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(zhēng)了近十年，在56歲時(shí)去世。她與命運(yùn)對(duì)抗著，直到見(jiàn)到了自己第一個(gè)外孫，享受了天倫之樂(lè)。不過(guò)，我的其他幾個(gè)孩子卻沒(méi)有機(jī)會(huì)了解她，感受她的和藹可親。

我們經(jīng)常聊起“媽咪的媽咪”，而我發(fā)現(xiàn)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?cè)鴨?wèn)道，這種情況是不是也會(huì)發(fā)生在我身上。我一直都告訴他們，不要擔(dān)心，而真相是，我身體里有一個(gè)“缺陷”基因，BRCA1。這個(gè)基因會(huì)極大地增加我患上乳腺癌和子宮癌的風(fēng)險(xiǎn)。

我的醫(yī)生估計(jì)我有87%的幾率會(huì)患上乳腺癌，50%的幾率會(huì)患上子宮癌，當(dāng)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?cè)斐傻摹；駼RCA1有缺陷的人平均患上乳腺癌的幾率是65%。

當(dāng)我知道這種情況降臨到我身上時(shí)，我決定主動(dòng)出擊，盡可能地減少風(fēng)險(xiǎn)。我決定進(jìn)行一個(gè)預(yù)防性的雙乳腺切除手術(shù)。我從乳房開(kāi)始，因?yàn)槲一既橄侔┑娘L(fēng)險(xiǎn)高于子宮癌，且手術(shù)更為復(fù)雜。

4月27日，我結(jié)束了針對(duì)乳腺切除手術(shù)的三個(gè)月療程。在此期間，我沒(méi)有對(duì)外透露，同時(shí)也沒(méi)有影響工作。

不過(guò)，我現(xiàn)在要公布于世，原因是我希望女士們能從我的經(jīng)歷中有所收益。癌癥現(xiàn)在仍然是一個(gè)讓人感到恐懼的詞，讓人感到深深的無(wú)力。不過(guò)，如今有可能通過(guò)驗(yàn)血來(lái)發(fā)現(xiàn)你是否屬于乳腺癌和子宮癌的患病高危人群，并采取應(yīng)對(duì)措施。

我的治療從2月2日的“乳頭延遲”(nipple delay)手術(shù)開(kāi)始，即切除乳頭后方乳腺導(dǎo)管中的病變，并將更多的血液導(dǎo)入這個(gè)部位。這會(huì)導(dǎo)致疼痛和大量瘀傷，不過(guò)能增強(qiáng)留住乳頭的機(jī)率。

兩周后，我作了一個(gè)大手術(shù)，切除了乳腺組織并填充了一些臨時(shí)填充物。這個(gè)手術(shù)用了八個(gè)小時(shí)。醒過(guò)來(lái)時(shí)，我的胸部里插著導(dǎo)流管和擴(kuò)張器，就像科幻電影的場(chǎng)景一般。不過(guò)，手術(shù)過(guò)后數(shù)天，就能恢復(fù)正常生活。

9周之后，最后一次手術(shù)是乳房重建，填充植入物。在過(guò)去幾年，這個(gè)手術(shù)已經(jīng)取得了很大的進(jìn)步，而且手術(shù)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(shù)很難。不過(guò)，我非常高興我做了這樣一個(gè)決定。我患上乳腺癌的機(jī)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(huì)帶走我了。

孩子們不會(huì)看到讓他們感到不安的事情發(fā)生，這讓我很安心。他們會(huì)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(méi)有任何不同。他們知道我愛(ài)他們，也會(huì)盡一切可能陪在他們身邊。從個(gè)人的角度來(lái)看，我沒(méi)有感到自己缺失了女人的任何部分。我會(huì)為做出了一個(gè)堅(jiān)定的選擇而備感鼓舞，這個(gè)選擇沒(méi)有絲毫損害我作為一個(gè)女人的方方面面。

有布拉德·皮特這樣一個(gè)伴侶，我感到很榮幸。他十分愛(ài)我，且支持我。所以，對(duì)女友或妻子也在經(jīng)歷這一切的所有男人來(lái)說(shuō)，你要知道，你在她們這次的生命轉(zhuǎn)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(guò)了每一次手術(shù)的時(shí)刻。我們想方設(shè)法地找機(jī)會(huì)一起開(kāi)懷大笑。我們了解這個(gè)決定有益于我們的家庭，也能讓我們倆走得更近。事實(shí)上，確實(shí)如此。

對(duì)于讀到本文的女性來(lái)說(shuō)，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(gè)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(guān)的信息或醫(yī)療專(zhuān)家來(lái)幫助你度過(guò)生命中的這一階段，讓你足夠了解相關(guān)的資料。

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

據(jù)世界衛(wèi)生組織的數(shù)據(jù)，每年因乳腺癌去世的人數(shù)達(dá)到45.8萬(wàn)人，主要來(lái)自中低收入國(guó)家。讓更多的女性能進(jìn)行基因檢測(cè)和以延長(zhǎng)生命為目的的預(yù)防性治療就成為了重中之重。這無(wú)關(guān)乎于她們的收入和背景，也不管他們生活在哪個(gè)國(guó)度。測(cè)試BRCA1和BRCA2的費(fèi)用——在美國(guó)的的費(fèi)用要3000多美元(約1.8萬(wàn)元)——將許多女性排斥在外。

我選擇公開(kāi)我的個(gè)人經(jīng)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(jìn)行基因檢測(cè)，而且如果她們患病的機(jī)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?yàn)槲覀兡軕?yīng)對(duì)和掌握這些挑戰(zhàn)。

本文發(fā)表于2013年5月14日