Many women became familiar with the breast cancer type 1 gene (BRCA1) when actress Angelina Jolie announced that she had undergone a double mastectomy as a preventative measure. The reasoning that Jolie shared with the media was focused on her risk—according to her medical professionals, Jolie’s variation on the BRCA1 gene gave her an 87 percent chance of developing breast cancer. So even though she did not have breast cancer, Jolie felt HER risk was too high to ignore this genetic predisposition and had the double mastectomy.
I’m not writing to judge Angelina Jolie or the decision she made, which seems to have been the “right” choice for her. I’m writing because I know that having a preventative double mastectomy will not be the first choice for many women. And these women need to understand all sides of this issue before making a choice that’s right for them.
First, it’s important for you to know that only about two percent (2%) of all breast cancers involve an inherited gene, either the BRCA1 or the BRCA2! The first has a higher risk than the second, and both genes are also associated with ovarian cancer. (BRCA1 is more common in Hispanic, African American, and Jewish women of Ashkenazi descent.) That said, if you have a strong history of breast or ovarian cancer, but test negative for either gene, your family history may be a bigger indicator of your breast cancer risk than the gene is.1 Jolie’s mother died in her fifties of ovarian cancer, and Jolie has a significant family history of breast and ovarian cancer—including an aunt who died from breast cancer shortly after her announcement.
One aspect of the story that really got people’s attention was the statistic “87 percent risk.” That number sounds frightening, because it’s so specific! Jolie’s medical professionals didn’t cite an 85 or a 90 percent chance, or a range—they gave Jolie an 87 percent risk of developing cancer. Let’s look more closely at this, because it’s a great example of our misunderstanding of the genetic connection to disease.
Jolie’s “number” is based on older estimates, which have been disputed by the National Institutes of Health. In fact, a 1997 study showed the risk of Jolie’s particular mutation to be closer to 56 percent. There are many factors that affect a woman’s chance of developing breast cancer—regardless of whether she has the BRCA1 or BRCA2 gene.
• In an blog called “What Doctors Didn’t Tell Angelina Jolie”2 journalist Lynn McTaggart points out, “New evidence shows that even a faulty BCRA1 gene, as Jolie has, may require epigenetic modification, or ‘silencing,’ before cancer progresses.”3 In layman’s terms, this means that a physiological change is required to activate the gene.
• Vitamin D levels play a huge role in protecting women from cancers of all kinds. We now know that the risk of breast cancer is cut in half in women with adequate levels of vitamin D. 4
• The nutrition a girl gets at critical times in her life, particularly as a fetus and during puberty, greatly influence the expression of genes like BRCA1.5
• Daily intake of fruits and vegetables also lowers your risk of breast cancer. Karolyn Gazella writes, “Specific to BRCA1 and BRCA2, a 2009 study featured in the journal Breast Cancer Research and Treatment demonstrated that women with the inherited mutation who ate more fruits and vegetables significantly reduced their risk of developing cancer compared to the women with the mutation who ate fewer fruits and vegetables.”6
• In a 2006 study also featured in Breast Cancer Research and Treatment, women who carried the mutation and had normal weight, and prevented weight gain as they aged, also had a much lower risk of developing cancer than women with the mutation who were overweight.
• Our families’ emotional legacies play a large role in all our health issues, and are hard to quantify in studies—although they absolutely are a factor.
If you look at your family history and wonder whether you should have genetic testing, think hard about why you want to do so. The recent Supreme Court decision that denied a patent to the company that developed the breast cancer gene test has resulted in a flurry of other parties offering the test at a much lower cost. This is a double-edged sword for at-risk women unless they are fully informed about their true risks. Click here to read these risks.
Before you have the testing, ask yourself the following: What would I do with the information? Would you be swayed by your doctor to get a preventative double mastectomy? Would you stop looking for ways to mitigate your risk? Would you let medical test results override your inner guidance?
Whether the results are negative or positive, there are no guarantees. Regardless of what your choices are, or what your results may be, the most powerful thing you can do for your breast health is to cultivate a loving relationship with them, making breast-healthy lifestyle choices, and, if you are concerned, monitor their health with an attitude of self-love and self-care—not a “search and destroy mentality.” Acknowledge that your breasts—like every other part of your body—have the ability to become and stay healthy throughout your life.
