cancer: It’s Not Nature vs. Nurture—It’s Both

Dean Ornish is Founder and President of the non-profit Preventive Medicine Research Institute and Clinical Professor of Medicine at UCSF.

Genetics and lifestyle are both in play

In 2003, a mountain climber (Aron Ralston) became trapped under an 800 pound boulder while canyoneering alone in Utah. After five days stuck beneath the massive boulder, Ralston amputated his own right hand, freeing himself and saving his life.

Last year, Angelina Jolie underwent a prophylactic bilateral mastectomy because she has a BRCA1 mutation that greatly increases her risk of breast cancer in hopes that it would save her life as well.

In both cases, after careful and thoughtful consideration, two individuals decided to sacrifice important parts of their bodies in order to survive.

And in both cases, there were critics.

Rex Tanner, a 10-year search-and-rescue veteran and commander of Grand County Search and Rescue, questioned if Ralston had other options.

Melissa Etheridge publicly criticized Angelina Jolie for undergoing a prophylactic double mastectomy. “I wouldn’t call it the brave choice. I actually think it’s the most fearful choice you can make when confronting anything with cancer.”

When Etheridge was diagnosed with breast cancer, she chose to make changes in diet and lifestyle as well as having a lumpectomy and undergo chemotherapy. (Etheridge is BRCA2 positive, which has a lower risk of developing breast cancer than the BRCA1 mutation carried by Jolie.)

BRCA1 and BRCA2 are genes that help prevent cancer by repairing DNA. Some people have mutations in these genes that impair their ability to serve that function, thus significantly increasing the risk of breast cancer and ovarian cancer. The estimated risks of developing breast cancer by age 70 are 55% to 65% for women who carry a deleterious mutation in the BRCA1 gene (and maybe as high as 85%) and 45% to 47% for women who carry a deleterious mutation in the BRCA2 gene.

Given these odds, it’s understandable why some women elect to have prophylactic bilateral mastectomies. It can be a rational choice, not a fearful one. These are intensely personal and private decisions that I deeply respect, made by people who I imagine have given great thought and consideration to various options. Only they know what they’re really feeling.

At the same time, I do not agree with a recent article that stated, “Shame on Melissa Etheridge for using her privilege and public platform to blame herself for her breast cancer.”

To say that diet and lifestyle may play a role in breast cancer does not mean that people who change their lifestyle are blaming themselves or that you can always prevent breast cancer by eating and living more healthfully. You do what you can even though there is not certainty.

Having the BRCA mutation significantly increases the risk of breast cancer, but it is not always the only factor. Lifestyle choices may increase or decrease the risk of breast cancer, but that knowledge is an opportunity to empower ourselves, not to blame.

According to the National Cancer Institute, “Even with total mastectomy, not all breast tissue that may be at risk of becoming cancerous in the future can be removed.” Because of this, a bilateral prophylactic mastectomy reduces the risk of breast cancer by 95% in women who have the BRCA mutation and by up to 90% in women who have a strong family history of breast cancer—but not by 100%. Thus, even if a woman decides to have a prophylactic mastectomy, she may also benefit from making lifestyle changes as well.

While studies may provide information on risks in populations, there is an element of mystery in applying these studies to an individual. At least 15% of women with the BRCA1 mutation and at least 50% of women with the BRCA2 mutation do not get breast cancer—lifestyle factors may play a role.

Not everyone who eats meat, smokes, and is overweight, stressed, and sedentary gets breast cancer—protective genes may play a role. And you may eat well, move more, love well, and stress less and still die of breast cancer. Genes may override the best lifestyle, but not always.

While there is no assurance that lifestyle changes may prevent breast cancer in those who have the BRCA mutation, there is evidence that lifestyle changes are worth making, whether or not a person decides to undergo prophylactic surgery.

For example, high serum levels of insulin-like growth factor I (IGF-I) are associated with an increased risk of breast cancer, especially in women with the BRCA mutation. IGF-I contributes to a chronic inflammatory state, which has been linked with an increased risk of many chronic diseases, including breast cancer.

Serum IGF-I levels were higher in those consuming animal protein (particularly dairy) and lower in those consuming vegetables.

In one study, women with the highest levels of IGF-I had a 3.5-fold increased breast cancer risk, compared to those with the lowest. However, women with the BRCA mutation who had the highest levels of IGF-I were seven times more likely to develop breast cancer than those with low IGF-I levels. In this context, lifestyle changes may be particularly important in those with the BRCA mutation.

Another study showed that soy intake was associated with a lower risk of breast cancer but meat intake was associated with a higher risk of breast cancer. Both the protective effects of soy and the harmful effects of meat consumption were higher in those with BRCA mutations.

