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 detrimental genetic exams — had been a poignant mixture of particulars about her most cancers journey and a cautionary story for ladies.
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 web site as a approach of encouraging ladies to coach themselves in regards to the illness and the significance of applicable screening exams.
Munn’s expertise reveals some truths that girls might not know: Most ladies who get breast most cancers don’t have a genetic predisposition. Mammograms don’t detect all cancers. A person threat evaluation — which Munn’s OB/GYN physician really useful — can level to the necessity for added testing to search out tumors mammograms have missed.
Munn, 43, recognized 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 generally known as luminal B regardless of having a standard mammogram and testing detrimental on a genetic take a look at that she mentioned checked for 90 totally different most cancers genes.
Her physician did a person threat evaluation, discovering Munn’s lifetime threat was 37%, thought-about very excessive, and referred her to extra intensive testing, which detected most cancers in each breasts.
Munn mentioned in a sequence of Instagram posts that she initially saved her analysis personal, explaining, “I wanted to catch my breath and get by way of a number of the hardest components earlier than sharing.” She lauds her OB/GYN, Thais Aliabadi, MD, who determined to calculate the chance rating. “The truth that she did saved my life,” Munn wrote.
Munn’s preventing spirit and constructive perspective 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 accomplice with whom she shares a 2-year-old son. He researched therapies and drugs and posted photos bedside of their son.
Munn thanked her medical doctors and different employees at Cedars-Sinai Medical Heart in Los Angeles and Windfall Saint John’s Well being Heart 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 mentioned the actress isn’t doing interviews at the moment. 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,” mentioned 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 therapy.
“Solely 5 to 10% of people that get breast most cancers have a gene that exams 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 therapy in circumstances just 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 mentioned. Luminal A has a greater prognosis and is simpler to deal with. Luminal B has a worse prognosis, she mentioned, and it’s generally dubbed B for “unhealthy.”
Luminal B “requires chemotherapy and if it recurs; it’s simply more durable. It stops responding to endocrine remedy or estrogen-blocking medicine and so we’ve got to make use of different therapies.”
Genomic testing helps medical doctors resolve if the luminal tumors are A or B kinds, she mentioned. The prognosis for luminal B cancers can nonetheless be good, Johnson mentioned.
Past Mammograms
“Mammograms aren’t excellent,” Johnson mentioned. The screening can particularly miss cancers in breasts with dense tissue as a result of the cancers don’t present up as nicely 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 keeping with the CDC. The mammogram report might embody details about whether or not breast density is excessive or low.
If breasts are dense, an ultrasound or breast MRI can be good supplementary exams, Johnson mentioned.
Despite the fact that mammograms miss some cancers, Johnson urges ladies to bear the exams as really useful. The U.S. Preventive Providers Job Pressure, in its draft suggestion, requires mammograms starting at age 40 and repeated each different 12 months.
Even when mammogram outcomes present no proof of most cancers, if a girl feels one thing uncommon in her breasts, it’s time to return to the physician and ask about additional testing, Johnson mentioned.
An MRI is commonly finished in ladies as younger as Munn, Mortimer mentioned, if they’re recognized to have dense breasts or a household historical past, each recognized to boost breast most cancers threat. “In somebody with a household historical past, we alternate MRIs with mammograms to extend the probabilities of detection,” she mentioned.
Particular person Assessments
In her Instagram posts, Munn praises her OB/GYN for suggesting a person threat evaluation. “Dr. [Thais] Aliabadi checked out components like my age, familial breast most cancers historical past, and the truth that I had my first little one after the age of 30,” Munn wrote on Instagram. “She found my lifetime threat 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 threat evaluation is on the Nationwide Most cancers Institute web site. 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 analysis, age at first menstrual interval, age when first little one was born (over 30 raises threat), and first-degree kin (your mother and father, sibling, or little one) with breast most cancers.
From that, it predicts a 5-year threat and a lifetime threat of creating breast most cancers, evaluating the affected person’s threat with the typical threat of the inhabitants.
For example, a 43-year-old White lady 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 threat of breast most cancers, barely above the typical threat of 12.1%.
Therapy Choices
Apart from the kind of tumor detected, components equivalent to lymph node involvement drive therapy choices, Johnson and Mortimer mentioned.
For a younger lady with luminal B breast most cancers, the standard routine can be surgical procedure, chemotherapy, and estrogen-blocking remedy. “The luminal B prognosis continues to be good should you do the chemo in addition to the endocrine remedy.” Johnson mentioned.
Fashions can assess survival charges if the therapy consists of chemotherapy or doesn’t, Johnson mentioned, serving to ladies to make their very own choices.
Mortimer known as Munn’s OB/GYN “fairly wonderful” to recommend the chance calculator and take motion, discovering the tumor a lot sooner than the subsequent scheduled mammogram would have.