Please leave me a comment and let me know your thoughts on genetic testing for the breast cancer gene as well as what you think would be the right decision for you if you found out you had either the BRCA1 or BRCA2 genes. And if you enjoyed this blog, please share it with others!
[1] American College of Obstetrics & Gynecology, Committee on Genetics, 1996, Breast-Ovarian Cancer Screening, Committee decision no. 96, Washington, D.C.
[2] McTaggart, L. What Doctors Didn’t Tell Angelina Jolie, May 31, 2013,
[3] Birgisdottir, V. Epigenetic silencing and deletion of the BRCA1 gene in sporadic breast cancer, Breast Cancer Res, 2006, 8: R38.
[4] National Human Genome Research Institute, Three Breast Cancer Gene Alterations in Jewish Community Carry Increased Cancer Risk, but Lower Than in Previous Studies, 1997.
[5] De Assis S, Hilakivi-Clarke L. Timing of dietary estrogenic exposures and breast cancer risk, Ann N Y Acad Sci, 2006; 1089: 14–35.
[6] Gazella, K. Angelina Jolie Missed an Important Opportunity, Psychology Today: The Healing Factor, May 16, 2013.
If I knew I had the gene, it would motivate me to make healthful lifestyle choices, and possibly monitor for breast cancer more frequently, but certainly not to remove my breasts. My mother and aunt both had breast cancer in their 40’s, but my mother had an unclassified variant. Mammograms failed her as she had been getting them every year but when they found it they said it was so advanced and aggressive she must have had it for years. Thank you for the information!
I am 67 years old and a retired NP. I have no history of any sort of cancers on either side of my family tree. I enrolled in a study focused on personalizing preventative breast screening for woman. I was randomized to the group that included genetic testing. I found out I have the BRCA2 mutation. Shock. I have opted to have increased breast screening (MRI 6 months, alternating Mammogram 6 months with clinical breast exam). I am considering a salphingo-oophrectomy but not bilateral mastectomy. Everyone in my family has died at age 80+ of CVD. Go figure.
Dear Dr. Northrup, I was in an unhappy/failing second marriage and visited my Primary Care Physician who I trusted. I was 58 years and had stopped my periods at 50, I never suffered menopause symptoms only stress from my life situation. My doctor suggested BHRT and assured me “I’d feel 35 again”. (I’d had a Tubal ligation (no problems) at 37, after the birth of my 8th child. I weighed a healthy 125-130 lbs, 137 lbs was my highest weight when 40 weeks gestation.
My left nipple became inverted at 16 yrs old when my breasts began to grow and my left breast grew around the nipple. My right breast didn’t match the size of growth and my nipple remained out. I breast fed 7 babies. I experienced one miscarriage (#6)in first Trimester. So, 21 yrs. later I am given BHRT cream, Estrodiol and Progesterone. After using for two weeks both breasts had become increasingly warm, uncomfortable and my bra became intolerable to wear on my size C cup breasts. My right nipple INVERTED, HAD CLEAR, STICKY DISCHARGE AND WAS BURNING. I called the prescribing doctor who said nothing but to “Call my doctor”. My “doctor” told me I should see a plastic surgeon. After seeing a dozen MD’s, I’ve gotten no answer and my nipple is still inverted and I feel “tension” of it being pulled in still. I can pull it out, but it goes back in.
Does this happen with BHRT? Is it a “hormone reaction” in my breast tissue? You’re my last hope.