In the EPIC study of 366,521 women, an increased risk of breast cancer was associated with high saturated fat intake and alcohol intake. In postmenopausal women, BMI was positively and physical activity negatively associated with breast cancer risk.

Those aged 50 to 65 reporting a high intake of animal protein (but not plant protein) in their diet had a 400% higher risk of dying from cancer during the following 18 years, in part because diets high in animal protein increase IGF-I levels.

Those with BRCA mutations who had gained a significant amount of weight since age 18 were 4.6 times more likely to have developed breast cancer.

Another study found a strong and significant inverse relationship between the quality of diet and BRCA-associated risk of breast cancer. Those with BRCA mutations who had high intakes of diverse fruits and vegetables had a significantly lower risk of developing breast cancer.

Lifestyle changes may slow, stop, or even reverse the progression of early-stage prostate cancer. Many experts believe that what’s true of prostate cancer may also be true of at least some forms of breast cancer, although not necessarily those with the BRCA mutation.

These comprehensive lifestyle changes may beneficially change gene expression in over 500 genes in only three months—upregulating genes that are protective, downregulating genes that promote illness, particularly the RAS oncogenes that promote prostate cancer, breast cancer, and colon cancer. But there is no evidence proving that lifestyle changes directly affect the expression of BRCA genes.

These lifestyle changes may increase telomerase and lengthen telomeres, the ends of our chromosomes that control aging on a cellular level. Telomeres usually shorten as we get older, and as our telomeres get shorter, the risk of premature death from many forms of cancer (including some forms of breast cancer), heart disease, and dementia increase.

Whether or not someone chooses to have a prophylactic mastectomy, changing diet and lifestyle may reduce the risk of developing breast cancer. And in comparison to removing both breasts, it’s hard to view changing lifestyle as a radical intervention. Lifestyle changes may help reduce risk, but no study has shown that lifestyle changes alone can eliminate the risk of breast cancer, especially in those carrying the BRCA mutation.

According to Dr. Laura Esserman, Director of the UCSF Carol Franc Buck Breast Care Center, “If someone from a BRCA family wants to do everything they can do to avoid the fate many of their relatives may have faced, diet and lifestyle should be as much a part of their strategy as prophylactic surgery. Some women will want to do all they can, some will pick and choose among the risk-reducing options. But diet and lifestyle will improve their health in many other ways, not just reduce their risk of cancer, so it ought to be part of any choice going forward.”

No one has all the answers, so whatever a woman who has the BRCA mutation chooses to do requires courage and an element of faith. And a lot of love and support.

Dean Ornish is Founder and President of the non-profit Preventive Medicine Research Institute and Clinical Professor of Medicine at UCSF. He is the author ofThe Spectrum and five other bestsellers. He is a leading researcher in how comprehensive lifestyle changes may reverse heart disease and other chronic illnesses without drugs or surgery and may even begin to reverse aging at a cellular level.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Cancer

Many Breast Cancer Patients Get Unnecessary Radiation

About two thirds of breast cancer patients may be getting more radiation treatment than they really need according to the latest study

When it comes to treating cancer, the common approach is often “more is better.” Throwing everything medically possible at growing tumors can keep them from spreading and, most important, help patients survive their disease.

But in a paper appearing in JAMA on Dec. 10, researchers say it’s time to rethink that strategy. They found that women with early stage breast cancers may not need the usual seven weeks of radiation therapy after surgery to remove their tumors. Instead, a three-week course with higher intensity radiation can be just as effective.

“The fact is, more is not always better in cancer care,” says the study’s lead author Dr. Justin Bekelman, assistant professor of radiation oncology, medical ethics and health policy at Penn Medicine’s Abramson Cancer Center. “Often less is just right. But the challenge in cancer care is that way of thinking is not where we are today.”

MORE: No More Chemo: Doctors Say It’s Not So Far-Fetched

It’s a challenge, he says, because it goes against the intuitive idea that hitting tumors with more radiation or chemo is going to have a better chance of killing them and preventing them from spreading. But in recent years, data is showing that in some cases, there are alternatives that could be just as effective but easier on patients and even less expensive. As four trials have demonstrated, shorter regimens can result in similar survival as the longer course of radiation. Bekelman and his colleagues wanted to know how many women were picking up the shorter regimen.

The researchers analyzed records from 9 million women provided by Anthem, Inc. Among them, more than 15,000 were diagnosed with early stage breast cancer and had surgery to remove their tumors followed by radiation. While rates of shorter course radiation did increase from 11% in 2008 to 34.5% in 2013, that percentage still represented only a third of the women who could have taken advantage of the shorter radiation treatment.

MORE: Removing Both Breasts May Not Improve Survival From Breast Cancer

Why the reluctance to adopt the therapy that takes less time and allows women to return to their normal lives sooner? “I think physicians are much more comfortable with the longer treatment,” says Bekelman, “I wonder to what extent physicians are engaging with their patients to discuss the pros and cons of treatment schedules because they are so comfortable with the longer treatment.”

