KTRS News
LOS ANGELES (AP) — Angelina Jolie says that she has had a preventive double mastectomy after learning she carried a gene that made it extremely likely she would get breast cancer.
The Oscar-winning actress and partner to Brad Pitt made the announcement in the form of an op-ed she authored for Tuesday's New York Times (http://nyti.ms/17o4A0f ) under the headline, "My Medical Choice." She writes that between early February and late April she completed three months of surgical procedures to remove both breasts.
Jolie, 37, writes that she made the choice with thoughts of her six children after watching her own mother die too young from breast cancer.
"My mother fought cancer for almost a decade and died at 56," Jolie writes. "She held out long enough to meet the first of her grandchildren and to hold them in her arms. But my other children will never have the chance to know her and experience how loving and gracious she was."
She writes that "They have asked if the same could happen to me."
Jolie said that after genetic testing she learned she carries the "faulty" BRCA1 gene and had an 87 percent chance of getting the disease herself.
She said she has kept the process private so far, but wrote about with hopes of helping other women.
"I wanted to write this to tell other women that the decision to have a mastectomy was not easy. But it is one I am very happy that I made," Jolie writes. "My chances of developing breast cancer have dropped from 87 percent to under 5 percent. I can tell my children that they don't need to fear they will lose me to breast cancer."
She is anything but private in the details she provides, giving a step-by-step description of the procedures.
"My own process began on Feb. 2 with a procedure known as a 'nipple delay,'" she writes, "which rules out disease in the breast ducts behind the nipple and draws extra blood flow to the area."
She then describes the major surgery two weeks later where breast tissue was removed, saying it felt "like a scene out of a science-fiction film," then writes that nine weeks later she had a third surgery to reconstruct the breasts and receive implants."
Many women have chosen preventive mastectomy since genetic screening for breast cancer was developed, but the move and public announcement is unprecedented from a star so young and widely known as Jolie.
She briefly addresses the effects of the surgery on the idealized sexuality and iconic womanhood that have fueled her fame.
"I do not feel any less of a woman," Jolie writes. "I feel empowered that I made a strong choice that in no way diminishes my femininity."
She also wrote that Brad Pitt, her partner of eight years, was at the Pink Lotus Breast Center in Southern California for "every minute of the surgeries."
Jolie, daughter of Hollywood luminary Jon Voight, has appeared in dozens of films including 2010's "The Tourist" and "Salt," the "Tomb Raider" films, and 1999's "Girl, Interrupted," for which she won an Academy Award.
But she has appeared more often in the news in recent years for her power coupling with Pitt and her charitable work with refugees as a United Nations ambassador.
The Oscar-winning actress and partner to Brad Pitt made the announcement in the form of an op-ed she authored for Tuesday's New York Times (http://nyti.ms/17o4A0f ) under the headline, "My Medical Choice." She writes that between early February and late April she completed three months of surgical procedures to remove both breasts.
Jolie, 37, writes that she made the choice with thoughts of her six children after watching her own mother die too young from breast cancer.
"My mother fought cancer for almost a decade and died at 56," Jolie writes. "She held out long enough to meet the first of her grandchildren and to hold them in her arms. But my other children will never have the chance to know her and experience how loving and gracious she was."
She writes that "They have asked if the same could happen to me."
Jolie said that after genetic testing she learned she carries the "faulty" BRCA1 gene and had an 87 percent chance of getting the disease herself.
She said she has kept the process private so far, but wrote about with hopes of helping other women.
"I wanted to write this to tell other women that the decision to have a mastectomy was not easy. But it is one I am very happy that I made," Jolie writes. "My chances of developing breast cancer have dropped from 87 percent to under 5 percent. I can tell my children that they don't need to fear they will lose me to breast cancer."
She is anything but private in the details she provides, giving a step-by-step description of the procedures.
"My own process began on Feb. 2 with a procedure known as a 'nipple delay,'" she writes, "which rules out disease in the breast ducts behind the nipple and draws extra blood flow to the area."
She then describes the major surgery two weeks later where breast tissue was removed, saying it felt "like a scene out of a science-fiction film," then writes that nine weeks later she had a third surgery to reconstruct the breasts and receive implants."
Many women have chosen preventive mastectomy since genetic screening for breast cancer was developed, but the move and public announcement is unprecedented from a star so young and widely known as Jolie.
She briefly addresses the effects of the surgery on the idealized sexuality and iconic womanhood that have fueled her fame.
