The most surprising fact that people do not know about breast cancer is that about 80% of women diagnosed with breast cancer do not have a single relative with breast cancer. Much more than just family history and inherited genes factor into the breast cancer equation.

It is absolutely a good thing that she [Angelina Jolie] helped to educate the world about the existence of this mutation; hopefully, as a result, more compassionate understanding exists regarding the choices BRCA carriers must face.

Options other than mastectomy include high risk surveillance and risk reduction. Surveillance is a combination of monthly self breast exam, annual mammography and whole breast screening ultrasound, annual breast MRI, and biannual clinical breast exam.

In my practice, the majority of mutation carriers choose mastectomy; however, for those without cancer, they have much more control over the timing. For younger women, we might wait until they have found a life partner, or until after childbearing. Older women who find out they carry a mutation have unwittingly escaped a large percentage of their risk, and therefore, the calculated future risk is not necessarily a daunting number.

Risk reduction for BRCA2 carriers includes taking tamoxifen. Removing ovaries prior to age 40 drops breast cancer risk in half. Ovarian cancer surveillance is unfortunately inadequate at early detection, but birth control pills reduce ovarian cancer incidence up to 60%.

The Angelina Effect refers to the fact that a powerful, beautiful, well-respected and world-renowned woman unabashedly revealed private medical details about a gene mutation which affects 1 in 500 people. In so doing, she raised awareness and sparked conversations around the world amongst known BRCA carriers, possible carriers, and the circle of family and friends who care about them.

Nearly every BRCA mutation carrier's main concern is how to avoid the fate of relatives who have had, and possibly died from, breast or ovarian cancer.