Sincerely, Debra
My doctor’s office suddenly started leaving me messages that I have to schedule a mammogram. They’ve never done this before. When I asked why they were suddenly calling me about this, they said it’s because they were told to by my health insurance. Apparently, these decisions are no longer decided by doctors and their patients, but by health insurance companies. No, I will not be having a mammogram just because my insurance company tells me to.
https://www.angelinajoliebiography.com/angelina-jolie-mother/
Dear Doctor Northrup, I hope you can give me some advice. I am 61 and have had two biopsies, I showed atypical cells and the other LCIS. They have given me a lifetime risk of 50% and want me to take the drug, Exemestane, 25 mg. For five years which will drop my percentage by 50%, could you please give me your opinion, I have been following you for years. Thank you, Patty
I think Angelina’s choice was incredibly extreme. I believe that ‘physicological’ and nutritional changes – meditation, exercise and visualizations – alot of the things that you are also suggesting could have been a better choice for Ms. Jolie. A vegan diet would have helped had she been given more responsible assistance in how to do it. This was just unbelievable to me that this person did what she did, when – down the road – who knows what will happen with the genes and her body after undergoing this inCredible mutilation. Some people believe doctors are gods when really they need to connect with their deeper self – their spiritual well being. Living life as a torn-up – cut up woman wouldn’t be my idea of a life. Somehow I am CERTAIN i would have chosen ALL the alternative routes for self healing – then left the rest up to the gods!
I am 57 years old. I had a hysterectomy at 32 because of heavy periods. I had an oophorectomy at 38 because of a cyst (pathology was benign). I went through my menopause at age 41 and have “very low postmenopausal estrogen and progesterone.” My oldest sister was diagnosed with Primary Peritoneal Cancer. My youngest sister opted to have a test and found out she has the mutation BRCA1. They are both overweight, their diets are horrible, they do not exercise, they have huge amounts of stress in their lives, and they don’t supplement properly or test for hormone levels. I am 5’5″, and I weight approx. 123 lbs. I eat organic and take green foods and great supplements (worked with naturopaths for years). I exercise on a recumbent stationary bike 30 minutes while watching tv every day. I’m basically happy and have a great marriage. I do not want to be scared to death about this. I asked my doctor, and he wants me to have the genetic testing. I only have one ovary and my breasts are very small. My mother’s cousin is a breast cancer survivor (but had her period until she was 59). My mother’s aunt (cousin’s mom) got uterine cancer (but had her period until she was 58). No breast or ovarian cancer in any other members of our family! I want some sound advise, and I’m impressed by you! My vitamin D levels are perfect, and my blood work is perfect.
Hi Dr Northrup, It’s not easy to block fear, having seen cancer eating the bodies of loved ones. My mom died when I was 15. I survived cervical cancer. Found it hard to love and trust my body, took the test, calculated, listened to my inner voice. Had ovariectomy, mastectomy & immediate reconstruction with my belly-fat.
I’ve chosen to get rid of my fear. To enhance my chances to be alive for my 3 daughters when they have their own difficult choices to make. To live. A fan in Amsterdam, Holland
Hi Beth- your husband is my hero. Breast reconstruction is not a walk in the park. But most women are pleased with their results. It’s a choice. Ask your inner wisdom to give you the answer! Tatjana– breast adenomas do NOT need to be removed. And can often be shrunk by painting iodine on your breasts are taking more iodine. The blog I just posted today gives you the information you did. thanks every one for your wonderful comments here!!
I come from a culture that encourage us to breastfeed the babies for as long as we can. I have been a pharmacist for almost fourty years and I realize now that this is the best insurance for preventing breast cancer. My best regard, Dr Northup, I am your biggest fan in Maracaibo, Venezuela.
Thank you for all your positive input and your wonderful books that have inspired so many of us. It is so important to make choices based on love rather than based on fear. It is so great to hear you propagate that, especially coming from a conventional medical background.
After listening to the conversation on the Hayhouse World Summit, which I absolutely loved, I looked up your website. I wasn’t surprised, as this EXACT topic was the centre of our conversation with my daughter over breakfast this morning. Even though I am an MD and ND, I know coming from another doctor’s “pen” it’s more effective than mom’s words. Much appreciated!
Thanks for this incredible information! A year ago I was diagnosed with LCIS and ADH, two conditions that are precursors to breast cancer. The surgeon removed the “funky” cells and we are monitoring, but what shocked me were the (off-handed) suggestions that I get a double mastectomy, even at this early, non-cancerous stage! Like they assumed I’d get cancer. Thanks to a great nutritionist and naturopath, I’m working on healing my body — a much better solution, in my opinion. 😉
Thank you for giving us another side to the decision that Ms. Jolie made. It is all about choices. She had every right to do what she did. But each of us has to do what is best for us.