"I do not feel any less of a woman," Jolie writes. "I feel empowered that I made a strong choice that in no way diminishes my femininity."
She also wrote that Brad Pitt, her partner of eight years, was at the Pink Lotus Breast Center in Southern California for "every minute of the surgeries."
Jolie, daughter of Hollywood luminary Jon Voight, has appeared in dozens of films including 2010's "The Tourist" and "Salt," the "Tomb Raider" films, and 1999's "Girl, Interrupted," for which she won an Academy Award.
But she has appeared more often in the news in recent years for her power coupling with Pitt and her charitable work with refugees as a United Nations ambassador.
ST. LOUIS (AP) -- Lance Lynn overcame early control woes and St. Louis used a three-run seventh inning to beat the New York Mets 6-3 on Monday night.
Lynn (6-1) allowed three runs on three hits and four walks the first two innings. He only gave up one hit and one walk in his last five innings. He is 4-0 at home this season. It was the Cardinals' 10th win in the past 12 games.
Rick Ankiel, signed by the Mets earlier in the day after clearing waivers and playing against the team that revived his career as a position player, just missed a diving catch on Ty Wigginton's pinch-hit bloop double to shallow center off Scott Rice (1-3) to open the seventh.
Matt Carpenter followed Wigginton's hit with a sharp grounder off Rice's leg and the ball rolled into foul territory down the first-base line. Wigginton never stopped running and his head-first slide barely beat the tag to snap a 3-3 tie. Matt Holliday homered with one out and Yadier Molina had an RBI double with two outs, both off Scott Atchison for the three-run cushion.
Daniel Murphy had three hits with a two-run double for the Mets, busting out of a 7-for-54 slump with one RBI the previous 14 games. The Mets have dropped four straight.
Lynn threw a career-high 125 pitches, four more than the previous high exactly one year ago in a loss to the Braves. Three relievers worked the last two innings with Edward Mujica earning his 10th save in 10 chances.
Lynn threw 54 pitches and Mets starter Jeremy Hefner needed 46 the first two innings in a game tied at 3, a distinct change after three straight days of pitching brilliance. Colorado's Jorge De La Rosa carried a no-hitter into the seventh Sunday, the Cardinals' Adam Wainwright went 7 2-3 innings before his no-hit bid ended Saturday and St. Louis rookie Shelby Miller retired the final 27 hitters after allowing a leadoff hit on Friday.
Three of the first four batters reached against Hefner including Allen Craig's RBI double just inside the third-base line for the lead and Jon Jay added a bases-loaded sacrifice fly that barely counted when Matt Holliday sprinted home just ahead of third baseman David Wright's tag on Craig, attempting to advance on left fielder Lucas Duda's throw.
Murphy tied it in the second with a two-run double, a liner that right fielder Carlos Beltran appeared to lose running out of the shadows into a patch of sunlight in right. Murphy scored from second on an infield hit after shortstop Daniel Descalso could not handle Wright's slow roller and the ball rolled free.
Notes: LHP John Gast makes his major league debut for the Cardinals in place of injured Jake Westbrook on Tuesday night against Dillon Gee (2-4, 5.55). Gast was 3-1 with a 1.16 ERA at Triple-A Memphis and began the year with 32 consecutive scoreless innings. ... Chris Carpenter, all but ruled out for the season in February due to nerve issues in his shoulder, threw another bullpen session Monday and remained on track in his bid to return as a reliever, but there's no specific timetable. "When he puts his mind to something and his body cooperates, we know what kind of talent he has." ... Descalso got his third start at SS for St. Louis. ... The Mets' John Buck struck out three times for a total of 13 the last six games.
© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
Lynn (6-1) allowed three runs on three hits and four walks the first two innings. He only gave up one hit and one walk in his last five innings. He is 4-0 at home this season. It was the Cardinals' 10th win in the past 12 games.
Rick Ankiel, signed by the Mets earlier in the day after clearing waivers and playing against the team that revived his career as a position player, just missed a diving catch on Ty Wigginton's pinch-hit bloop double to shallow center off Scott Rice (1-3) to open the seventh.
Matt Carpenter followed Wigginton's hit with a sharp grounder off Rice's leg and the ball rolled into foul territory down the first-base line. Wigginton never stopped running and his head-first slide barely beat the tag to snap a 3-3 tie. Matt Holliday homered with one out and Yadier Molina had an RBI double with two outs, both off Scott Atchison for the three-run cushion.
