茱莉的选择
茱莉的选择
安吉丽娜·朱莉今天披露,因为有基因缺陷,罹患乳癌和卵巢癌风险较高。已经接受预防性的双乳腺切除术,以降低罹癌风险。她真酷!
My Medical Choice
By ANGELINA JOLIE
LOS ANGELES
http://www.nytimes.com/2013/05/14/opini ... ST_FB&_r=0
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 never have the chance to know her and experience how loving and gracious she was.
We often speak of “Mommy’s mommy,” and I find myself trying to explain the illness that took her away from us. They have asked if the same could happen to me. I have always told them not to worry, but the truth is I carry a “faulty” gene, BRCA1, which sharply increases my risk of developing breast cancer and ovarian cancer.
My doctors estimated that I had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer, although the risk is different in the case of each woman.
Only a fraction of breast cancers result from an inherited gene mutation. Those with a defect in BRCA1 have a 65 percent risk of getting it, on average.
Once I knew that this was my reality, I decided to be proactive and to minimize the risk as much I could. I made a decision to have a preventive double mastectomy. I started with the breasts, as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex.
On April 27, I finished the three months of medical procedures that the mastectomies involved. During that time I have been able to keep this private and to carry on with my work.
But I am writing about it now because I hope that other women can benefit from my experience. Cancer is still a word that strikes fear into people’s hearts, producing a deep sense of powerlessness. But today it is possible to find out through a blood test whether you are highly susceptible to breast and ovarian cancer, and then take action.
My own process began on Feb. 2 with a procedure known as a “nipple delay,” which rules out disease in the breast ducts behind the nipple and draws extra blood flow to the area. This causes some pain and a lot of bruising, but it increases the chance of saving the nipple.
Two weeks later I had the major surgery, where the breast tissue is removed and temporary fillers are put in place. The operation can take eight hours. You wake up with drain tubes and expanders in your breasts. It does feel like a scene out of a science-fiction film. But days after surgery you can be back to a normal life.
Nine weeks later, the final surgery is completed with the reconstruction of the breasts with an implant. There have been many advances in this procedure in the last few years, and the results can be beautiful.
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. 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.
It is reassuring that they see nothing that makes them uncomfortable. They can see my small scars and that’s it. Everything else is just Mommy, the same as she always was. And they know that I love them and will do anything to be with them as long as I can. On a personal note, I do not feel any less of a woman. I feel empowered that I made a strong choice that in no way diminishes my femininity.
I am fortunate to have a partner, Brad Pitt, who is so loving and supportive. So to anyone who has a wife or girlfriend going through this, know that you are a very important part of the transition. Brad was at the Pink Lotus Breast Center, where I was treated, for every minute of the surgeries. We managed to find moments to laugh together. We knew this was the right thing to do for our family and that it would bring us closer. And it has.
For any woman reading this, I hope it helps you to know you have options. I want to encourage every woman, especially if you have a family history of breast or ovarian cancer, to seek out the information and medical experts who can help you through this aspect of your life, and to make your own informed choices.
I acknowledge that there are many wonderful holistic doctors working on alternatives to surgery. My own regimen will be posted in due course on the Web site of the Pink Lotus Breast Center. I hope that this will be helpful to other women.
Breast cancer alone kills some 458,000 people each year, according to the World Health Organization, mainly in low- and middle-income countries. It has got to be a priority to ensure that more women can access gene testing and lifesaving preventive treatment, whatever their means and background, wherever they live. The cost of testing for BRCA1 and BRCA2, at more than $3,000 in the United States, remains an obstacle for many women.
I choose not to keep my story private because there are many women who do not know that they might be living under the shadow of cancer. It is my hope that they, too, will be able to get gene tested, and that if they have a high risk they, too, will know that they have strong options.
Life comes with many challenges. The ones that should not scare us are the ones we can take on and take control of.
My Medical Choice
By ANGELINA JOLIE
LOS ANGELES
http://www.nytimes.com/2013/05/14/opini ... ST_FB&_r=0
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 never have the chance to know her and experience how loving and gracious she was.
We often speak of “Mommy’s mommy,” and I find myself trying to explain the illness that took her away from us. They have asked if the same could happen to me. I have always told them not to worry, but the truth is I carry a “faulty” gene, BRCA1, which sharply increases my risk of developing breast cancer and ovarian cancer.
