安吉莉娜·茱莉：我为何要切除双乳

liver411

安吉莉娜·茱莉 2013年05月14日

洛杉矶



我母亲和癌症进行了近10年的战斗，在56岁那年去世。她勉力撑着，直到盼来了头几个外孙，将他们搂在怀里。但我的其他几个孩子没有机会认识她，也无从得知他们的外祖母是多么慈爱、多么亲切。

我们常在一起谈到“妈妈的妈妈”，我要费很大力气才能跟他们说清楚，将她从我们身边夺走的究竟是怎样一种疾病。他们曾问我，我是不是也会生同样的病。我一直让孩子们别担心，但事实上，我携带着那种“有毛病”的基因——BRCA1，而它会大幅度增加我罹患乳腺癌和卵巢癌的风险。

我的医生们预测，我患乳腺癌的危险为87%，患卵巢癌的风险为50%，不过对于每个女性来说，风险的概率都不尽相同。

只有小部分的乳腺癌是因遗传性的基因突变而导致。平均来说，BRCA1缺陷的人患乳腺癌的危险为65%。

一旦意识到了这就是我面对的现实，我立刻决定要积极行动，尽可能降低自己患病的风险。我做出决定，接受了预防性双乳切除术。我选择先从乳房入手，因为我患乳腺癌的风险要高于卵巢癌，而且这项手术更为复杂。

4月27日，我完成了为期三个月的乳房切除术治疗。在此期间我既确保了自己的隐私，同时也继续工作。

但我现在将之写了出来，因为我希望其他女性能从我的经历中受益。“癌症”仍是一个令人为之胆寒的词语，会让人心生深深的无力感。但现在，你可以通过一个血检来获知自己是否是乳腺癌和卵巢癌的易感人群，进而采取行动。

我的治疗从2月2日开始，首先进行的是所谓“乳头保留术”，这样可以清扫乳头下面的乳管，并增加该部位的血供。治疗会有点疼，也会留下不少淤青，但它会增加双乳乳头保留下来的可能性。

两周后我接受了最主要的手术，切除了乳房组织，并暂时置入填充物。手术可长达八小时。醒来时你会发现双胸留下了引流管和扩张器。这让人觉得像极了科幻电影的场景。但手术后几天，你的生活就能恢复如常了。

九周后，我接受了最后一次手术，用假体再造双乳。在近几年来，这项手术已经取得了很多进展，最后出来的乳房“成品”非常漂亮。

我写下这些，是想要告诉其他女性：做出切除双乳的决定并不容易。但我很高兴自己这样做了。我患乳腺癌的风险从87%降到了不到5%。现在我能告诉我的孩子们，他们不用担心妈妈死于乳腺癌了。

孩子们并没有看到任何让他们不适的改变，这一点让我如释重负。他们能看到我身上小小的疤痕，仅此而已。除此之外都还是原来的那个妈妈，一模一样。他们知道我爱着他们，为了能尽可能长久地与他们在一起，我愿意做任何事情。从个人层面来说，我并没有感觉身为女人自己少了点什么，相反，我为自己做出了一个坚强、同时又完全没有影响自己女性特质的决定而感到力量倍增。

我庆幸自己拥有布拉德·皮特(Brad Pitt)，一位如此忠诚、始终支持着我的伴侣。所以，如果你的妻子或女友也遇到了同样的事情，你要知道，在这个转变的阶段，你的作用非常重要。给我治疗的医院是粉莲花乳房中心(Pink Lotus Breast Center)，在我手术的每一分钟，布拉德没有离开过半步。我们在一起大声欢笑。我们都知道，对于我们的家人来说，这样做是正确的，它将令我们更加亲密。事实也的确如此。

对于看到这篇文章的女性，我希望它有助于你明白自己拥有各种选择。我希望鼓励所有女性，尤其是有乳腺癌或卵巢癌家族史的女性，去主动寻找相关资讯和医疗专家，帮助你度过生命中的这个关卡，并在充分了解讯息后做出你自己的决定。

很多出色的整体医学(holistic)医生在寻找手术以外的另类方案。我个人的治疗方案将会在合适的时候，在粉莲花乳房中心的网站公布。希望这会对其他女性有用。

据世界卫生组织(World Health Organization)数据，每年死于乳腺癌的人数达到45.8万人左右，死者多数来自低收入至中等收入国家。我们的当务之急是要确保更多女性——不论她们的经济状况和背景如何，不论她们身处哪里——都有机会接受基因测试和预防性治疗，而这能挽救她们的生命。在美国，测试BRCA1和BRCA2的费用为3000多美元，这对于许多妇女来说仍是一大阻碍。

我之所以决定要向公众讲出自己的经历，是因为还有很多妇女并不知道她们或许正生活在癌症的阴影之下。我希望她们同样能接受基因测试，而且如果检测结果表明她们属较高风险人群，应该了解到自己仍有非常可靠的办法。

生活总会给你带来无数挑战。有些挑战，我们可以迎难而上，占据主动，只有这样，我们才不会心生恐惧。

安吉莉娜·茱莉是演员、导演。
翻译：学清

liver411

May 14, 2013
My Medical Choice
By ANGELINA JOLIE
LOS ANGELES

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.

Angelina Jolie is an actress and director.