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SANJAY GUPTA MD
"The Angelina Effect"; Actress Doesn't Regret Double Mastectomy; "I Feel Empowered, Supported in Cancer Fight"
Aired May 18, 2013 - 16:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
FREDRICKA WHITFIELD, CNN ANCHOR: Right now, time for a special edition of SANJAY GUPTA, M.D. on Angelina Jolie and breast cancer.
DR. SANJAY GUPTA, HOST: Today, what "TIME" magazine is now calling the Angelina effect. A very public announcement prompts a worldwide conversation about breast cancer.
You are also going to hear from another actress and breast cancer survivor, Christina Applegate.
As I'm sure you know, Angelina Jolie made a brave decision, I would call it, this week, revealing she underwent a preventative double mastectomy. Now, to be clear, she did not have breast cancer, but instead discovered she had the mutated BRCA1 gene, which greatly increased her risk for breast and ovarian cancers.
In an op-ed published in "The New York Times", Jolie wrote, quote, "I choose not to keep my story private because there are many women who do not know 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."
And she's right about that. I mean, there are thousands of women who are unaware that they may carry this genetic mutation. But it's also important to stress that only 5 percent to 10 percent of women diagnosed with breast cancer do, in fact, have the defective BRCA1 or BRCA2 geneses, breast cancer 1 or 2 genes.
So, joining me to talk about this, put it in some context is Cecelia Bellcross. She's director of genetic counseling at Emory University.
Thanks for joining us.
Now, we try to get to a little context. And I think Angelina in her op-ed did as well. But most women do not have the defective gene. I mean, less than 1 percent.
CECELIA BELLCROSS, EMORY UNIVERSITY SCHOOL OF MEDICINE: Correct. Less than 1 percent of women in the general population, actually less than half a percent would carry a mutation in BRCA 1 or 2.
GUPTA: And the way you do get diagnosed, only 5 percent to 10 percent of women diagnosed have the gene.
BELLCROSS: Right. At most. Recent data suggests maybe only 3 percent to 5 percent.
GUPTA: So, what is a woman to take from this? You hear the announcement from Angelina Jolie. You may worry about breast cancer. Who should get tested?
BELLCROSS: Again, the vast majority of women are not going to carry a mutation in BRCA 1 or 2. We look for clues in the family history. And that would be multiple cases of breast cancer in the family, earlier age of onset, ovarian cancer in the family as well. A woman who's had both breasts and ovarian cancer is a very strong indicator. Also male breast cancer.
And Ashkenazi Jewish ancestry, because one in 40 women of Ashkenazi Jewish descent actually carry a mutation in one of these genes. So, they can have less of a striking family history and still be at rest to carry a mutation.
GUPTA: I shared earlier that my own mother is a breast cancer survivor.
GUPTA: So, my mother. Now I have three daughters. And again, a lot of people were asking this in their families.
GUPTA: Looking at their own family trees. What would you counsel my family, for example?
BELLCROSS: Well, it would depend on the age your mother was diagnosed with breast cancer. It would also depend on the pathology of the breast cancer. There are certain types of breast cancer that are more likely to be associated with mutations.
And then I would look at the more extended family -- sisters, cousins, nieces, nephews, aunts, uncles, grandparents.
And one thing that's really important for women to understand is that these gene mutations are equally inherited by men and women and fathers can pass them to their daughters. So, often people think about, oh, if I have a mother or if I have a sister.
BELLCROSS: You have to look on the father's side of the family. You have to look at aunts and uncles, cousins, grandparents to really see the pattern that's going on.
GUPTA: One of the things that was mentioned in the op-ed again is the cost. It's not cheap. I mean, I think $4,000 roughly. Unless you are considered high risk, I believe, in which case, it may be covered by many insurance companies. BELLCROSS: Yes, many insurance companies do cover BRCA1 and 2 testing. Often with policies that say you have to meet certain criteria. Again, there has to be some level of suspicion in the family or in that individual based on their personal cancer history.
But also, even though the first person in the family tested costs $4,000, once a specific mutation is identified then the testing for every other family member is only $475.
GUPTA: I see.
BELLCROSS: So, if you think of it in the context of a family, it's actually pretty cost effective.
GUPTA: Yes. I mean, I think these numbers are very important. Again, a lot of people trying to put this together for themselves and their families especially this week.
Cecelia Bellcross, thanks so much for joining us.
BELLCROSS: You're very welcome. My pleasure.
