A Canadian breast cancer specialist wants people to learn from actress Angelina Jolie's experience and seek genetic testing.
Jolie wrote an op-ed piece that appeared in the New York Times Tuesday called "My Medical Choice" about her decision to have a preventative double mastectomy after her mother died of cancer at age 56 and tests for the "faulty" BRCA 1 mutation revealed she had a high likelihood of developing breast and ovarian cancer.
Below we answer some questions about the procedure:

Is the testing covered in Canada?

Provincial health plans cover the cost of BRCA1 and BRCA2 mutation testing in patients that meet criteria, such as a diagnosis of breast or ovarian cancer of a family history.
"Only 10 per cent of the women with a mutation have been identified, so if we can use this to increase the number to 20 or 25 per cent I think that would be an opportunity," said Dr. Steven Narod, director of the Familial Breast Cancer Research Unit at Women's College Research Institute in Toronto.
The main factor that keeps women from getting the blood test for the mutation is that they don't know that tests are available and that doctors don't regularly ask about family medical history, Narod said.
"We know scientifically that you are just as likely to get a mutation from your dad as from your mom," Narod said.
"The fact is, we've missed all the women who inherited the mutation from their father because they didn't come to the attention of the geneticist because they didn't have the extended family history of breast cancer."

What did the procedure involve?

In double mastectomies, surgeons typically remove as much breast tissue as possible. In Jolie's case, because she was having a reconstruction done shortly afterward, the doctors preserved the skin covering her breasts, inserting "fillers" where the breast tissue would have been, to keep the skin elastic.
"Basically, you have to go through a full mastectomy, get tissue expanders put in, go through a full year of expansion to create a pocket in-between your rib cage and your pectoral muscles so they have somewhere to put the implant," said Theresa Quick of Toronto, who underwent a preventative double mastectomy last year.
Both of Quick's grandmothers died of breast cancer. Her mother also had breast cancer, carried BRCA 1 and died at 52 of ovarian cancer.
For those who test positive and choose to have a preventative mastectomy, the procedure and reconstructive surgery are paid for by provincial plans.

How many women have this faulty gene?

  • Angelina Jolie
  • Sharon Osbourne
  • Christina Applegate
  • Giuliana Rancic
  • Olivia Newton-John
  • Kathy Bates
  • Wendy Mesley
  • Wanda Sykes
  • Kylie Minogue
  • Hoda Kotb
  • Judy Blume
  • Sheryl Crow
  • Angelina Jolie revealed on Tuesday that she had undergone a preventive double mastectomy after learning she carries a gene that makes it likely she will develop breast cancer. Here are a dozen women who have helped bring attention to the disease. (Toby Melville/Reuters)
  • TV personality Sharon Osbourne, wife of rocker Ozzy Osbourne, also had a preventative double mastectomy after learning her genetics made her prone to breast cancer. (Jason Merritt/Getty Images)
  • Actress Christina Applegate, whose mother Nancy Priddy is a breast cancer survivor, had a double mastectomy in 2008. Her mother,. (Phil McCarten/Reuters)
  • E! News television personality Giuliana Rancic had a double mastectomy in 2011. On her Twitter account Rancic said she was proud of Jolie for ‘using her incredible platform to educate women’ about the surgical procedure. (David Becker/Getty)
  • Singer Olivia Newton-John is a breast cancer survivor who has become a major advocate for breast cancer research. She’s currently a product spokesperson for Liv-Kit, a breast self-examination product. (Stephane L'hostis/Getty)
  • Oscar-winning actress Kathy Bates had a double mastectomy in 2012. (Fred Prouser/Reuters)
  • CBC journalist Wendy Mesley was diagnosed with breast cancer in 2005, from which she has since recovered. In 2006, Mesley hosted the television documentary Chasing the Cancer Answer. (CBC)
  • Stand-up comedian and actor Wanda Sykes underwent a double mastectomy in 2011. (Jesse Grant/Getty)
  • Australian pop star Kylie Minogue announced she had breast cancer in April 2005. In the six months following the publicity surrounding her diagnosis there was a spike in the number of young women seeking out breast cancer screening. (Pascal Le Segretain/Getty)
  • Television news host Hoda Kotb allowed the Today Show to follow her through her treatment when she had a mastectomy in 2007. (John W. Ferguson/Getty)
  • American author Judy Blume was diagnosed with breast cancer in August 2012 after undergoing a routine ultrasound and had a mastectomy shortly thereafter. (Evan Agostini/Getty)
  • Singer Sheryl Crow, who had 'minimally invasive' surgery after being diagnosed with breast cancer in 2006, Crow praised Angelina’s bravery on Twitter, writing: ‘Ladies, please check out Angelina Jolie's story today, especially if you have breast cancer in your family history.’ (Ethan Miller/Getty)
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Only a small percentage of women have this same faulty gene, or a similar mutated version of a related gene, BRCA2.
While breast cancer is the most common cancer in women over 20, five to 10 per cent of all cases are hereditary.
These mutations are most commonly found in women of Eastern European Jewish descent; one study found 2.3 per cent of women in that group had the mutations — about five times higher than in the general population. Other ethnic groups, including the Norwegian, Dutch and Icelandic people, also have slightly higher rates of these mutations.
In Jolie's case, Narod speculated she may have inherited a mutation specific to French Canadians that represents 80 per cent of the BRCA1 mutations in Quebec.

How do these genes increase a woman's risk of breast cancer?

The average woman has a 12 per cent risk of developing breast cancer sometime during her life. In comparison, women who have inherited a faulty version of a breast cancer gene are about five times more likely to get breast cancer.

What other preventive options exist?

Narod said women at high risk from mutations are offered screening tests such as MRIs to detect cancer earlier.
Drugs such as tamoxifen and raloxifene can also be given preventatively for women without breast cancer who carry the mutations although clinical trials into their long-term use are ongoing.
Another preventive surgery, bilateral prophylactic oophorectomy — removing both ovaries and Fallopian tubes — is also an option.
Among BRCA1 carriers, the number of deaths from ovarian cancer is about the same as the number of deaths from breast cancer, Narod said, noting there is no screening or early detection available for ovarian cancer.

How relevant is Jolie's decision to other women?

For most women, genetics will not play a big part in whether or not they get breast cancer.
"The majority of women considering their breast cancer risk should focus on things like a healthy lifestyle, eating a balanced diet, keeping a healthy weight and not drinking too much alcohol," said Dr. Peter Johnson, chief clinician at Cancer Research U.K.
With files from CBC's Kelly Crowe and The Associated Press