March 14, 2024—Actress Olivia Munn’s candid disclosures on Instagram about her aggressive breast most cancers — a shock discovery after a “clear” mammogram and unfavorable genetic checks — had been a poignant mixture of particulars about her most cancers journey and a cautionary story for girls.
Munn earlier this week revealed her 10-month battle with breast most cancers, which resulted in 4 surgical procedures and a double mastectomy, and used the social media website as a means of encouraging girls to teach themselves in regards to the illness and the significance of acceptable screening checks.
Munn’s expertise reveals some truths that girls could not know: Most ladies who get breast most cancers don’t have a genetic predisposition. Mammograms don’t detect all cancers. A person danger evaluation — which Munn’s OB/GYN physician really useful — can level to the necessity for extra testing to seek out tumors mammograms have missed.
Munn, 43, identified for her work on The Each day Present with Jon Stewart, as economist Sloan Sabbith on the HBO political drama The Newsroom, and films together with Magic Mike, wrote intimately on Instagram about discovering out she had an aggressive type of most cancers referred to as luminal B regardless of having a traditional mammogram and testing unfavorable on a genetic check that she stated checked for 90 totally different most cancers genes.
Her physician did a person danger evaluation, discovering Munn’s lifetime danger was 37%, thought-about very excessive, and referred her to extra intensive testing, which detected most cancers in each breasts.
Munn stated in a collection of Instagram posts that she initially stored her prognosis personal, explaining, “I wanted to catch my breath and get via a few of the hardest elements earlier than sharing.” She lauds her OB/GYN, Thais Aliabadi, MD, who determined to calculate the danger rating. “The truth that she did saved my life,” Munn wrote.
Munn’s preventing spirit and constructive angle are obvious. “I’m fortunate,” she posted. “We caught it with sufficient time that I had choices.” She praised the efforts of John Mulaney, her associate with whom she shares a 2-year-old son. He researched remedies and drugs and posted photos bedside of their son.
Munn thanked her medical doctors and different employees at Cedars-Sinai Medical Middle in Los Angeles and Windfall Saint John’s Well being Middle in Santa Monica, together with her surgical oncologist, Armando Giuliano, MD, her reconstructive surgeon, Jay Orringer, MD, her oncologist, Monica Mita, MD, and Aliabadi.
A spokeswoman for Munn stated the actress shouldn’t be doing interviews presently. Spokespersons at Cedars-Sinai declined to touch upon Munn’s case.
Genetics and Breast Most cancers
“Most individuals who get breast most cancers don’t have an inherited genetic mutation,” stated Nathalie Johnson, MD, medical director of the Legacy Well being Programs Most cancers Institute and the Legacy Breast Well being Facilities in Portland, OR, who was not concerned in Munn’s remedy.
“Solely 5 to 10% of people that get breast most cancers have a gene that checks constructive,” agreed Joanne Mortimer, MD, director of Ladies’s Cancers Program and a medical oncologist at Metropolis of Hope in Duarte, CA. Mortimer was additionally not concerned in Munn’s care and spoke usually about breast most cancers remedy in circumstances much like Munn’s.
Most cancers Subtypes
Luminal breast cancers are these originating inthe luminal or inside lining of the mammary ducts. Each luminal A and luminal B want estrogen to develop, Johnson stated. Luminal A has a greater prognosis and is less complicated to deal with. Luminal B has a worse prognosis, she stated, and it’s typically dubbed B for “dangerous.”
Luminal B “requires chemotherapy and if it recurs; it’s simply tougher. It stops responding to endocrine remedy or estrogen-blocking medication and so we’ve to make use of different therapies.”
Genomic testing helps medical doctors determine if the luminal tumors are A or B types, she stated. The prognosis for luminal B cancers can nonetheless be good, Johnson stated.
Past Mammograms
“Mammograms aren’t excellent,” Johnson stated. The screening can particularly miss cancers in breasts with dense tissue as a result of the cancers don’t present up as properly on the imaging.
Density refers back to the quantity of fibrous and glandular tissues within the breast in comparison with fatty tissue. About half of ladies age 40 and above have dense breasts, in accordance with the CDC. The mammogram report could embrace details about whether or not breast density is excessive or low.
If breasts are dense, an ultrasound or breast MRI can be good supplementary checks, Johnson stated.
Although mammograms miss some cancers, Johnson urges girls to bear the exams as really useful. The U.S. Preventive Providers Activity Power, in its draft advice, requires mammograms starting at age 40 and repeated each different yr.
Even when mammogram outcomes present no proof of most cancers, if a lady feels one thing uncommon in her breasts, it’s time to return to the physician and ask about additional testing, Johnson stated.
An MRI is usually executed in girls as younger as Munn, Mortimer stated, if they’re identified to have dense breasts or a household historical past, each identified to boost breast most cancers danger. “In somebody with a household historical past, we alternate MRIs with mammograms to extend the possibilities of detection,” she stated.
Particular person Assessments
In her Instagram posts, Munn praises her OB/GYN for suggesting a person danger evaluation. “Dr. [Thais] Aliabadi checked out elements like my age, familial breast most cancers historical past, and the truth that I had my first baby after the age of 30,” Munn wrote on Instagram. “She found my lifetime danger was at 37%.”
That rating prompted the physician to refer Munn for an MRI after which an ultrasound and biopsy. “The biopsy confirmed I had Luminal B most cancers in each breasts,” Munn wrote. “Luminal B is an aggressive, fast-moving most cancers.” Thirty days later, Munn had a double mastectomy.
One such danger evaluation is on the Nationwide Most cancers Institute website. It takes under consideration a historical past of breast most cancers, earlier radiation to the chest, genetic mutations, age, race, ethnicity, historical past of a breast biopsy with a benign prognosis, age at first menstrual interval, age when first baby was born (over 30 raises danger), and first-degree kin (your dad and mom, sibling, or baby) with breast most cancers.
From that, it predicts a 5-year danger and a lifetime danger of creating breast most cancers, evaluating the affected person’s danger with the common danger of the inhabitants.
As an illustration, a 43-year-old White girl with no historical past of breast most cancers or earlier radiation, no genetic mutations, no earlier breast biopsies, first interval at age 12, 30 or older at first childbirth, and no first-degree kin with breast most cancers has a 13.2% lifetime danger of breast most cancers, barely above the common danger of 12.1%.
Therapy Choices
Apart from the kind of tumor detected, elements similar to lymph node involvement drive remedy selections, Johnson and Mortimer stated.
For a younger girl with luminal B breast most cancers, the standard routine can be surgical procedure, chemotherapy, and estrogen-blocking remedy. “The luminal B prognosis remains to be good in case you do the chemo in addition to the endocrine remedy.” Johnson stated.
Fashions can assess survival charges if the remedy consists of chemotherapy or doesn’t, Johnson stated, serving to girls to make their very own selections.
Mortimer referred to as Munn’s OB/GYN “fairly superb” to counsel the danger calculator and take motion, discovering the tumor a lot sooner than the subsequent scheduled mammogram would have.