Thank You for your informative blogs Dr. Northrup. I personally would not take Genetic testing for any type of cancer. I believe that eating healthy and living healthy, the mind/body connection is what is more important.
I am 34 years old. I have a strong history of breast cancer. So, when i read about Angelina Jolie, I could understand her fear. My family thinks I should consider doing the gene test. But my gut tells me otherwise. If I do it and its positive, it would weigh on my mind. I would rather work on myself. I have just begun but I believe I can break this cycle. I believe that family history might increase the risk but it’s not the deciding factor.
Thanks for all the information you have provided over the years to empower women. Genetic testing for breast cancer? I personally would never trust the test results – I’ve had too many negative experiences when it comes to docs and the tests they recommend. The mind/body connection is so important. If I found out I had cancer, I would eat super healthy and do internal work to understand what beliefs I have that are creating the cancer. Surgery/chemo/radiation would be LAST resorts for me.
Take it from a Stage 3 endometrial cancer survivor.. I went to the best Dr’s in Boston..listened to them and then to my gut. Read on the internet. Surgery is a must.. it is the number one thing you need to do without question. God knows where I would be without it. I am a control freak..but I had incredible laparoscopic surgery by Harvard Surgeons. However, I did not follow their “standard of care’ protocols.. I refused Chemo..but did do radiation. There again the Radiation Oncologist knew what they were doing. My complaint is that I had numerous false positives along the way with ct scans etc and tumor test etc. that caused incredible anxiety. It is a crazy time in one’s life where you have to balance your gut with what the medical profession is telling you. Tons of false positives during evaluation etc. I am in remission, and nearing the end of a high risk period.. do not know what tools and strength I had to resist the ‘standard of Care” protocols.. all I know is that I would forever be a destroyed human being if I went along with everything they recommended. However, very grateful for the great surgery and radiation treatments.. by a very talented group of Dr’s.
Dr Northrup, I am an O.R. nurse [Australia]and every day I see people in poor health of their own making. I laughed when I read Judith’s comments. I also turned fifty this year and received the poo testing kit, a mammogram appointment and a pap smear reminder. Apart from the pap smear which I do believe in the others went in the rubbish bin! All the attention seems to be on looking for problems and treating them rather than preventing them. Thankyou for your entertaining and informative blogs.
Thanks you so much for posting this.
When I first heard the story about Angelina, I cried out, “Her doctors lied to her, they didn’t tell her the whole story”. True, it may have been a lie of omission, but it had the same effect on her decision nonetheless.
I thought it was widely known that it takes many, many factors to ‘turn on’ any gene expression. What happened here?
While I agree that it is just a number and an individual one at that, we that have tested and took preventive measures did so from a place of knowledge. I would not discourage anyone to test if they fit the parameters. But the important part if to do so with a genetic counselor and as complete a family history as you can. Knowledge and information can only lead to empowerment.
Hi Dr. Northrup, thank you for shining the light on this pervasively fearful topic. I appreciate all you’ve said in this article. Would you please elaborate and offer practical suggestions on how to have an attitude of self-love and self-care when monitoring our breasts? Thank you!
I’m 50 & mother died of breast cancer at 53, so this topic is of intimate interest to me. I think genetic testing for breast cancer is fascinating, but I would never do it. I’m certain that if I tested positive for the gene, that information would catapult me straight into fear! Knowing that it’s not a predictor of the future is not enough for me to be able respond to the information with love instead of fear.
You mention good vitamin D levels and daily intake of fruits and vegetables. I read of a study that revealed autopsy results on women with Ductal Carcinoma In Situ; in many, the cancer had not progressed. Perhaps diet is the key in preventing cancer, stopping progression in it’s earliest stage, or even reversing cancer in it’s earliest stage. Would a positive result for BRCA 1 or BRCA 2 prevent a women from getting health insurance?
