The decision to get a preventive double mastectomy as Jolie did may seem extreme, but for women who are faced with a definitive risk of breast cancer, the decision has to do more with logic than emotion.
Allison Dalton learned nearly every female relative in her mother's generation was dealing with breast or ovarian cancer.
"All of the women who had breast cancer, except for my mother, ended up dying from breast cancer," Dalton said.
Genetic testing at the age of 24 revealed Dalton also carried a genetic predisposition to these cancers. Three years ago, the now 41-year-old Dalton decided she didn't need to wait to be diagnosed. Like Jolie, Dalton wanted to be around to see her daughter grow up, so she had both her breasts surgically removed.
Breast surgeon Dr. Deanna Attai says every woman's risk will be different.
"A woman who tests positive for BRCA gene mutation can have as high as a 60 to 80 percent chance of eventually developing a breast cancer. (For) those patients, prophylactic mastectomy is certainly indicated," Attai said.
Women who test positive for one or two genes that predisposed them to cancer have other options besides prophylactic mastectomy, they can take Tamoxifen, which studies show can prevent some cancers, but not all. Women can also choose to watch and wait, which involves screening two to four times a year.
"Surveillance, obviously, is not preventative, it's aimed at early detection," Attai said. "By close surveillance, we would usually include mammogram, ultrasound and MRI."
Like Jolie, many women who undergo prophylactic mastectomy choose to undergo breast reconstruction. Dalton decided against it.
"I also wasn't physically comfortable with having fake breasts, but that's truly personal," she said.
Every decision leading up to surgery is personal and individual. Dalton's advice is to talk to people you trust but most of all trust yourself.
"I would never push anybody to do something that they weren't comfortable with," Dalton said.
The comprehensive BRCA test costs between $3,000 and $4,000, depending on where you go. Most of the time, insurance covers the cost. About half of the women who get positive results decide to go ahead with the preventive surgery.
For women like Dalton, meeting with a genetic counselor is one of the first steps in answering questions about what to do next.
At City of Hope in the city of Duarte, board certified genetic counselor Kathleen Blazer sees patients like Patti James, who faced tough choices.
It's called genetic counseling, and Blazer says a person doesn't just find out about their own health risks.
"Very often, these are people coming to us with maybe a new cancer diagnosis, so they're getting so much information, all at the same time ... so it can be very emotionally challenging" Blazer said.
For James, the decision was to go ahead with preventative surgery. It wasn't easy, but she felt like it put her back in control of her own fate.
"I would recommend it to anybody who has a strong family history," James said. "It will empower you. It will give you choices."