My doctors estimated that I had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer, although the risk is different in the case of each woman.
Only a fraction of breast cancers result from an inherited gene mutation. Those with a defect in BRCA1 have a 65 percent risk of getting it, on average.
Once I knew that this was my reality, I decided to be proactive and to minimize the risk as much I could. I made a decision to have a preventive double mastectomy. I started with the breasts, as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex.
On April 27, I finished the three months of medical procedures that the mastectomies involved. During that time I have been able to keep this private and to carry on with my work.
But I am writing about it now because I hope that other women can benefit from my experience. Cancer is still a word that strikes fear into people’s hearts, producing a deep sense of powerlessness. But today it is possible to find out through a blood test whether you are highly susceptible to breast and ovarian cancer, and then take action.
My own process began on Feb. 2 with a procedure known as a “nipple delay,” which rules out disease in the breast ducts behind the nipple and draws extra blood flow to the area. This causes some pain and a lot of bruising, but it increases the chance of saving the nipple.
Two weeks later I had the major surgery, where the breast tissue is removed and temporary fillers are put in place. The operation can take eight hours. You wake up with drain tubes and expanders in your breasts. It does feel like a scene out of a science-fiction film. But days after surgery you can be back to a normal life.
Nine weeks later, the final surgery is completed with the reconstruction of the breasts with an implant. There have been many advances in this procedure in the last few years, and the results can be beautiful.
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. 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.
It is reassuring that they see nothing that makes them uncomfortable. They can see my small scars and that’s it. Everything else is just Mommy, the same as she always was. And they know that I love them and will do anything to be with them as long as I can. On a personal note, I do not feel any less of a woman. I feel empowered that I made a strong choice that in no way diminishes my femininity.
I am fortunate to have a partner, Brad Pitt, who is so loving and supportive. So to anyone who has a wife or girlfriend going through this, know that you are a very important part of the transition. Brad was at the Pink Lotus Breast Center, where I was treated, for every minute of the surgeries. We managed to find moments to laugh together. We knew this was the right thing to do for our family and that it would bring us closer. And it has.
For any woman reading this, I hope it helps you to know you have options. I want to encourage every woman, especially if you have a family history of breast or ovarian cancer, to seek out the information and medical experts who can help you through this aspect of your life, and to make your own informed choices.
I acknowledge that there are many wonderful holistic doctors working on alternatives to surgery. My own regimen will be posted in due course on the Web site of the Pink Lotus Breast Center. I hope that this will be helpful to other women.
Breast cancer alone kills some 458,000 people each year, according to the World Health Organization, mainly in low- and middle-income countries. It has got to be a priority to ensure that more women can access gene testing and lifesaving preventive treatment, whatever their means and background, wherever they live. The cost of testing for BRCA1 and BRCA2, at more than $3,000 in the United States, remains an obstacle for many women.
I choose not to keep my story private because there are many women who do not know that they might be living under the shadow of cancer. It is my hope that they, too, will be able to get gene tested, and that if they have a high risk they, too, will know that they have strong options.
Life comes with many challenges. The ones that should not scare us are the ones we can take on and take control of.
