【我的醫療選擇】 My Medical Choice

【我的醫療選擇】---
安潔莉娜裘莉 2013/05/14

我的母親花了將近十年對抗癌症，在56歲那一年病逝。她堅持得夠久，所以可以看到她的第一個孫子並擁入懷中。但是我其他的孩子卻永遠沒有機會，知道並碰觸到她那樣的關愛和珍貴。（麥：小布和裘莉有三個親生子女，三個領養子女）

我們總說「媽咪的媽咪」，當我發現我試圖向孩子們解釋這個從我們身邊奪走她的疾病。孩子問我，這個病也會帶走你嗎？我總是說不必擔心，但是事實上是，我身上有一種基因，BRCA1，正快速的增加我罹患卵巢癌和乳癌的機率。

我的醫師估算我有87%的機率罹患乳癌，50%罹患卵巢癌，雖然這個風險對每個女人來說都不盡相同。從遺傳來的基因突變導致的乳癌是很少數的，檢查BRCA1的結果是65%，平均值來說。

當我知道，這是我的真實人生時，我決定積極面對並盡可能降低我的風險。我決定去做預防性的兩段式乳房切除術。我從胸部開始，因為我的乳癌風險比卵巢癌風險高，手術也更複雜。4月27日，我完成了長達三個月的醫療過程，包括切除乳房。這段時間裡，我一邊保密，也同時繼續我的工作。

但現在，我把這些寫下來，因為我希望有其他的女性，可以從我的經驗中得到些幫助。癌症永遠是一個把恐懼刻進心頭的字眼，製造無限的無力感。但今天透過血清測試，你可以知道你是不是乳癌和卵巢癌的高危險群，並做出行動。

我自己是從2月2號開始的，一般叫做「乳暈乳頭保留式切除法」，讓乳房內的疾病基因繞道，並將血液導入另一個區域。這會有些疼痛並造成許多淤血黑青，但他增加了保留乳頭的可能性。

兩週之後是主要手術，乳房組織移除，並植入暫時性組織，這會花上八小時。你醒來十全身上閜插滿管線，真的感覺非常像科幻電影裡頭的場景。但是只要過幾天，你就可以回到正常生活。

九週之後，最後的手術則是乳房重建手術，也就是義乳手術。最近幾年這個手術有很多新進展，所以結果是非常美麗的。

我想寫下這些是因為，要女人做出乳房切除術的決定是極其困難的。但是我很高興我做出這個決定。因為我罹患乳癌的機率從87%降到低於5%。我可以告訴孩子們，不必擔心我會因為乳癌而離開他們。

同時我也能保證，他們不會看到讓他們不舒服的事。他們只會看到非常微小的疤痕，就只是這樣了。其餘的，還是「媽咪」，這個永遠不變的角色。他們會知道我深愛他們，而且願意為了跟他們在一起更久，而付出一切。在我的私人筆記中，我不覺得我有任何一處不像女人。我甚至覺得更有力量，因為我做了強韌的決定，所以無損我的女性魅力。

我很幸運於擁有我的伴侶，布萊德比特，他充滿愛和支持。所以，任何一位不管是妻子或是女友面臨這件事的男士先生們，你們在過程中扮演極為重要的角色。布萊德人總是在Pink Lotus Breast醫學中心，那個我接受治療的地方，每一分每一秒。我們計畫著要尋找一起歡笑的時刻。我們也知道這對家人是一個對的決定，也相信會讓我們更緊密。事實上也是這樣的。

任何一位讀到這一篇的女性，我希望這能讓你知道，你是有選項的。我想鼓勵所有的女性，特別是有家族病史的，乳癌或卵巢癌，去找到那些資訊或是醫療專家，幫你度過生命中的這個片刻，也幫助你做出有資訊基礎的決定。我自己的養生之道將會貼在這個醫學中心的網站中，我希望可以幫助其他的女性。

根據世界衛生組織的統計，乳癌每年造成45萬8千人死亡，主要都是在中低收入的國家。最必須優先著手的，就是更多女性要接受基因檢查，和救命的預防性治療，無論他們的身分地位，無論住在哪裡。測試BRCA1和BRCA2的價格，在美國超過3千美金，這依舊是很多女性最大的障礙。

我選擇不保留自己的隱私，是因為太多女性甚至並不知道他們生活在癌症的陰影之下。我當然希望她們也可以進行基因檢測，一旦她們發現自己身處高風險族群時，也知道自己有很多選項。

人生總是充滿挑戰的。唯有掌握在自己手裡的，才不致使我們受到驚懼。

安潔莉娜 裘莉

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. 

Angelina Jolie is an actress and director.