Daniel Murphy had three hits with a two-run double for the Mets, busting out of a 7-for-54 slump with one RBI the previous 14 games. The Mets have dropped four straight.
Lynn threw a career-high 125 pitches, four more than the previous high exactly one year ago in a loss to the Braves. Three relievers worked the last two innings with Edward Mujica earning his 10th save in 10 chances.
Lynn threw 54 pitches and Mets starter Jeremy Hefner needed 46 the first two innings in a game tied at 3, a distinct change after three straight days of pitching brilliance. Colorado's Jorge De La Rosa carried a no-hitter into the seventh Sunday, the Cardinals' Adam Wainwright went 7 2-3 innings before his no-hit bid ended Saturday and St. Louis rookie Shelby Miller retired the final 27 hitters after allowing a leadoff hit on Friday.
Three of the first four batters reached against Hefner including Allen Craig's RBI double just inside the third-base line for the lead and Jon Jay added a bases-loaded sacrifice fly that barely counted when Matt Holliday sprinted home just ahead of third baseman David Wright's tag on Craig, attempting to advance on left fielder Lucas Duda's throw.
Murphy tied it in the second with a two-run double, a liner that right fielder Carlos Beltran appeared to lose running out of the shadows into a patch of sunlight in right. Murphy scored from second on an infield hit after shortstop Daniel Descalso could not handle Wright's slow roller and the ball rolled free.
Notes: LHP John Gast makes his major league debut for the Cardinals in place of injured Jake Westbrook on Tuesday night against Dillon Gee (2-4, 5.55). Gast was 3-1 with a 1.16 ERA at Triple-A Memphis and began the year with 32 consecutive scoreless innings. ... Chris Carpenter, all but ruled out for the season in February due to nerve issues in his shoulder, threw another bullpen session Monday and remained on track in his bid to return as a reliever, but there's no specific timetable. "When he puts his mind to something and his body cooperates, we know what kind of talent he has." ... Descalso got his third start at SS for St. Louis. ... The Mets' John Buck struck out three times for a total of 13 the last six games.
© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
WOMEN HAVE NEW OPTIONS FOR BREAST CANCER SURGERY
Tuesday, 14 May 2013 06:39 Published in Health & Fitness
CHICAGO (AP) -- Treating breast cancer almost always involves surgery, and for years the choice was just having the lump or the whole breast removed. Now, new approaches are dramatically changing the way these operations are done, giving women more options, faster treatment, smaller scars, fewer long-term side effects and better cosmetic results.
It has led to a new specialty - "oncoplastic" surgery - combining oncology, which focuses on cancer treatment, and plastic surgery to restore appearance.
"Cosmetics is very important" and can help a woman recover psychologically as well as physically, said Dr. Deanna Attai, a Burbank, Calif., surgeon who is on the board of directors of the American Society of Breast Surgeons. Its annual meeting in Chicago earlier this month featured many of these new approaches.
More women are getting chemotherapy or hormone therapy before surgery to shrink large tumors enough to let them have a breast-conserving operation instead of a mastectomy. Fewer lymph nodes are being removed to check for cancer's spread, sparing women painful arm swelling for years afterward.
Newer ways to rebuild breasts have made mastectomy a more appealing option for some women. More of them are getting immediate reconstruction with an implant at the same time the cancer is removed rather than several operations that have been standard for many years. Skin and nipples increasingly are being preserved for more natural results.
Some doctors are experimenting with operating on breast tumors through incisions in the armpit to avoid breast scars. There's even a "Goldilocks" mastectomy for large-breasted women - not too much or too little removed, and using excess skin to create a "just right" natural implant.
Finally, doctors are testing a way to avoid surgery altogether, destroying small tumors by freezing them with a probe through the skin.
"Breast surgery has become more minimalistic," said Dr. Shawna Willey of Georgetown's Lombardi Comprehensive Cancer Center.
"Women have more options. It's much more complex decision-making."
Breast cancer is the most common cancer in women around the world. In the U.S. alone, about 230,000 new cases are diagnosed each year.
Most can be treated by just having the lump removed, but that requires radiation for weeks afterward to kill any stray cancer cells in the breast, plus frequent mammograms to watch for a recurrence.
Many women don't want the worry or the radiation, and choose mastectomy even though they could have less drastic surgery. Mastectomy rates have been rising. Federal law requires insurers to cover reconstruction for mastectomy patients, and many of the improvements in surgery are aimed at making it less disfiguring.
