My Medical Choice By ANGELINA JOLIE - Published: May 14, 2 1! 1" !

Co##e$%s

Lo&e$ Ca'elli MY MOTHER fought cancer for almost a decade and died at 56. She held out long enough to meet the first of her grandchildren and to hold them in her arms. But my other children will ne er ha e the chance to !now her and e"#erience how lo ing and gracious she was. $e often s#ea! of %Mommy&s mommy'( and ) find myself trying to e"#lain the illness that too! her away from us. They ha e as!ed if the same could ha##en to me. ) ha e always told them not to worry' *ut the truth is ) carry a %faulty( gene' BR+,-' which shar#ly increases my ris! of de elo#ing *reast cancer and o arian cancer. My doctors estimated that ) had an ./ #ercent ris! of *reast cancer and a 50 #ercent ris! of o arian cancer' although the ris! is different in the case of each woman. Only a fraction of *reast cancers result from an inherited gene mutation. Those with a defect in BR+,ha e a 65 #ercent ris! of getting it' on a erage. Once ) !new that this was my reality' ) decided to *e #roacti e and to minimi1e the ris! as much ) could. ) made a decision to ha e a #re enti e dou*le mastectomy. ) started with the *reasts' as my ris! of *reast cancer is higher than my ris! of o arian cancer' and the surgery is more com#le". On ,#ril 2/' ) finished the three months of medical #rocedures that the mastectomies in ol ed. 3uring that time ) ha e *een a*le to !ee# this #ri ate and to carry on with my wor!. But ) am writing a*out it now *ecause ) ho#e that other women can *enefit from my e"#erience. +ancer is still a word that stri!es fear into #eo#le&s hearts' #roducing a dee# sense of #owerlessness. But today it is #ossi*le to find out through a *lood test whether you are highly susce#ti*le to *reast and o arian cancer' and then ta!e action. My own #rocess *egan on 4e*. 2 with a #rocedure !nown as a %ni##le delay'( which rules out disease in the *reast ducts *ehind the ni##le and draws e"tra *lood flow to the area. This causes some #ain and a lot of *ruising' *ut it increases the chance of sa ing the ni##le. Two wee!s later ) had the ma5or surgery' where the *reast tissue is remo ed and tem#orary fillers are #ut in #lace. The o#eration can ta!e eight hours. You wa!e u# with drain tu*es and e"#anders in your *reasts. )t does feel li!e a scene out of a science6fiction film. But days after surgery you can *e *ac! to a normal life.

7ine wee!s later' the final surgery is com#leted with the reconstruction of the *reasts with an im#lant. There ha e *een many ad ances in this #rocedure in the last few years' and the results can *e *eautiful. ) wanted to write this to tell other women that the decision to ha e a mastectomy was not easy. But it is one ) am ery ha##y that ) made. My chances of de elo#ing *reast cancer ha e dro##ed from ./ #ercent to under 5 #ercent. ) can tell my children that they don&t need to fear they will lose me to *reast cancer. )t is reassuring that they see nothing that ma!es them uncomforta*le. They can see my small scars and that&s it. E erything else is 5ust Mommy' the same as she always was. ,nd they !now that ) lo e them and will do anything to *e with them as long as ) can. On a #ersonal note' ) do not feel any less of a woman. ) feel em#owered that ) made a strong choice that in no way diminishes my femininity. ) am fortunate to ha e a #artner' Brad 8itt' who is so lo ing and su##orti e. So to anyone who has a wife or girlfriend going through this' !now that you are a ery im#ortant #art of the transition. Brad was at the 8in! 9otus Breast +enter' where ) was treated' for e ery minute of the surgeries. $e managed to find moments to laugh together. $e !new this was the right thing to do for our family and that it would *ring us closer. ,nd it has. 4or any woman reading this' ) ho#e it hel#s you to !now you ha e o#tions. ) want to encourage e ery woman' es#ecially if you ha e a family history of *reast or o arian cancer' to see! out the information and medical e"#erts who can hel# you through this as#ect of your life' and to ma!e your own informed choices. ) ac!nowledge that there are many wonderful holistic doctors wor!ing on alternati es to surgery. My own regimen will *e #osted in due course on the $e* site of the 8in! 9otus Breast +enter. ) ho#e that this will *e hel#ful to other women. Breast cancer alone !ills some :5.'000 #eo#le each year' according to the $orld Health Organi1ation' mainly in low6 and middle6income countries. )t has got to *e a #riority to ensure that more women can access gene testing and lifesa ing #re enti e treatment' whate er their means and *ac!ground' where er they li e. The cost of testing for BR+,- and BR+,2' at more than ;<'000 in the =nited States' remains an o*stacle for many women. ) choose not to !ee# my story #ri ate *ecause there are many women who do not !now that they might *e li ing under the shadow of cancer. )t is my ho#e that they' too' will *e a*le to get gene tested' and that if they ha e a high ris! they' too' will !now that they ha e strong o#tions. 9ife comes with many challenges. The ones that should not scare us are the ones we can ta!e on and ta!e control of. ,ngelina >olie is an actress and director.