Despite a remarkable increase in the depth of our understanding and management of breast cancer in the past 50years, the disease is still a major public health problem worldwide and poses significant ...challenges. The palpability of breast tumors has facilitated diagnosis and documentation since ancient times. The earliest descriptions of breast cancer date back to around 3500BCE. For centuries to follow, theories by Hippocrates (460BCE) and Galen (200CE), attributing the cause of breast cancer to an “excess of black bile” and treatment options including the use of opium and castor oil, prevailed. Surgical resection was introduced in the 18th century. The advent of modern medicine led to the development of novel treatment options that include hormonal, targeted and chemo-therapies. There are still several therapeutic challenges including the treatment of triple negative breast cancer (TNBC), and overcoming drug resistance.
The increased incidence and awareness of breast cancer has led to significant changes in diagnosis and treatment in recent decades. But, mankind has come a long way. Herein, I have traced how our understanding of breast cancer has evolved from the early description of the disease around 460BCE as “black bile-containing crab-like tumors” to the conventional as a heterogeneous disease with high degree of diversity between and within tumors, as well as among breast cancer patients. How is breast cancer treated today and how do risk factors, breast cancer subtype and drug resistance contribute to the therapeutic challenges at the turn of the 21st century?
Breast cancer remains a serious public health issue worldwide. However, appreciable growth in our understanding of breast cancer in the past century has led to remarkable progress in the early detection, treatment and prevention of the disease. The clinical focus is shifting more towards tailored therapy as more targets are characterized and novel highly innovative approaches are developed.
Tracing the history of breast cancer, highlights how increased awareness of the disease, and progress in research and development have enhance our understanding of the disease.
•The humoral, lymphatic and anti-hormonal theories of breast cancer•Introduction of radical mastectomy, radiotherapy, mammography, and targeted therapy•The introduction of randomized trial•Breast cancer foundations, awareness and the Angelina Jolie effect•Promising future for tailored therapy
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Risk-reducing mastectomy (RRM) is one of key prevention strategies in female carriers of germline BRCA pathogenic/likely pathogenic variants (PV/LPV). We retrospectively investigated the rate, timing ...and longitudinal trends of bilateral RRM uptake and the incidence and types of cancers among unaffected BRCA carriers who underwent genetic counseling at the Institute of Oncology Ljubljana in Slovenia.
Female BRCA carriers without personal history of cancer were included in the study. Clinical data on PV/LPV type, date of RRM, type of reconstructive procedure, occult carcinoma and histopathology results was collected and analyzed.
Of the 346 unaffected BRCA carriers (median age 43 years, 70% BRCA1, 30% BRCA2, median follow-up 46 months) who underwent genetic testing between October 1999 and December 2019, 25.1% had a RRM (range 35–50 years, median age at surgery 38 years). A significant difference in time to prophylactic surgery between women undergoing RRM only vs. women undergoing RRM combined with risk-reducing salpingo-oophorectomy was observed (22.6 vs 8.7 months, p = 0.0009). We observed an upward trend in the annual uptake in line with the previously observed Angelina Jolie effect. In 5.7% of cases, occult breast cancer was detected. No women developed breast cancer after RRM. Women who did not opt for surgical prevention developed BRCA1/2-related cancers (9.3%).
The uptake of RRM among unaffected BRCA carriers is 25.1% and is similar to our neighboring countries. No women developed breast cancer after RRM while women who did not opt for surgical prevention developed BRCA1/2 related cancers in 9.3% of cases. The reported data may provide meaningful aid for carriers when deciding on an optimal prevention strategy.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Reporting on the growth of volunteer tourism, a recent Time magazine article explains, 'Getting in touch with your inner Angelina Jolie is easier than it used to be!'. In myriad ways celebrities like ...Angelina Jolie and Madonna have made international volunteering sexy. These women and their adopted children from the so-called 'Third World' have come to symbolise popular humanitarianism in the West. This paper addresses the cultural politics of female celebrity humanitarianism and the corollary implications of this practice for 20-something female volunteer tourists in northern Thailand. Based on 16 months of ethnographic fieldwork, I argue that the cultural politics of gendered generosity in these encounters overshadows the institutional and historical relationships on which the experience is based and that, in a neoliberal sleight of hand, the political is displaced by the individual with celebrity sheen.