Dr Northrup,
I am full of love and gratitude for all the information you provide! My grandmother and mother both died of breast cancer. My mothers death (3 years ago–her 2nd bout) coincided with my menopause. I carry alot of guilt because our relationship was full of negativity. I have been cleaning house using diet, bio-identical hormones, yoga, healing touch, body talk, and just recently tapping. I truly believe that her cancer came because she was lost to herself. NAMASTE
Hi Dr Northrup – I completely agree on the fear-based hype on cancer prevention. As a Naturopath I believe in the principle of Primum non nocere and living a life a healthy as possible, ENJOYING the moments and getting rid of toxic emotions. I think the genetics are just the most likely way an emotional issue is going to find it´s way to exteriorize itself when kept bottled up. Many blessings and thanks for all the great information
Thank you for your post! We live in a terrorist time: everything is studied for making us afraid. Afraid of loosing our job, afraid of not finding a job, afraid of what we eat anf of what we don’t eat, afraid of becoming sick… and so on… And in all this terror, we forget to live! I want my life back! I want my sons life back!!!!!
Your words and knowledge always inspire and encourage us to see all the possibilities available to us. You teach every one of us to trust our innate and inner wisdom and to live in balance with nature. I am 48 and it is the healthiest I have felt in my life as I choose to eat well, exercise, focus on what I do want, appreciate everything I have, enjoy loving relationships and share my passion and knowledge with others. Much love and appreciation to you Christiane.
Hi Dr. Northrup,
Thank you so much for all the information you have been sharing for years. I personally would not choose genetic testing because what people don’t realize is we inherit habits from our immediate families and lifestyle choices as well which in most cases if something goes wrong everyone wants to assign to genes. I did have a question for you though about breast fibroadenomas, do you share opinion that if they are bigger than 2-3 cm they should be removed?
Thanks
Dr Northrup,
I carry the BRCA2 gene mutation and have been fortunate enough to connect to a path focused on wellness and breast health as opposed to medical intervention and surgery. Your message is so absolutely empowering to all women, we are grateful to have such wisdom to turn to.
I’m an ovarian cancer survivor, and it is so wonderful to hear from someone who knows that the issue is more complex than numbers, screening, and preemptive intervention. Thank you. I have a family history the BRCA gene, and may well have arrived at the moment of losing my ovaries much sooner than I did, and all I can say is that I’m thankful to have kept them until the age of 55. I miss them too much to believe that taking them preemptively would have improved my life in any way.
Connie I hope you are well and was hoping you could answer me if you are familiar with the rad51d mutation which also shows increase risk for ovarian cancer …
I regret doing my genetic testing – never thought the emotional stress and anxiety that I’ve received over this …… I have been told my all doctors and genetic Counsleor to remove my ovaries
I think that breast health is intimately associated with emotional health. In German New Medicine, the breast ducts are associated with a sudden, intense conflict of separation from a loved one including ones inner self. Check out German New Medicine, I think it’s right up your alley…I know it helped me to understand my own breast tumour and how to recover from t! You are a Godsend Dr. Northrup!
Thank you for addressing what we have been conditioned to internalize: that our breasts are ticking time bombs, almost certain to betray us with cancer. Too many of us have a love/hate relationship with our bodies, because we live with such uncertainty about their health, worth, and beauty.
I long for the day when we all come to see the body as nothing more than the interesting “costume” for the Soul. Imagine…
My mantra: Health is my body’s natural state.
I have been buying your books, reading your newsletters, blogs etc for over 20 years. While I value your opinion, for Angelina I think that was a wise decision given her doctor’s advice and there being so much cancer in her family. I understand that she is taking preventative measures to combat ovarian cancer too.
Dr Northrup, thank you for articulating so well, that being proactive with our health does not have to be so drastic! Little by little, small lifestyle tweaks in our nutrition, fitness, sleep, and laughter produce amazing, transformational changes in how we feel, our energy level and our immune system.
Thank you for another informative column. I agree that the extent of a positive family history of breast and ovarian cancer is more important that BRCA testing results. There are no doubt other undocumented inherited mutations which increase the risk of these cancers. Epigenetic expression of these genes is definitely influenced by the environment. And primary prevention is more important than screening. Unfortunately, thermography as a primary screening tool has not been shown to be accurate.