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Re: 茱莉的选择
社会主义好啊!我好事去看了看,NHS管这个。
http://www.nhs.uk/Livewell/Breastcancer ... ction.aspx
http://www.nhs.uk/Livewell/Breastcancer ... story.aspx
http://www.nhs.uk/Livewell/Breastcancer ... ction.aspx
http://www.nhs.uk/Livewell/Breastcancer ... story.aspx
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Re: 茱莉的选择
查出来携带 BRCA1 mutation 的人有50%的以上的几率会得乳腺癌,能降到百分之五到十的几率。而且拿掉了很多 breast tissue,其实得乳腺癌的几率应该低于普通女性了。现在还可以做 reconstruction,我觉得这种选择简直是 no brainer。
携带 BRCA mutations 的女性并非人群中大多数,所以她们的乳腺癌只占全部乳腺癌中案例的少数。这跟已知有 mutations 者的乳腺癌几率不是一回事儿。
其实这不是新事物,Ashkenazi 支的犹太女性因为长期近亲交配,普遍携带 BRCA1 & 2 的变异,好多人中年就得乳腺癌,好多年轻女性选择预防性切除。
携带 BRCA mutations 的女性并非人群中大多数,所以她们的乳腺癌只占全部乳腺癌中案例的少数。这跟已知有 mutations 者的乳腺癌几率不是一回事儿。
其实这不是新事物,Ashkenazi 支的犹太女性因为长期近亲交配,普遍携带 BRCA1 & 2 的变异,好多人中年就得乳腺癌,好多年轻女性选择预防性切除。
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Re: 茱莉的选择
嗯,有道理。Jun wrote:查出来携带 BRCA1 mutation 的人有50%的以上的几率会得乳腺癌,能降到百分之五到十的几率。而且拿掉了很多 breast tissue,其实得乳腺癌的几率应该低于普通女性了。现在还可以做 reconstruction,我觉得这种选择简直是 no brainer。
携带 BRCA mutations 的女性并非人群中大多数,所以她们的乳腺癌只占全部乳腺癌中案例的少数。这跟已知有 mutations 者的乳腺癌几率不是一回事儿。
其实这不是新事物,Ashkenazi 支的犹太女性因为长期近亲交配,普遍携带 BRCA1 & 2 的变异,好多人中年就得乳腺癌,好多年轻女性选择预防性切除。
哎,如果都切除了,那为什么还有5%的乳腺癌发病率呢?是没切干净么?
跟这个基因有关的其它种类的癌,目前还是没有办法吧?
我有个印象,新闻里报道美国有一家,女儿是智力发育障碍,她爸爸做主做了乳腺切除和女性腺体的切除。
Re: 茱莉的选择
应该是还有保留一定的乳房 tissue。其他种类的癌好像风险没那么高,平时注意经常去检查就好了,到五十就可以把卵巢摘了,再吃点 hormone replacement 药。silkworm wrote:哎,如果都切除了,那为什么还有5%的乳腺癌发病率呢?是没切干净么?
跟这个基因有关的其它种类的癌,目前还是没有办法吧?
我有个印象,新闻里报道美国有一家,女儿是智力发育障碍,她爸爸做主做了乳腺切除和女性腺体的切除。
给智障女儿切除啥啥的事儿,我有模糊的印象仿佛在哪儿听到过,或许是 Law and Order 之类的电视剧,而且好像不是因为基因变异而是别的什么原因(怕女儿怀孕)?
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Re: 茱莉的选择
她文章里说决定接受预防性手术,从双乳乳腺切除开始,因为这手术更复杂,也因为基因决定她得乳腺癌概率87%,远高于子宫癌概率50%。看样子是打算子宫过几年切。至于是把乳房全切掉,还是做到基本外型不变留有乳头,这是个人选择吧。silkworm wrote:要是切,还是全切干净了为好啊。
乳腺癌患者们,最怕的就是一边切了,治疗完了,另一边发作了。
我跟踪读了点资料,NHS 是建议一边乳腺癌得患者查这个基因,家族同时有乳腺癌和子宫癌病史。如果有,应该考虑双侧切除乳腺或者子宫。
这些都是很私人的事情,不公开也没什么可指责的。不过她做的这么大方,语气这么正面和胜利,我觉得非常棒。
哦,说个逗的,BBC新闻说这事时管Brad Pitt 叫她老公。他们订婚有一阵儿,其实还没结婚,不过孩子都养了六个,也难怪记者糊涂。
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Re: 茱莉的选择
小K,你误解我的意思了,我说的切干净是针对这个:Knowing wrote:她文章里说决定接受预防性手术,从双乳乳腺切除开始,因为这手术更复杂,也因为基因决定她得乳腺癌概率87%,远高于子宫癌概率50%。看样子是打算子宫过几年切。至于是把乳房全切掉,还是做到基本外型不变留有乳头,这是个人选择吧。silkworm wrote:要是切,还是全切干净了为好啊。
乳腺癌患者们,最怕的就是一边切了,治疗完了,另一边发作了。
对于基本外形不变、留有乳头,这是在乳腺癌患者的切除确定有癌症的乳房时,已经多多少少有在做了。以前的mastectomy是直接齐根切除,多余皮肤去掉,然后愈合期间上压力泵压紧。现在有些医生可以开小刀口,“掏空”内部组织,保留暂时多余的皮肤,以便之后的整型手术。Jun wrote:应该是还有保留一定的乳房 tissue。silkworm wrote:哎,如果都切除了,那为什么还有5%的乳腺癌发病率呢?是没切干净么?
