安吉麗娜·朱莉：我的乳腺癌治療選擇

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Life comes with many challenges. The ones that should not scare us are the ones we can take on and take control of.

我的母親與癌癥斗爭了近十年，在56歲時去世。她與命運對抗著，直到見到了自己第一個外孫，享受了天倫之樂。不過，我的其他幾個孩子卻沒有機會了解她，感受她的和藹可親。

我們經常聊起“媽咪的媽咪”，而我發(fā)現自己總是在努力地向他們解釋將她從我們身邊奪走的疾病。孩子們曾問道，這種情況是不是也會發(fā)生在我身上。我一直都告訴他們，不要擔心，而真相是，我身體里有一個“缺陷”基因，BRCA1。這個基因會極大地增加我患上乳腺癌和子宮癌的風險。

我的醫(yī)生估計我有87%的幾率會患上乳腺癌，50%的幾率會患上子宮癌，當然這種幾率因人而異。

只有一小部分的乳腺癌是由遺傳性基因突變造成的?；駼RCA1有缺陷的人平均患上乳腺癌的幾率是65%。

當我知道這種情況降臨到我身上時，我決定主動出擊，盡可能地減少風險。我決定進行一個預防性的雙乳腺切除手術。我從乳房開始，因為我患乳腺癌的風險高于子宮癌，且手術更為復雜。

4月27日，我結束了針對乳腺切除手術的三個月療程。在此期間，我沒有對外透露，同時也沒有影響工作。

不過，我現在要公布于世，原因是我希望女士們能從我的經歷中有所收益。癌癥現在仍然是一個讓人感到恐懼的詞，讓人感到深深的無力。不過，如今有可能通過驗血來發(fā)現你是否屬于乳腺癌和子宮癌的患病高危人群，并采取應對措施。

我的治療從2月2日的“乳頭延遲”(nipple delay)手術開始，即切除乳頭后方乳腺導管中的病變，并將更多的血液導入這個部位。這會導致疼痛和大量瘀傷，不過能增強留住乳頭的機率。

兩周后，我作了一個大手術，切除了乳腺組織并填充了一些臨時填充物。這個手術用了八個小時。醒過來時，我的胸部里插著導流管和擴張器，就像科幻電影的場景一般。不過，手術過后數天，就能恢復正常生活。

9周之后，最后一次手術是乳房重建，填充植入物。在過去幾年，這個手術已經取得了很大的進步，而且手術做得很漂亮。

我記錄下這些，是想告訴其他的女性，下決定做切除手術很難。不過，我非常高興我做了這樣一個決定。我患上乳腺癌的機率從87%下降到5%。我可以告訴我的孩子，他們不必害怕乳腺癌會帶走我了。

孩子們不會看到讓他們感到不安的事情發(fā)生，這讓我很安心。他們會看到我身上的一些小傷疤，但僅此而已。其他所有的一切都只是“媽咪”，與以往沒有任何不同。他們知道我愛他們，也會盡一切可能陪在他們身邊。從個人的角度來看，我沒有感到自己缺失了女人的任何部分。我會為做出了一個堅定的選擇而備感鼓舞，這個選擇沒有絲毫損害我作為一個女人的方方面面。

有布拉德·皮特這樣一個伴侶，我感到很榮幸。他十分愛我，且支持我。所以，對女友或妻子也在經歷這一切的所有男人來說，你要知道，你在她們這次的生命轉折中尤為重要。皮特陪我在粉蓮乳腺治療中心(Pink Lotus Breast Center)度過了每一次手術的時刻。我們想方設法地找機會一起開懷大笑。我們了解這個決定有益于我們的家庭，也能讓我們倆走得更近。事實上，確實如此。

對于讀到本文的女性來說，我希望這篇文章能幫助你了解到你有選擇。我想給予每一個女性勇氣，特別是擁有家族乳腺癌史或子宮癌史的女性，去尋求相關的信息或醫(yī)療專家來幫助你度過生命中的這一階段，讓你足夠了解相關的資料。

我承認，有許多實力超強的全能性醫(yī)生致力于找到能替代手術的方法。我的治療方法將會及時地發(fā)布在粉蓮乳腺治療中心的網站上。我希望能對其他女性有所幫助。

據世界衛(wèi)生組織的數據，每年因乳腺癌去世的人數達到45.8萬人，主要來自中低收入國家。讓更多的女性能進行基因檢測和以延長生命為目的的預防性治療就成為了重中之重。這無關乎于她們的收入和背景，也不管他們生活在哪個國度。測試BRCA1和BRCA2的費用——在美國的的費用要3000多美元(約1.8萬元)——將許多女性排斥在外。

我選擇公開我的個人經歷，原因是有許多女性還不知道她們生活在患上癌癥的可能性之中。我希望她們也能進行基因檢測，而且如果她們患病的機率比高，她們也能知道能有更好的辦法。

生活中充滿著挑戰(zhàn)。一些挑戰(zhàn)嚇不倒我們，是因為我們能應對和掌握這些挑戰(zhàn)。

本文發(fā)表于2013年5月14日