Here are some of the major trends:
IMMEDIATE RECONSTRUCTION
Doctors used to think it wasn't good to start reconstruction until cancer treatment had ended - surgery, chemotherapy, radiation. Women would have a mastectomy, which usually involves taking the skin and the nipple along with all the breast tissue, followed by operations months later to rebuild the breast.
Reconstruction can use tissue from the back or belly, or an implant. The first operation often is to place a tissue expander, a balloon-like device that's gradually inflated to stretch the remaining skin and make room for the implant. A few months later, a second surgery is done to remove the expander and place the implant. Once that heals, a third operation is done to make a new nipple, followed by tattooing to make an areola, the darkened ring around it.
The new trend is immediate reconstruction, with the first steps started at the time of the mastectomy, either to place a tissue expander or an implant. In some cases, the whole thing can be done in one operation.
Nationally, about 25 to 30 percent of women get immediate reconstruction. At the Mayo Clinic, about half do, and at Georgetown, it's about 80 percent.
SPARING SKIN, NIPPLES
Doctors usually take the skin when they do a mastectomy to make sure they leave no cancer behind. But in the last decade they increasingly have left the skin in certain women with favorable tumor characteristics. Attai compares it to removing the inside of an orange while leaving the peel intact.
"We have learned over time that you can save skin" in many patients, Willey said. "Every single study has shown that it's safe."
Now they're going the next step: preserving the nipple, which is even more at risk of being involved in cancer than the skin is. Only about 5 percent of women get this now, but eligibility could be expanded if it proves safe. The breast surgery society has a registry on nipple-sparing mastectomies that will track such women for 10 years.
"You really have to pick patients carefully," because no one wants to compromise cancer control for cosmetic reasons, Attai said.
"The preliminary data are that nipple-sparing is quite good," but studies haven't been long enough to know for sure, Willey said. "It makes a huge difference in the cosmetic outcome. That makes the woman's breast recognizable to her."
Dr. Judy Boughey, a breast surgeon at the Mayo Clinic, said the new approach even has swayed patients' treatment choices.
"We're seeing women choosing the more invasive surgery, choosing the mastectomy," because of doctors' willingness to spare skin and nipples, she said.
It helped persuade Rose Ragona, a 51-year-old operations supervisor at O'Hare Airport in Chicago. She had both breasts removed on April 19 with the most modern approach: Immediate reconstruction, with preservation of her skin and nipples.
"To wake up and just see your breasts there helped me immensely," she said.
She chose to have both breasts removed to avoid radiation and future worry.
"I felt it was a safer road to go," she said. "I can't live the rest of my life in fear. Every time there's a lump I'm going to worry."
FREEZING TUMORS
Attai, the California breast surgeon, is one of the researchers in a national study testing cryoablation. The technique uses a probe cooled with liquid nitrogen that turns tumors into ice balls of dead tissue that's gradually absorbed by the body. This has been done since 2004 for benign breast tumors and the clinical trial is aimed at seeing if it's safe for cancer treatment.
"The technology is amazing. This is done in the office under local anesthesia, a little skin puncture," Attai said.
In the study, women still have surgery at some point after the freezing treatment to make sure all the cancer is destroyed. If it proves safe and effective, it could eliminate surgery for certain cancer patients.
"I'd love to see the day when we can offer women with small breast tumors a completely non-operative approach, and I do think that's coming soon," Attai said.
---
Marilynn Marchione can be followed at HTTP://TWITTER.COM/MMARCHIONEAP
© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
It has led to a new specialty - "oncoplastic" surgery - combining oncology, which focuses on cancer treatment, and plastic surgery to restore appearance.
"Cosmetics is very important" and can help a woman recover psychologically as well as physically, said Dr. Deanna Attai, a Burbank, Calif., surgeon who is on the board of directors of the American Society of Breast Surgeons. Its annual meeting in Chicago earlier this month featured many of these new approaches.
More women are getting chemotherapy or hormone therapy before surgery to shrink large tumors enough to let them have a breast-conserving operation instead of a mastectomy. Fewer lymph nodes are being removed to check for cancer's spread, sparing women painful arm swelling for years afterward.
Newer ways to rebuild breasts have made mastectomy a more appealing option for some women. More of them are getting immediate reconstruction with an implant at the same time the cancer is removed rather than several operations that have been standard for many years. Skin and nipples increasingly are being preserved for more natural results.