Re: 茱莉的选择
我认识一家犹太人,妈妈和乳腺癌斗争了18年后去世了。女儿因为从小妈妈就进进出出医院一直抑郁,后来结婚生了俩娃也查出这个基因,也选择双切了。其实就是个她的乳房她作主的事儿,那么多人隆大胸也没人说啥。乳房这个除了喂奶就是纯摆设儿的东西,早切早好。那么多女人死于乳腺癌,what a waste!
又没头脑又不高兴
Re: 茱莉的选择
我也不是很清楚为什么做了手术之后仍然有 5% 的可能性,或许手术本身就不能把乳腺组织彻底除干净,或许医学上认为把乳腺组织彻底挖干净对身体损伤太大,得不偿失。不过我觉得 5% 的几率是完全可以接受的,无 BRCA 基因变异的普通妇女患乳腺癌的几率在10%左右。再说了,借用 The Onion 的一条 headline: World Death Rate Remains Steady at 100%。 自古人生谁无死,医学所追求的不过是 1. 尽量推后死亡的时间,2. 尽量提高活着的 quality of life (后面一条美国医生还做得特别差)。BRCA 基因是个特例,致病率特别高,其他的各种疾病的各种基因,以及各种预防手段,都是 a number's game,但是选择就没那么 clear cut 了。例如每日坐着8小时以上的人早死率比每日坐着4小时以下的人平均高20%(换言之,寿命短上好几年),吓人吧?可是让大家把工作椅子拿掉,换成站着工作,不知有几个人能坚持。
胸太大确实会造成背痛且影响到锻炼身体。
胸太大确实会造成背痛且影响到锻炼身体。
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Re: 茱莉的选择
From NIH website:
How effective is preventive mastectomy in preventing or reducing the risk of breast cancer?
Existing data suggest that preventive mastectomy may significantly reduce (by about 90 percent) the chance of developing breast cancer in moderate- and high-risk women (2, 6, 7). However, no one can be certain that this procedure will protect an individual woman from breast cancer. Breast tissue is widely distributed on the chest wall, and can sometimes be found in the armpit, above the collarbone, and as far down as the abdomen. Because it is impossible for a surgeon to remove all breast tissue, breast cancer can still develop in the small amount of remaining tissue.
Re: 茱莉的选择
应该是因为联邦现在承认同性婚姻了吧。她和她爹说是和解了,关系疏远的很,结婚就没通知,是这两天记者问才知道的。pitt 全家人倒是都在。乔治克鲁尼也没被邀请,不知道有没有不爽--还说是好朋友呢!还一度谣传说要在他的lake como 大宅结婚呢!哼!等他结婚也不请他们!
昨天我一对纽约弯蜜也婚了。可爱!说起来他们都办过好几次仪式了,一开始在一起弄过个小仪式,后来civil union 又弄过一次仪式,现在结婚又来一次!
英国同性婚姻刚合法,很搞笑的是,两人如果civil union 过,现在不能直接结婚,得申请把civil union 解除--或者等年底法律修改。
昨天我一对纽约弯蜜也婚了。可爱!说起来他们都办过好几次仪式了,一开始在一起弄过个小仪式,后来civil union 又弄过一次仪式,现在结婚又来一次!
英国同性婚姻刚合法,很搞笑的是,两人如果civil union 过,现在不能直接结婚,得申请把civil union 解除--或者等年底法律修改。
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Re: 茱莉的选择
他们也要离婚!我再也不相信孩子能巩固家庭了!
http://www.bbc.co.uk/news/entertainment-arts-37422843
http://www.bbc.co.uk/news/entertainment-arts-37422843
Angelina Jolie has filed for divorce from Brad Pitt, the actress's lawyer has confirmed.
Robert Offer said the actress filed for "dissolution of marriage" on Monday, adding the "decision was made for the health of the family".
"She will not be commenting, and asks that the family be given its privacy at this time," Offer added in the statement.
The couple have been together since 2004 but only married in August 2014.
The couple have six children together - Maddox, Pax, Zahara, Shiloh, and twins Knox and Vivienne.
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