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BFBNIB, DOBA, INZLJ, IZUM, KILJ, NMLJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, ZRSKP
Angelina Jolie's high-profile visit to NATO in 2018 signals a move to brand the alliance's strategic narrative within the language of celebrity through engagement with popular culture. The ...partnership represents a significant change in the alliance's approach to global security. It also builds on a shift in NATO's self-narrative through the advocacy of gender justice related to the Women, Peace and Security (WPS) agenda. Rather than fading into the background, NATO appears to be pursuing the limelight for the purpose of ‘awareness raising’ as a tool to implement the WPS agenda. Drawing upon feminist scholarship on the WPS agenda, NATO, and research on celebrity humanitarianism and politics, we provide a critical study of this change in NATO's strategic narrative, through the analysis of visual and textual material related to Jolie's visit to NATO. Our focus is on the significance of this partnership and its contribution to legitimising the alliance's self-defined ‘military leadership’ in the area of conflict-related sexual violence. While Jolie's visit to NATO opened the alliance to public scrutiny it also symbolised a form of militarism, surrounded by orchestrated visual representations. As such, it only marginally disrupted the militarist logic present in NATO's wider WPS engagement.
Unnafected female carriers of
and
pathogenic/likely pathogenic variants (P/LPVs) are at higher risk of breast cancer (BC) and ovarian cancer (OC). In the retrospective single-institution study in the ...Czech Republic, we analyzed the rate, longitudinal trends, and effectiveness of prophylactic risk-reducing mastectomy (RRM) and risk-reducing salpingo-oophorectomy (RRSO) on the incidence of BC and OC in
/
carriers diagnosed between years (y) 2000 to 2020. The study included 496 healthy female
/
carriers. The median follow-up was 6.0 years. RRM was performed in 156 (31.5%, mean age 39.3 y, range 22-61 y) and RRSO in 234 (47.2%, mean age 43.2 y, range 28-64 y)
/
carriers. A statistically significant increase of RRM (from 12% to 29%) and RRSO (from 31% to 42%) was observed when comparing periods 2005-2012 and 2013-2020 (
< 0.001). BC developed in 15.9% of
carriers without RRM vs. 0.6% of
carriers after RRM (HR 20.18, 95% CI 2.78- 146.02;
< 0.001). OC was diagnosed in 4.3% vs. 0% of
carriers without vs. after RRSO (HR not defined due to 0% occurrence in the RRSO group,
< 0.001). Study results demonstrate a significant increase in the rate of prophylactic surgeries in
healthy carriers after 2013 and the effectiveness of RRM and RRSO on the incidence of BC and OC in these populations.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
The purpose of this study was to evaluate socio-demographic characteristics of clients claiming genetic counseling for hereditary breast and ovarian cancer (HBOC) in Austria. Furthermore, changes of ...these parameters before and after Angelina Jolie's (AJ) disclosure of carrying a BRCA mutation were evaluated.
In this prospective, nonrandomized study 268 consecutive clients seeking genetic counseling for HBOC at the Medical University of Vienna, Department of Obstetrics and Gynecology, Vienna, Austria between June 2012 and June 2014 were included. Socio-demographic data and source of information about HBOC and genetic counseling were evaluated. First, socio-demographic parameters were compared to the general Austrian population. Second, changes in these parameters after AJ's public disclosure of carrying a BRCA mutation were analyzed.
