安吉丽娜·朱莉：我的乳腺癌治疗选择

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.

我的母亲与癌症斗争了近十年，在56岁时去世。她与命运对抗着，直到见到了自己第一个外孙，享受了天伦之乐。不过，我的其他几个孩子却没有机会了解她，感受她的和蔼可亲。

我们经常聊起“妈咪的妈咪”，而我发现自己总是在努力地向他们解释将她从我们身边夺走的疾病。孩子们曾问道，这种情况是不是也会发生在我身上。我一直都告诉他们，不要担心，而真相是，我身体里有一个“缺陷”基因，BRCA1。这个基因会极大地增加我患上乳腺癌和子宫癌的风险。

我的医生估计我有87%的几率会患上乳腺癌，50%的几率会患上子宫癌，当然这种几率因人而异。

只有一小部分的乳腺癌是由遗传性基因突变造成的。基因BRCA1有缺陷的人平均患上乳腺癌的几率是65%。

当我知道这种情况降临到我身上时，我决定主动出击，尽可能地减少风险。我决定进行一个预防性的双乳腺切除手术。我从乳房开始，因为我患乳腺癌的风险高于子宫癌，且手术更为复杂。

4月27日，我结束了针对乳腺切除手术的三个月疗程。在此期间，我没有对外透露，同时也没有影响工作。

不过，我现在要公布于世，原因是我希望女士们能从我的经历中有所收益。癌症现在仍然是一个让人感到恐惧的词，让人感到深深的无力。不过，如今有可能通过验血来发现你是否属于乳腺癌和子宫癌的患病高危人群，并采取应对措施。

我的治疗从2月2日的“乳头延迟”(nipple delay)手术开始，即切除乳头后方乳腺导管中的病变，并将更多的血液导入这个部位。这会导致疼痛和大量瘀伤，不过能增强留住乳头的机率。

两周后，我作了一个大手术，切除了乳腺组织并填充了一些临时填充物。这个手术用了八个小时。醒过来时，我的胸部里插着导流管和扩张器，就像科幻电影的场景一般。不过，手术过后数天，就能恢复正常生活。

9周之后，最后一次手术是乳房重建，填充植入物。在过去几年，这个手术已经取得了很大的进步，而且手术做得很漂亮。

我记录下这些，是想告诉其他的女性，下决定做切除手术很难。不过，我非常高兴我做了这样一个决定。我患上乳腺癌的机率从87%下降到5%。我可以告诉我的孩子，他们不必害怕乳腺癌会带走我了。

孩子们不会看到让他们感到不安的事情发生，这让我很安心。他们会看到我身上的一些小伤疤，但仅此而已。其他所有的一切都只是“妈咪”，与以往没有任何不同。他们知道我爱他们，也会尽一切可能陪在他们身边。从个人的角度来看，我没有感到自己缺失了女人的任何部分。我会为做出了一个坚定的选择而备感鼓舞，这个选择没有丝毫损害我作为一个女人的方方面面。

有布拉德·皮特这样一个伴侣，我感到很荣幸。他十分爱我，且支持我。所以，对女友或妻子也在经历这一切的所有男人来说，你要知道，你在她们这次的生命转折中尤为重要。皮特陪我在粉莲乳腺治疗中心(Pink Lotus Breast Center)度过了每一次手术的时刻。我们想方设法地找机会一起开怀大笑。我们了解这个决定有益于我们的家庭，也能让我们俩走得更近。事实上，确实如此。

对于读到本文的女性来说，我希望这篇文章能帮助你了解到你有选择。我想给予每一个女性勇气，特别是拥有家族乳腺癌史或子宫癌史的女性，去寻求相关的信息或医疗专家来帮助你度过生命中的这一阶段，让你足够了解相关的资料。

我承认，有许多实力超强的全能性医生致力于找到能替代手术的方法。我的治疗方法将会及时地发布在粉莲乳腺治疗中心的网站上。我希望能对其他女性有所帮助。

据世界卫生组织的数据，每年因乳腺癌去世的人数达到45.8万人，主要来自中低收入国家。让更多的女性能进行基因检测和以延长生命为目的的预防性治疗就成为了重中之重。这无关乎于她们的收入和背景，也不管他们生活在哪个国度。测试BRCA1和BRCA2的费用——在美国的的费用要3000多美元(约1.8万元)——将许多女性排斥在外。

我选择公开我的个人经历，原因是有许多女性还不知道她们生活在患上癌症的可能性之中。我希望她们也能进行基因检测，而且如果她们患病的机率比高，她们也能知道能有更好的办法。

生活中充满着挑战。一些挑战吓不倒我们，是因为我们能应对和掌握这些挑战。

本文发表于2013年5月14日