One reason they might favor the longer therapy is because they are concerned about potential side effects from the higher intensity radiation exposure in the shorter regimen. That can result in scarring and adverse effects for women decades later, he says.

That might explain why more younger women chose the longer, traditional radiation regimen, since they and their doctors may have been more concerned about scarring in their breast tissue later.

But the studies on the shorter course treatment include follow up with women up to 10 years after their therapy, and there’s no strong evidence that such adverse effects occur.

MORE: High-Tech 3D Mammograms Probably Saved This Woman’s Life

In addition, the women choosing the shorter course spent about 10% less in the first year after their treatment than those who opted for the traditional radiation regimen. “The savings in patient time and hassle and spending were really large, so it was a little surprising that more women weren’t using the [shorter course] of radiation,” says Bekelman.

Having data might help, he says, to convince both doctors and patients that when it comes to radiation, less may actually do more — in saving lives, reducing anxiety and inconvenience, and lowering health care costs.

TIME remembrance

Former Miss America Mary Ann Mobley Dies at 75

Mobley was crowned Miss America in 1959

Actress, philanthropist and former Miss America Mary Ann Mobley died Tuesday morning in Beverly Hills, Calif., after a second battle with breast cancer, one of her daughters has announced in a statement to NBC News. She was 75.

Born in Biloxi, Mississippi, Mobley, was crowned Miss America in 1959 and became one of the few Miss Americas to launch a successful TV and movie career. She graduated from “Ole Miss” in 1958 and was the university’s first Carrier Scholar and the first woman voted into the Alumni Hall of Fame.

“When I was a little boy growing…

Read the rest of our story from our partners at NBC News

TIME Cancer

3D Mammograms Are Better For Dense Breasts

A new study adds to growing support for 3D mammograms

No option is perfect when it comes to mammography. That’s particularly true for women with dense breasts, who are burdened with a greater risk for cancer and tumors that are harder to find. But a new study shows that 3D mammograms can increase cancer detection in women with dense breasts.

The new research, presented at the annual meeting of the Radiological Society of North America (RSNA), compared 3D mammography with full-field digital mammography (FFDM) to just FFDM on its own in 25,547 women between ages 50 and 69.

The 3D mammography screening method detected much more cancer than FFDM alone: 211 cancers compared to only 163. When it came to dense breasts, the 3D mammography and FFDM were able to identify 80% of the cancers, versus 59% via FFDM alone.

The new study is just the latest in a series of recent findings that support 3D mammography as a more accurate screening method for breast cancer. Prior research published this year has shown that 3D mammograms can save more lives, reduce medical costs and cut down on anxiety-inducing false positive results.

TIME Cancer

Why Meditation and Yoga Are Recommended for Breast Cancer

Non-invasive alternative therapies can clear an anxious mind

Up to 80% of American patients with breast cancer will undergo complementary therapies to manage anxiety and stress after they receive a diagnosis.

Though there’s no clear consensus on which integrative and alternative therapies work and which are ineffective, more and more medical practices have incorporated practices like mindfulness and acupuncture into their offerings. But a new study published in the Journal of the National Cancer Institute Monographs conducted by several major oncology facilities has examined which therapies benefit patients the most. The answer? Meditation, yoga and relaxation with imagery.

The three methods are known to be calming for those who practice them, and the researchers gave the practices an “A” for treating symptoms of mood disorders that are highly common among people with a recent diagnosis.

To come up with the grade, the researchers parsed through clinical trials conducted from 1990-2013 on complementary therapies paired with routine cancer treatment, like chemotherapy. The researchers then graded each therapy based on efficacy. Acupuncture was given a “B” for controlling chemo nausea, and music therapy also received a “B” for anxiety and stress.

“Women with breast cancer are among the highest users [of these therapies]…and usage has been increasing,” the authors write in their study. “Clear clinical practice guidelines are needed.” The study involved researchers from Columbia University’s Mailman School of Public Health, Herbert Irving Comprehensive Cancer Center, MD Anderson, University of Michigan, Memorial Sloan Kettering and more.

The researchers also gave some therapies low grades. For example, healing touch was given a “C” for lowering pain, and aloe vera gel was not recommended at all for preventing skin reactions from radiation therapy. The researchers also point out that while some natural products were shown to be effective, they did not have the safety data to back them up, suggesting more formal research is needed before some of the therapies can be officially recommended.

As patients with breast cancer and other forms of cancer continue to seek other ways to deal with some of the emotional side effects that stem from serious illness, it will become increasingly important for hospitals to find ways to answer their unmet needs—which might include a yoga class.

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