GUPTA: Appreciate it.
GUPTA: Christina Applegate is an Emmy Award-winning actress. She's also a wife, a mother and a breast cancer survivor herself.
Well, today, she's not only speaking out about how she detected the deadly disease, but she's helping women all across America access the same screenings she had.
GUPTA (voice-over): Knowing she had a strong family history of breast cancer, actress Christina Applegate began mammograms at 30. But a mammogram is not the test that detected her cancer.
CHRISTINA APPLEGATE, ACTRESS: The doctor I've been getting my mammogram from just said, you know, it's time that we start doing MRIs because of the density and, you know, their inability to really see what was going on.
And, you know, luckily for me, you know, he did that, because they found on the MRI the calcifications which then, you know, through the biopsy found it was cancer.
GUPTA: She's also a carrier of the BRCA1 mutation.
APPLEGATE: I was so resistant to the idea of mastectomy. I thought this is ridiculous. I'm not doing that.
GUPTA (on camera): You didn't want to have a mastectomy at all. But after all the data came back, and you looked it all, you talked to your doctor, you decided that a double mastectomy was the best thing to do.
APPLEGATE: When my head goes into vanity sometimes I go, darn it, you know, I miss those gals. But then, you know, it's closely followed by this is about your life. And, you know, what's the sacrifice of that?
GUPTA (voice-over): Healthy and now cancer-free, Applegate is on a mission to provide other women the same access to screenings that she had.
APPLEGATE: I can't stress it enough. It saved my life. I mean, there's no ifs, ands or butts about it. I just had a mammogram.
There was nothing on it. You know, this was something that found it at a stage that was -- that was curable instead of at a stage where it's not.
I also unfortunately know that, you know, that the MRI screenings are incredibly expensive and a lot of insurance companies don't cover that, which is why I started my foundation because it just really upset me so much that these women were opting not to have this really valuable screening because of money, and because we're not taking care of these women who are high risk.
GUPTA: Her foundation called Right Action for Women has provided hundreds of women funding to get both the MRI and BRCA genetic testing.
GUPTA: And up next, I'm going to speak with another breast cancer patient. She's our very own Zoraida Sambolin, and she says Angelina Jolie's announcement this week empowered her to share her own story.
(BEGIN VIDEO CLIP)
ZORAIDA SAMBOLIN, ANCHOR, CNN'S "EARLY START": At the beginning, I was really scared. And I was in a really dark place because I allowed myself to go to worst case scenario. So when I was told I had breast cancer I was driving to pick up my son from school. And so, I really had to kind of compose myself and gather myself because I didn't want him to know.
That night I let myself feel. I talked to the doctor. He talked to me about different options. That was my darkest hour.
(END VIDEO CLIP)
GUPTA: That, of course, is CNN "EARLY START" anchor Zoraida Sambolin talking about, I guess, inevitable dark moments that come with a cancer diagnosis. And Zoraida joins me now from her native Chicago, along with Dr. John Kim, who's going to perform Zoraida's breast reconstruction. Before we begin, I just want viewers to be forewarned, this subject is obviously sensitive and during the segment, we're going to be showing some images of nude breasts that may not be appropriate viewing for everyone. Try to give you a heads-up before those images come up on the screen.
Zoraida and Dr. Kim, thanks for joining us.
Zoraida, you know, I've had a chance to sort of follow your discussions this past week. I said this to you before, it's I think so important, so powerful, the message that you've had this week. You also talked about this idea that Angelina Jolie's announcement earlier this week gave you this opening to talk about the recent diagnosis.
Was it hard to reveal your personal struggle to now such a wide audience?
SAMBOLIN: Yes. I mean, it's not -- it's not something easy to talk about. There are a couple of things that are more complicated to talk about than others, you know? It's an emotional decision, when I think about my children, especially, you know, when I think about my daughter and I think about perhaps her increased risk factor now.
I have talked about the fact that when I think about my sexuality, you know, that was -- it was something I had to deal with. I was embarrassed that I even cared. And so, you know, all of those were really complicated. And then to tell everybody that this is what I'm worried about and this is what's concerning me, and this is the decision I made -- yes, it was -- it was liberating and it was also difficult.
GUPTA: Yes, I'm sure it's frightening. Just so many people, I'm sure all around you that know about this that didn't before. My understanding is in a little bit more than a week now, you're going to get the double mastectomy which means both breasts will be removed. And during that same procedure, you're going to go breast reconstruction -- at least the first step of breast reconstruction.