Some doctors are experimenting with operating on breast tumors through incisions in the armpit to avoid breast scars. There's even a "Goldilocks" mastectomy for large-breasted women - not too much or too little removed, and using excess skin to create a "just right" natural implant.
Finally, doctors are testing a way to avoid surgery altogether, destroying small tumors by freezing them with a probe through the skin.
"Breast surgery has become more minimalistic," said Dr. Shawna Willey of Georgetown's Lombardi Comprehensive Cancer Center.
"Women have more options. It's much more complex decision-making."
Breast cancer is the most common cancer in women around the world. In the U.S. alone, about 230,000 new cases are diagnosed each year.
Most can be treated by just having the lump removed, but that requires radiation for weeks afterward to kill any stray cancer cells in the breast, plus frequent mammograms to watch for a recurrence.
Many women don't want the worry or the radiation, and choose mastectomy even though they could have less drastic surgery. Mastectomy rates have been rising. Federal law requires insurers to cover reconstruction for mastectomy patients, and many of the improvements in surgery are aimed at making it less disfiguring.
Here are some of the major trends:
IMMEDIATE RECONSTRUCTION
Doctors used to think it wasn't good to start reconstruction until cancer treatment had ended - surgery, chemotherapy, radiation. Women would have a mastectomy, which usually involves taking the skin and the nipple along with all the breast tissue, followed by operations months later to rebuild the breast.
Reconstruction can use tissue from the back or belly, or an implant. The first operation often is to place a tissue expander, a balloon-like device that's gradually inflated to stretch the remaining skin and make room for the implant. A few months later, a second surgery is done to remove the expander and place the implant. Once that heals, a third operation is done to make a new nipple, followed by tattooing to make an areola, the darkened ring around it.
The new trend is immediate reconstruction, with the first steps started at the time of the mastectomy, either to place a tissue expander or an implant. In some cases, the whole thing can be done in one operation.
Nationally, about 25 to 30 percent of women get immediate reconstruction. At the Mayo Clinic, about half do, and at Georgetown, it's about 80 percent.
SPARING SKIN, NIPPLES
Doctors usually take the skin when they do a mastectomy to make sure they leave no cancer behind. But in the last decade they increasingly have left the skin in certain women with favorable tumor characteristics. Attai compares it to removing the inside of an orange while leaving the peel intact.
"We have learned over time that you can save skin" in many patients, Willey said. "Every single study has shown that it's safe."
Now they're going the next step: preserving the nipple, which is even more at risk of being involved in cancer than the skin is. Only about 5 percent of women get this now, but eligibility could be expanded if it proves safe. The breast surgery society has a registry on nipple-sparing mastectomies that will track such women for 10 years.
"You really have to pick patients carefully," because no one wants to compromise cancer control for cosmetic reasons, Attai said.
"The preliminary data are that nipple-sparing is quite good," but studies haven't been long enough to know for sure, Willey said. "It makes a huge difference in the cosmetic outcome. That makes the woman's breast recognizable to her."
Dr. Judy Boughey, a breast surgeon at the Mayo Clinic, said the new approach even has swayed patients' treatment choices.
"We're seeing women choosing the more invasive surgery, choosing the mastectomy," because of doctors' willingness to spare skin and nipples, she said.
It helped persuade Rose Ragona, a 51-year-old operations supervisor at O'Hare Airport in Chicago. She had both breasts removed on April 19 with the most modern approach: Immediate reconstruction, with preservation of her skin and nipples.
"To wake up and just see your breasts there helped me immensely," she said.
She chose to have both breasts removed to avoid radiation and future worry.
"I felt it was a safer road to go," she said. "I can't live the rest of my life in fear. Every time there's a lump I'm going to worry."
FREEZING TUMORS
Attai, the California breast surgeon, is one of the researchers in a national study testing cryoablation. The technique uses a probe cooled with liquid nitrogen that turns tumors into ice balls of dead tissue that's gradually absorbed by the body. This has been done since 2004 for benign breast tumors and the clinical trial is aimed at seeing if it's safe for cancer treatment.
"The technology is amazing. This is done in the office under local anesthesia, a little skin puncture," Attai said.
In the study, women still have surgery at some point after the freezing treatment to make sure all the cancer is destroyed. If it proves safe and effective, it could eliminate surgery for certain cancer patients.
"I'd love to see the day when we can offer women with small breast tumors a completely non-operative approach, and I do think that's coming soon," Attai said.
---
Marilynn Marchione can be followed at HTTP://TWITTER.COM/MMARCHIONEAP
© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
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