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Introduction

In May 2013, actress Angelina Jolie announced some startling news. In an op-ed published in the New York Times titled "My Medical Choice," she told the world that she had recently had surgery to remove both of her breasts. The procedure is called a double mastectomy. Thousands of women who have been diagnosed with invasive breast cancer have it done every year, usually followed by surgeries to reconstruct their breasts. But Angelina did not have cancer. She was perfectly healthy. She had taken this drastic step because she had undergone genetic testing and been found to have mutations in a gene called BRCA1.

In the vast majority of female patients, breast cancer is probably caused by multiple factors. Possible risk factors include having denser breast tissue, being exposed to certain toxins, using birth control pills, and being overweight. But in up to 5 to 10 percent of patients, genetics plays a strong role. Women who inherit mutations in certain genes, most notably BRCA1, have a dramatically increased risk of contracting breast and ovarian cancer at an early age and dying from it. Angelina's mother had passed away from cancer at age 56, having been diagnosed when she was in her forties. As Angelina revealed, her doctors had presented her with a cold, hard truth: she had an 87 percent chance of developing breast cancer and a 50 percent chance of developing ovarian cancer.

Angelina didn't have to have her breasts removed. It was a preventive choice that she made. Other options that women in her position can consider include receiving preventive chemotherapy and holistic treatments. Angelina chose surgery because she decided that it would "minimize the risk" as much as possible. According to her doctors, the procedures reduced her chance of contracting breast cancer to below 5 percent. "I can now tell my children that they don't need to fear they will lose me to breast cancer," Angelina remarked.1

Many of us at Cleveland Clinic took notice of Angelina's announcement—and not just because we count ourselves as fans of her work. Her experience directed public attention to an area that we believe represents the exciting frontier of twenty-first-century medicine. It's called personalized (or precision) healthcare. Traditionally, most doctors have taken a "one size fits all" approach to treating patients. When you get sick, for instance, you're usually given medications that have been evaluated on the basis of how well they work in a large population of people. When you go in for your annual physical, you're given advice on how to prevent chronic diseases that is based on what we know holds true for patients in general. But people aren't all the same. We're similar in some ways and different in others. We each have personal preferences about how we want to be treated, and we each have basic genetic differences that affect how likely our bodies are to get ...

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