We're going to show some images now -- some of these images again that may not be appropriate for everybody. But these are former patients of yours, Dr. Kim. And I wonder if you can talk through some of these before and after images and talk about what's now available to women that maybe wasn't available 15 years ago and how you go about trying to get the natural look that you are describing.
DR. JOHN KIM, PLASTIC & RECONSTRUCTIVE SURGEON: Right. So, the way to get the natural look, it comes from two main sources. We want to get the volume filled back to what the woman wants in terms of the size of the breast. And we want to get the shape of the breast back down, too. And you can do that by using your own tissue again, typically from the tummy, sometimes from the back.
In this particular case, this woman had bilateral double mastectomies. We were able to see on the before that she had her nipples and breasts -- they were smaller, probably a B cup. She wished, if possible, to get a larger size. So with the combination of newer technology, with newer types of implants, newer techniques, we were able to preserve her nipple.
And if you notice on the side there is a little scar. There is a tiny scar that goes laterally or towards the outside. With that slight scar we were able to completely reduce the risk, as best as possible with the double mastectomy, but then give her breasts even in clothing, outside of clothing make her feel natural and give her the sense of self and whatever other issues related to sexuality back again.
GUPTA: You know, this may be more of a psychological question. Given these advanced techniques and what's now possible in the world of reconstruction, do you find women are more -- I'm not sure aggressive is the word, but more likely to go ahead and have a mastectomy or a double mastectomy when they're confronting this diagnosis?
KIM: Over the past several years, more and more women who have breast cancer on one side are electing to get prophylactic mastectomy on the other side. And I think from talking to them and calling over hundreds of patients, I think the idea is that they want to reduce risk as much as they can. When they see what's possible in terms of reconstructing the breast after that maximal risk reduction is done then they feel that, you know what, this is a trade-off, this is a balance. And they are willing to undergo this maybe a little bit more radical surgery because they know they will get the form and features of their breasts back to a reasonable degree.
And I think it is empowering that the evolution of reconstruction has perhaps allowed women a little bit more choice when it comes to breast surgical options.
GUPTA: And, Zoraida, I know you have had a lot of conversations with Dr. Kim about this, and maybe seen some of the same images. Was that part of your decision-making as well? I mean, this idea that these reconstructive options are available? How much does that play into your thinking regarding the cancer treatment?
SAMBOLIN: Well, it played into it a lot. The first option I was given was a lumpectomy with radiation when we were just talking about the type 2 (ph) cancer. And, you know, I thought long and hard about that. And the radiation was actually what scared me.
And, you know, I almost felt a sense of relief, Sanjay, when there was that area, and I thought, OK, good, because now it can just all go. And I don't have to worry about that anymore. I don't have to worry about side effects with radiation.
And so, it was -- it was a big factor in my decision. You know, it was. I wanted to feel still like a woman.
GUPTA: Well, I really appreciate your time. I think a lot of people are going to gain a lot out of this discussion.
Zoraida Sambolin and Dr. John Kim -- of course, Zoraida, we wish you luck. Live strong. Hope to check in with you soon. Up next, the eternal question of what to eat. Michael Pollan, he's going to stop by. You know him. He's got a piece of eating advice that's really fun. It's also almost guaranteed to make you healthier.
Stay with us.
GUPTA: We hear a lot about the connection between diet and health. So, what if I told you there is one thing you can do that pretty much guarantees feeling better? It's not a workout. It's not a vegetable. It's not a supplement.
It's the simple act of cooking your own food.
Well, that's the case Michael Pollan makes in his new book. It's called "Cooked."
GUPTA: Thanks for being back on the show.
MICHAEL POLLAN, AUTHOR, "COOKED": Sure.
GUPTA: It's a great book. And, you know, I have tried to cook more food recently myself, just because I have enjoyed the process. I have small children and I find it very communal. It's a great social thing for families.
POLLAN: Yes, for sure.
GUPTA: You have written a lot of books now. Why did you decide to write this?
POLLAN: You know, what matters most about your diet are not really the nutrients, good or bad, even though we obsess about antioxidants and omega-3s. And it's important that scientists know about and work on that. But for the average person, the key fact about your diet is who is cooking it. Is it a human being, preferably yourself or a loved one, or is it a corporation?
And when corporations are cooking your food, that's when we get into trouble, because they cook really badly.
