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 adverse genetic exams — have 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 girls to coach themselves in regards to the illness and the significance of acceptable screening exams.
Munn’s expertise reveals some truths that ladies 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 helpful — can level to the necessity for added testing to search out tumors mammograms have missed.
Munn, 43, recognized for her work on The Every 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 often known as luminal B regardless of having a standard mammogram and testing adverse on a genetic check 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 prognosis non-public, 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 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 therapies and drugs and posted footage bedside of their son.
Munn thanked her medical doctors and different workers 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 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 Techniques 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 Girls’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 typically about breast most cancers therapy in instances 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 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 medication and so now we have to make use of different therapies.”
Genomic testing helps medical doctors resolve if the luminal tumors are A or B varieties, 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 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 girls age 40 and above have dense breasts, based on 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.
Though mammograms miss some cancers, Johnson urges girls to bear the exams as really helpful. The U.S. Preventive Providers Activity Power, in its draft advice, requires mammograms starting at age 40 and repeated each different 12 months.
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 mentioned.
An MRI is usually accomplished in girls 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 elements 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 prognosis, age at first menstrual interval, age when first little one was born (over 30 raises threat), and first-degree family members (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 family members 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, elements equivalent to lymph node involvement drive therapy selections, 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 in case you do the chemo in addition to the endocrine remedy.” Johnson mentioned.
Fashions can assess survival charges if the therapy contains chemotherapy or doesn’t, Johnson mentioned, serving to girls to make their very own selections.
Mortimer referred to as Munn’s OB/GYN “fairly wonderful” to counsel the chance calculator and take motion, discovering the tumor a lot sooner than the subsequent scheduled mammogram would have.