Hi Dr Northrup. I did not like Angelina’s decision at all and hoped it would not influence to many women to do the same thing, but I know it will.
I would not even get the testing. If they found a gene for breast cancer some other way,I would never have my breasts removed ,unless I had to, if there were no other options. I like them 🙂 they have been with me a while, and I am striving to take them with me to what ever is next .
I’m an ovarian cancer survivor, and it is so, so wonderful to hear from someone who knows that the issue is more complex than numbers, screening, and preemptive intervention. Thank you. I have a family history the BRCA gene, and may well have arrived at the moment of losing my ovaries much sooner than I did, and all I can say is that I’m thankful to have kept them until the age of 55. I miss them too much to believe that taking them preemptively would have improved my life in any way.
Thank you for this wonderful post. As a practitioner in the wholistic health field (Myofascial Release therapist) I know that the emotional component is a huge factor. Healing old wounds as well as current lifestyle changes for mind/body/consciousness/energy is really where it’s at in my eyes. Thank you for standing up and sharing this great information to the public. We all need not fear percentages ans scores as much and trust in our intuition- our infinite wisdom.
I have had breast cancer and a bilateral mastectomy. I am over 4 years cancer free. I did not choose to have reconstruction at the time of surgery because I have mixed feelings. I also found out that I have the BRCA 2 gene (but not my mom) and was encouraged to have a hysterectomy. I am now almost 47 years old and after reading what you wrote, I am wondering if I should reconstruct? Would the reconstructed breasts have the same “spirit”? My husband doesn’t care either way.
Our fear-mongering society supports a cure instead of prevention, fear instead of empowered positive thinking. I know that I will not get cancer, because I focus on RADIANT HEALTH! I LOVE my body, I look at the food I ingest (whether it’s ice cream or a local farm peach) as BENEFICIAL and NUTRITIOUS for my body. I am not AFRAID of cancer because cancer doesn’t ENTER my thoughts!
Thank you for enlightening/educating so many women!
Thank you again, Dr. Northrup, for letting us know we are not diseases waiting to happen. I am extremely fed up with with the medical profession and it’s constant emphasis on screenings as the best way to keep us healthy. What a false sense of security! I am so thrilled I have learned my body is always working to be healthy if only I give it what it needs on every level. How freeing and empowering. I can take care of myself, thank you very much!
I think i have a higher risk of breast cancer because my mom and grandmother both had breast cancer but i’m not getting gentically tested because I think that i would rather just take care of myself like you said and of course yearly mammograms !! I hope i’m doing the right thing.
My doctor’s office suddenly started leaving me messages that I have to schedule a mammogram. They’ve never done this before. When I asked why they were suddenly calling me about this, they said it’s because they were told to by my health insurance. Apparently, these decisions are no longer decided by doctors and their patients, but by health insurance companies. No, I will not be having a mammogram just because my insurance company tells me to.
Hi Dr. Northrup, Thanks for all of this advice and for showing the “other side.” I’m a writer with a BRCA2 mutation, and I published a story on Well+Good after Angelina’s editorial that talked about how the focus on BRCA mutations in the media is always on prophylactic surgeries. I think it’s important that people know that this is ONE choice, but not THE choice. Here’s the story: http://www.wellandgoodnyc.com/2013/05/18/why-angelinas-choice-matters/
Hi Dr Northrup – thank God we have someone like you to finally help empower us. I am listening to your radio show podcast, regarding age. What really got under my skin was as soon as I turned 50, the bowel testing kit arrived in the mail reminding me of my increased risk of dying of bowel cancer. Just to add to it, the other day another letter arrived reminding me that women aged between 50 and 65 are in the high risk group for breast cancer. I am so grateful for your advice THANK YOU
Dr Northrup, I’ve been listening to your Hayhouse radio show since it started. I love you. You have activated divine feminine freedom in me causing me to have deeper connections to everyone in my life. I can feel your radiance. I work as a cancer data registrar/analyst, abstracting cancer cases for a distinguished Calif med facility, seeing how real causes of people’s illnesses are overlooked I desire to study naturopathy. Dr Northrup, can you do a radio talk on 3rd charkra conditions hep C/B?