GUPTA: If you go to big restaurants, they may not be using as high quality food, but they also, as I think wrote in the book, they tend to sort of bury it with salt and sugar, and things like that.
POLLAN: Well, you know, their business model involves getting -- especially when talking about fast food mostly, and processed foods you find, those home meal replacements in supermarkets -- buy cheapest possible ingredients, dress them up with lots of salt, fat, and sugar which cover up a lot of sins of quality, and then use lots of additives to keep the food looking fresher than it really is, because it's got to stay on the shelf, or the freezer case for a year. And those additives are a problem. The salt, fat, sugar is a problem.
So, you would never cook that way at home. You know, you don't have Maltodextrin 80 or Polysorbate 80 in your pantries.
GUPTA: Sitting around in the pantry, right?
POLLAN: No, you don't need that stuff. But if you look at the ingredients, you find all these stuff in restaurant and processed food that no human would ever cook with.
GUPTA: It's going to take some getting used to a little bit. But I got to tell you, a lot of this made a lot of sense. I say it in part from a medical angle. But just going back to cooking for a second, have you done more cooking now? I mean --
POLLAN: Yes. I have really learned the importance of cooking as -- on many levels. From a health point of view, it is the easiest thing you can do to improve your health. If you are cooking, you can stop counting calories, you can stop worrying about nutrients.
You're not going to cook junk. You're not going to make French fries. It's too much work.
Whereas if you're out buying food, you're going to eat French fries twice a day. So, there's something built into the work itself that naturally pushes you toward a healthier diet. And I think the important thing for all us, because we are busy, and it's very hard to find time to cook, is get our kids into the kitchen. Get them to help.
POLLAN: Because the most important thing you can teach your kid for their long-term health and happiness is this life skill -- how to cook.
So, I think it offers us a lot. It offers us, also, if you cook, you're going to have family meals. You're all going to sit down together, because you've done all this work.
GUPTA: Eat real food has been a piece of advice you've been giving for a long time.
POLLAN: It's very simple.
GUPTA: I always enjoy speaking to you.
Congratulations on the book. I don't know how you do it. You fit a lot in. I really appreciate your time.
POLLAN: Well, me, too. Thanks a lot.
GUPTA: A check of your top stories just minutes away.
And, up next, the little known story of how laser eye surgery was born and what you should know if you're thinking of having it done.
GUPTA: Last but certainly not least today, I want to tell you the story of a woman who has helped millions of people see more clearly. Twenty-five years ago, she performed the first laser eye surgery to correct nearsightedness. This is Dr. Marguerite McDonald talking about her life's work.
DR. MARGUERITE MCDONALD, OPHTHALMOLOGIST: And we started with a little laser, the size of a bread box. We would shoot at plastic, or a rabbit, or monkey, and hand crank the diaphragm smaller, shoot for a few more seconds, hand crank again. It was like something from the Keystone Cops.
As time passed, we added more and more sophistication to it. So we were doing animals when a 62-year-old woman named Elberta Cassidy (ph) developed cancer in her eye socket. She said, you're going to have to remove my eyes in a few days to try to save my life. Would anybody like to experiment on my eye?
So, we got permission to rush her out past all the apes, past all the gorillas, and lay her down out of the primate center and do a treatment. We got the tissue 11 days later. The results were fantastic. We realized it was possible to sculpt the cornea without any thermal damage, without any scarring. So, we began to realize the impact this might have.
Poor Ms. Cassidy lost her battle with cancer and died. But I was able to convince the university to name the laser laboratory after her. It's unbelievable to me and very gratifying to me to run into people everywhere who are now enjoying life free of glasses and contacts. It's a game changer. I'm very honored to have been a part of it.
GUPTA: You know, if you are considering laser eye surgery there are some things you should keep in mind. First of all, you need to keep your expectations in check. If your vision is especially bad, laser surgery is less likely to be effective for you. Also, you should be at least 18 years old. Before that, your eyes are still developing and changing. And you need to be healthy.
Laser eye surgery is not recommended if you have diabetes, rheumatoid arthritis, glaucoma, or some other conditions that may affect the eye. As always, talk to your doctor first.
Look, any surgical procedure carries risks. If you're happy with your glasses and your contact lenses, it's probably not worth it to have the procedure. After all, we're here to help you chase life.
That's going to wrap things up for SGMD today. But stay connected with me at CNN.com/Sanjay. Let's keep the conversation going on Twitter @DrSanjayGupta.
Time now, though, for a check of your top stories making news right now.