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Angelina Jolie's Mastectomy Decision And Weighing Cancer Risks

On Wednesday's Morning Edition, David Greene talks with writer and breast cancer survivor Peggy Orenstein about actress Angelina Jolie's decision to have a double mastectomy to reduce her risk of breast cancer.

Jolie, whose mother died at 56 from ovarian cancer, has a genetic variant that puts her at high risk for ovarian and breast cancer. She made public her thinking and ultimate decision in an op-ed in Tuesday's New York Times. The disclosure has sparked discussion about breast cancer risk and prevention.

Orenstein recently wrote about her own experience and the downsides of cancer awareness in a much talked about cover story for the Times' Sunday Magazine called "Our Feel-Good War on Breast Cancer."

Orenstein tells Greene that Jolie's op-ed resonates with her, but she has some concerns about Jolie going public:

"I feel that it's really really important that women recognize that Angelina Jolie is in this very particular group of women that has this genetic mutation. She's not a woman of average risk, and to take her experience and generalize it either to ordinary women of average risk or even women with a family history, that concerns me."

Orenstein says the high volume of messages about breast cancer creates problems, too.

"Women are bombarded with breast cancer pretty much everywhere they go now. there's something pink that's reminding you of breast cancer. And the unfortunate result, and this is an unintended consequence, is that even as we have an epidemic of breast cancer, the average woman has an exaggerated sense of her own personal risk, so that we make decisions that are not in our own best interest."

Heart disease remains the No. 1 killer for women in the U.S. Cancers of all kinds come in second.

Orenstein had a recurrence of breast cancer 15 years after her first diagnosis and faced fresh set of decisions about her care:

"We live with risk. And breast cancer is one of those risks. When your risk is not particularly elevated, removing a body part has its own risks. I've had a mastectomy; it's pretty tough. And the reconstruction, while it looks really good and Angelina Jolie's probably looks better, it doesn't have sensation. So you're going to lose that as well."

On Jolie's risk factors and how they compare with those that are more common, Orenstein says:

"She had to make a decision about a very elevated risk in a family where there's been significant death from cancer. That's a different situation from where you have not a particularly elevated risk in your other breast. So what my doctors said to me was, if you make a decision to remove your other breast that's a psychological decision having to do with your risk tolerance — not a medical decision."

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