Subjects were more frequent female, younger and higher educated in comparison to Austria's general population (p < 0.001). Furthermore, level of education in participants was higher before than after AJ's disclosure (p = 0.046). Most clients were informed about genetic counseling by physicians. As expected, after AJ's public announcement patients were more frequent advised to genetic counseling by social media (p = 0.043) and family or friends (p = 0.010) than before.
In this present study we could demonstrate that particularly younger and female participants with high educational level attended significantly more often genetic counseling for HBOC. Increased presence of HBOC in media since AJ's disclosure of carrying a BRCA mutation had lead that information and awareness about HBOC was obtained by a wider audience from different social background.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Advanced epithelial ovarian cancer is the deadliest gynecologic cancer; yet public knowledge about the disease is limited. This essay critically examines the limited visibility of ovarian cancer ...using Angelina Jolie's medical announcements in 2013 and 2015 as examples. The essay also examines how Jolie's case reinforces and also challenges hegemonic notions of femininity, the woman's body and health, and how it explicates limitations in discourses of choice and risk. I argue that normative views about the female body play significant roles in shaping how and what we know about women's health.
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BFBNIB, NUK, PILJ, SAZU, UL, UM, UPUK
In May 2013 and March 2015, actress Angelina Jolie wrote in the New York Times about her choice to undergo preventive surgery. In her two op-eds, she explained that − as a carrier of the BRCA1 gene ...mutation − preventive surgery was the best way to lower her heightened risk of developing breast and ovarian cancer. By applying a digital methods approach to BRCA-related tweets from 2013 and 2015, before, during, and after the exposure of Jolie’s story, this study maps and interprets Twitter discursive dynamics at two time points of the BRCA Twitter stream. Findings show an evolution in curation and framing dynamics occurring between 2013 and 2015, with individual patient advocates replacing advocacy organizations as top curators of BRCA content and coming to prominence as providers of specialist illness narratives. These results suggest that between 2013 and 2015, Twitter went from functioning primarily as an organization-centered news reporting mechanism, to working as a crowdsourced specialist awareness system. This article advances a twofold contribution. First, it points at Twitter’s fluid functionality for an issue public and suggests that by looking at the life story—rather than at a single time point—of an issue-based Twitter stream, we can track the evolution of power roles underlying discursive practices and better interpret the emergence of non-elite actors in the public arena. Second, the study provides evidence of the rise of activist cultures that rely on fluid, non-elite, collective, and individual social media engagement.
Celebrities' health decisions have long been associated with heightened awareness and health trend changes. This is the first study conducted in an Arab population investigating the impact of ...international celebrity news on local communities using the case of Angelia Jolie's (AJ) prophylactic mastectomy and oophorectomy surgeries. The objective was to measure the effect of publicized medical information on cancer genetic testing knowledge, attitudes, and practices (KAP). This is a cross‐sectional study using a semi‐structured, self‐administered questionnaire for clinic visitors at the King Hussein Cancer Center (KHCC). We had predominantly female (n = 262, 66.3%) and healthy participants (n = 248, 66.5%). Approximately 80.7% (n = 330) recognized AJ, the actress, and of these, 71% (n = 232) were aware of her recent diagnosis and prophylactic surgeries. Males reported a higher knowledge score (p < .001). However, females had more initiative to seek information (18.3% vs. 10.1%; p = .04). People aware of Angelina's prophylactic procedures were inclined to seek information regarding cancer genetics (20.8% vs. 9.6% p = .003). Breast and ovarian cancer patients were more likely than other cancer patients to encourage family members to undergo prophylactic surgery in case of BRCA1/2 mutations (39.2% vs. 17.1% p = .03). Ninety‐three percent of the sample lacked knowledge regarding the availability of cancer genetic testing in Jordan. Results highlight a clear effect of celebrity medical news on our population, as well as openness to consider genetic testing as an early detection tool for women with a family history of breast and/or ovarian cancer. Generalization of these results to the population of Jordan requires further studies.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK, VSZLJ
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