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Angelina Jolie op-ed resonates with Syosset woman

Laurie Mischo had a preventive double mastectomy in

Laurie Mischo had a preventive double mastectomy in 2008. (May 14. 2013) Credit: Chris Ware

Laurie Mischo, mother of three in Syosset, said Angelina Jolie was right on target when she wrote in an op-ed that opting for a preventive double mastectomy made her "feel empowered that I made a strong choice that in no way diminishes my femininity."

"She's 100 percent correct," said Mischo, 58, who in July will celebrate the fifth anniversary of her own double mastectomy, which she, too, had after finding she carried a mutated gene that increases the risk of breast and ovarian cancer.

What's more, Mischo said, that empowerment also "goes for removing your ovaries."

Eight years ago, Mischo was diagnosed with ovarian cancer, underwent a hysterectomy and was in the chemotherapy stage when her doctor suggested she get the genetic testing that revealed she carried the mutated form of the BRCA2 gene.

She said she knew going into the testing with "no doubt in my mind" that if the results were positive, she would opt for the surgery.

Her internist advised her to allow her body to bounce back fully after the six-month chemo, so with mammograms and MRI breast image monitoring, she allowed two more years before scheduling the bilateral mastectomies.

Unlike Jolie's two-part procedure, Mischo had two surgeons at the same time, one removing her breast tissue and the other inserting the implants.

Since then, she said, her surgeons have called on her to share her experience with patients with varying concerns -- including worries they would lose all feeling in their breasts or be disfigured or have their movement restricted.

A tax and office administrator in an accounting firm, Mischo said that she understands what a tough decision it is for many women, especially those who are younger. In her case, though, "I couldn't sit on the fence. I just knew I didn't want to have to deal with waiting for the other shoe to fall."

Jolie's piece in The New York Times telling of the genetic mutation that led to her opting for a preventive double mastectomy is "a wonderfully open and honest editorial" that hopefully will lead to families having much-needed discussions about health history, a Long Island oncology expert said.

As a breast medical oncologist at a specialized center, "I see women daily on this," said Dr. Myra Barginear of the Don Monti Division of Oncology at the Cancer Institute of North Shore-LIJ Health System. "This is what I do."

And when her patients have tested positive for such genetic mutations, many have gone on to have preventive double mastectomies as Jolie did, she said.

While that "is the most highly effective strategy for breast cancer reduction," she said, it's still a "very personal decision" about an involved procedure that includes genetic and reproductive counseling and a lengthy recovery time. Besides the emotional toll for the patient and family members, she said, there can be a financial burden, as even those who have health insurance can be "underinsured" for such a procedure.

Of the op-ed piece, Barginear said, "I truly believe that knowledge is power" and that "it's vital we educate young women" in the value of knowing family history and in awareness of the genetic mutation that Jolie said she has.

Dr. Janice Lu, associate professor of medicine and director of breast medical oncology at Stony Brook University Medical Center, said Jolie's high-profile op-ed is likely to heighten awareness among younger women and those with a family history of breast and/or ovarian cancer.

She said she's seeing a trend of more women with the mutated genes considering such preventive mastectomies. Still, "it's not a trivial procedure," she said, and there is an alternative, which is monitoring through more frequent mammograms and breast MRIs to catch any development early.

While Barginear said that Jolie's article can be a jumpoff point for medical history discussions that were at one time taboo, she also said the message "should be kept in context."

Genetic mutation, she said, is "not a common reason for breast cancer," mirroring Jolie's own words that "Only a fraction of breast cancers result from an inherited gene mutation."

While a family history of cancer is common among those who are diagnosed, Barginear said, "less than 10 percent of all breast cancers and less than 15 percent of ovarian cancers are associated with inherited genetic mutations."

Men, too, can be are affected, she said, as mutated genes can lead to their higher risk for breast and/or prostate cancers.