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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.3 q8 ~3 Z0 y; t1 Y% c' r' C
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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.
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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.www2.tvboxnow.com( H( l4 W1 J* Q0 f( T
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.' }7 F4 H! B( u Z' ~
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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.公仔箱論壇" V3 g+ i6 z/ m0 ^, B
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.) _( G% S, i7 Z9 M8 V; s- T
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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.
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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.
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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 $3,000 in the United States, remains an obstacle for many women.tvb now,tvbnow,bttvb+ P5 |) f% A0 ^7 K! x
I choose not to keep my story private because there are many women who do not know that they might be living under the shadow of cancer. It is my hope that they, too, will be able to get gene tested, and that if they have a high risk they, too, will know that they have strong options.公仔箱論壇) I0 v* p6 t) Z e, `2 V" d
Life comes with many challenges. The ones that should not scare us are the ones we can take on and take control of.
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香港乳癌基金會創辦人張淑儀醫生指，若在直系親屬有三個成員有乳癌或卵巢癌，當中兩名屬四十歲或以下的年輕女性，或有男性，或兩邊乳房都發現有乳癌，醫生就會建議病人接受遺傳基因測試。而萬一驗出BRCA基因，也不代表必須進行切除手術。《紐約時報》報道引述美國醫務人員指，目前美國國內進行雙乳切除手術的女性越來越多，但她們患乳癌的風險並不高、甚至未攜有BCRA；亦有一邊乳房患癌的女性，選擇同時切除兩邊乳房。
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從醫學角度而言，許多早期乳腺癌患者是不用接受乳房切除術的……很多女性只有一側乳房患癌，但卻決定同時切除健康的乳房，儘管她們並沒有攜帶會增加她們患病風險的基因突變，健康乳房患癌的幾率也非常低。
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未攜帶突變的女性接受雙乳切除手術的趨勢讓女性健康倡導者很沮喪。莫洛博士（Memorial Sloan-Kettering Cancer Center負責人）稱，她經常試圖說服患者不要進行手術，但卻徒勞無功。一些人把自己罹患或複發癌症的風險想得遠遠高於實際情況。其他一些人則認為，如果切除雙乳並進行重造，她們的乳房會更勻稱。公仔箱論壇% w5 l/ l1 J; c( Y6 s j1 }
. z! ^) g( S+ C4 |+ W3 q( l人類基因不應該是任何公司的專利……耶魯大學一度打算研究成本更便宜的測試，檢測同樣的乳癌基因。但Myriad的基因專利，使其他BRCA1、BRCA2的基因測試無法誕生。Myriad是典型只看利潤的美國公司，在它眼中，利潤超越人命的價值。傳統經濟學家認為，版權及專利保護不足，會影響創新及科研的意欲。Stiglitz指出，儘管Myriad最先在人體當中分離出相關基因，但其他公共及國際組織遲早會有相同發現，而Myriad高昂的基因測試費用令公眾無法受惠。專利保障私人企業利益，同時犧牲了公眾利益。Stiglitz又提出，基因專利反而令公司欠缺動機再投資創新。
Myriad專利阻礙其他科研人員，開發更準確、更好的檢驗基因測試。所有學術研究建立在前人的結果之上。你總不能把數學公式註冊成專利，防止其他人使用。同理，基因變成專利，也阻礙科研的進步。 公仔箱論壇5 j4 p% Z( c' |7 o5 CStiglitz說，壟斷行業往往製造了種種的貪污的問題，例如在美國醫藥行業，有藥廠會向醫生、醫院分紅增加銷售額，結果有關藥物或者檢測方法售價，經常不合理地高於成本。 www2.tvboxnow.com6 E' G" @/ [0 v$ w+ ]
發達國家近年要求，更嚴格保障知識產權。知識產權體制不建全，造就低效率的情況，擁有壟斷地位的專利公司牟取暴利，學術知識傳播受到阻制，在Myriad的例子，更有可能造成不必要的人命損失。
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基因研究背後的金主是商業機構，專利權的肆虐在美國尤甚，往往扼殺了經費短絀的學術研究，已為人詬病多年，而這問題亦不獨限基因，實在令人氣憤。
Human beings are very good at worrying — it’s what keeps us alive and out of harm’s way. But we’re also good at overworrying, making irreversible decisions to reduce or avoid risks that don’t really exist at all. Jolie’s brave example can make us all smarter and help keep us all healthier — but only if we take the right lessons from it.
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