I admit to not being a big fan of many of her movies -- possibly the only man on the planet who will admit so -- but there's little denying that movie sensation Angelina Jolie has a history of selfless acts and humanitarian giving that's second to none.
MagforWomen.com, for instance, recently highlighted six celebrities that they felt best personified selflessness. Not surprisingly, Jolie and her partner, Brad Pitt, were the first celebrities mentioned because of their countless acts of humanitarian kindness. Included in MagforWomen's mention was the founding of the Jolie-Pitt Foundation, which was launched with a $1 million personal donation to social organizations such as Doctors Without Borders and Global Action for Children. Both Jolie and Pitt work with numerous other social organizations in addition to the two mentioned here.
Yet for all of her acts of selflessness, perhaps none shines more true, nor reflects more bravery, than her decision to publicly announce in a New York Times op-ed this week that she had a double mastectomy in February.
The motivation behind Jolie's big decision was complicated. Her mother passed away from breast cancer at the young age of 56 and she wanted to ensure she'd live a long life to see her children grow up. However, the reasoning behind the surgery appears spot on with her testing positive for the BRCA1 gene mutation, which presents carriers with a significantly higher risk of getting breast and ovarian cancer. Based on Jolie's op-ed, she had an 87% chance of developing breast cancer according to her doctors and a 50% chance of developing ovarian cancer. With her mother having died from the disease, she made the preventative choice to reduce her chances of developing breast cancer by having a double mastectomy to about 5%.
But, even more noteworthy than Jolie's act itself is the incredible amount of breast cancer awareness that will be raised by going public with this often private matter.
Times and treatments are changing
The scope of breast cancer treatment is improving. What's worth understanding is that there are multiple ways of treating breast cancer, with complete breast removal as just one of the effective options. Treatment options really depend on whether the patient is dealing with preventative, early stage, or late-stage disease.
In terms of preventative measures, genetic companies have made big strides over the past couple of decades with regard to disease detection. Myriad Genetics (NASDAQ:MYGN), for example, offers the BRACAnalysis genetic test to help determine if patients carry the BRCA1 or BRCA2 gene mutation that's responsible for a majority of hereditary breast and ovarian cancers. In addition to having a higher propensity to developing breast or ovarian cancer, BRCA1 or BRCA2 gene carriers are more susceptible to developing a second primary cancer. This test offered by Myriad gives patients a quick answer as to whether they're a carrier, helping them determine the next best course of action, which can include increased cancer screenings, hormone therapy, or, in Jolie's case, a preventative mastectomy.
Diagnostics can also play an important role in early and late-stage breast cancer diagnoses. Navidea Biopharmaceuticals (NYSEMKT:NAVB) had Lymphoseek, its external lymph-node imaging and intra-operative lymphatic mapping diagnostic device, approved by the Food and Drug Administration earlier this year to help doctors stage cancer. Discovering whether breast cancer has invaded adjacent lymph nodes has never been easier or safer thanks to Lymphoseek, and it can dramatically aid physicians in determining the best course of action for breast cancer patients.
The early-stage disease is dealt with mostly through hormonal therapies, which reduce the amount of estrogen in a woman's body and slow or stop tumor development. Generic versions of AstraZeneca's Arimidex and Novartis' (NYSE:NVS) Femara are two examples of aromatase inhibitors that work on post-menopausal women by temporarily blocking the activity of the aromatase enzyme that is responsible for making estrogen.
However, there are additional options available for women who aren't post-menopausal. For these women, a drug class known as SERMs are a viable treatment option. Drugs in this class bind to estrogen receptors and act both as an agonist and antagonist in that they suppress estrogen production in the breast, but can mimic its production in other parts of the body like the uterus. Perhaps the most famous SERM is AstraZeneca's Tamoxifen, which, in generic forms today, is still widely used.
Next to preventative diagnostics, perhaps the biggest moves by pharmaceutical companies with regard to breast cancer are being made in late-stage therapies. Roche's Herceptin is a staple among the physicians with regard to treating metastatic breast cancer. Between Herceptin -- which is actually approved by the FDA to treat early and late-stage breast cancer -- and Perjeta, which was approved last June in combination with Herceptin and docetaxel, Roche is working vigilantly to extend patients' progression-free survival and quality of life.
A new type of treatment that involves utilizing antibodies to carry toxins also shows plenty of promise. These antibodies work by releasing a toxin once they come into contact with very specific protein signatures released by the targeted cancer cells, and could be the key to targeted cancer treatments. One example is Roche and ImmunoGen's (NASDAQ:IMGN) Kadcyla, which was approved by the FDA in February as a second-line treatment for HER2-positive breast cancer. The drug combines the HER2 protein-blocking power of Herceptin and uses ImmunoGen's targeted antibody payload technology to deliver the chemotherapy agent directly to the cancer cells. With minimal healthy tissue death, Kadcyla improved progression-free survival and median overall survival by 3.2 months and 5.8 months, respectively, as compared to another current standard of treatment, which is GlaxoSmithKline's and Roche's Xeloda.
Even further down the road, Pfizer's (NYSE:PFE) Palbociclib, a clinical-stage therapy that received the rare breakthrough therapy designation earlier this year, could be a game-changer. In mid-stage trials as a first-line treatment for patients with ER+, HER2- locally advanced or metastatic breast cancer, and in combination with Novartis' Femara, Palbociclib more than tripled progression-free survival to 26.1 months from 7.5 months.
In sum, genetic testing is getting faster and cheaper; pharmaceutical drug delivery, targeting, and effectiveness are getting better; and the side effects associated with chemotherapy agents aren't worsening.
The battle for social awareness
Awareness and being proactive are half the battle when it comes to fighting breast cancer.
In terms of cancer-related deaths, breast cancer will claim more women's lives per year than lung and bronchus cancer, colon and rectum cancer, and corpus and uterus cancer... combined! And those are the second, third, and fourth most-deadly cancers for women, respectively.
This is how much of a concern breast cancer is for women and all the more reason why social awareness, like the type we witnessed from Angelina Jolie this week, is needed to bring this danger to light.
Regardless of how you feel about Angelina Jolie the actress, her courage in sharing her medical struggles -- knowing well that she's a highly followed public figure -- has created a scenario where women should be encouraged to get preventative breast cancer screenings and/or diagnostic testing. The purpose of Jolie's op-ed was the hope that "other women can benefit from my experience." I feel pretty confident that Jolie's hope will be translated into reality as we move forward.