《我的医疗决定》——安吉丽娜·朱莉

当地时间2013年5月14日，美国，据报道，安吉丽娜·朱莉（Angelina Jolie）向外界透露她在不久之前已经完成预防性的乳腺切除手术。

现年37岁，已是6个孩子母亲的朱莉称，她的母亲与癌症搏斗了近十年，于2007年死于卵巢癌，享年56岁。医生测试出朱莉带有一个“缺陷”基因BRCA1，大大增加她患乳腺癌和卵巢癌的风险。于是为了预防可能的风险，她决定接受九周的复杂手术，切除双侧乳腺。从今年2月份开始直至4月27日，她的双侧乳腺已经全部切除。目前，她患乳腺癌的几率已经从87%下降到5%。

朱莉表示，她感激她的伴侣布拉德·皮特在这整个过程中对她的爱和支持，并且她确信这对她的孩子们没有带来任何负面影响。“更何况我的选择并没有让我丧失女人味，这让我倍受鼓舞。”朱莉说。她还鼓励每个有乳腺癌或卵巢癌家族史的女性，都能寻求医生的帮助，做出对自己最明智的选择。

安吉丽娜朱莉是联合国特别使者之一，支持人权事业。在整个手术过程中，为了唤起大家对性暴力的意识，她还和英国外交部秘书长一同前往了刚果共和国，参加了G8论坛。

同时，朱莉还帮助筹集善款在巴基斯坦建立女子学校。

2月2日：在经历预防性双乳切除术之前，安吉丽娜开始了3个月的治疗过程，通过“乳头延迟”开始，这是要排除在乳头后面有可能出现的乳腺导管疾病，同时可以吸引更多的血液流向该区域

2月16日，安吉丽娜经历了长达8小时的大手术，先切除乳房组织，然后再进行填充

3月26日：在最初的手术过后，安吉丽娜现身刚果与威廉·黑格合影

4月4日：安吉丽娜在纽约出席世界妇女首脑大会，精神状态非常不错

4月11日：安吉丽娜在伦敦的八国集团首脑会议上与威廉·黑格合影

4月20日：安吉丽娜完成了乳房植入物重建的最后一次手术

4月27日：这位6个孩子的母亲完成了整个医疗过程，她被告知手术是成功的，她罹患乳腺癌的机会已经从87%下降到不足5%

5月14日：安吉丽娜通过《纽约时报》发表文章，公开了自己的决定

译文来自和菜头公众微信

我母亲和癌症抗争近十年，56岁时逝世。她强撑着，一直撑到自己第一对双胞胎外孙出世，撑到可以拥抱他们入怀。但是，我其它的孩子却再也不可能有机会见到外婆，再也不能知道外婆是怎样的和蔼可亲。

我和孩子们经常说起“妈咪的妈咪”，每当这时候我发现我会试着向孩子们解释那种把外婆带走的疾病。他们则会问我，我会不会也被相同的病带走？我总告诉他们说别担心，可事实上，我自身携带了一种“错误”的基因---BRCA1，这种基因极度地提高了我罹患乳腺癌和卵巢癌的可能。

我的医生估算过，我有87%的几率罹患乳腺癌，50%的几率罹患卵巢癌。但是，（携带这种基因）的妇女罹患癌症的风险有个体差异，并不相同。

只有一部分乳腺癌是因为遗传性基因缺陷造成，平均下来，携带BRCA1的女性有65%的可能罹患乳腺癌。

一旦我知道身处的现实状况，我决定先发制人，把可能的风险降低至最小。我决定做一次预防性的双侧乳腺切除手术。因为我的乳腺癌几率高于卵巢癌，而且手术更为复杂，所以第一步我从胸部开始。

4月27日，我结束了为期三个月针对乳腺的外科手术治疗。在这一时期，手术的事情对外秘而不宣，我同时也在继续开展自己的工作。

但是，为了有更多妇女可以从我的经历中获益，我现在要把这一切写出来。时至今日，“癌症”这个字眼依然让人心生恐惧，催生无力。可是今天我们可以通过血液筛查，判定你是否有很高概率罹患乳腺癌和卵巢癌，然后我们可以采取措施。

我自己的这一医治过程始于2月2日，以一个叫做“Nipple Delay”手术开始。手术切除了乳头后面的乳腺导管，吸引更多的血液留到这个区域。这会引起一些疼痛和很多瘀青，但是能更大可能的保住乳头。

两周以后，做了一次大型手术。切除了乳腺组织，然后用临时填充物填补起来。手术持续了8个小时，等醒来的时候，你会发现胸上插满了导管和扩张器。这感觉就像是自己身在科幻电影里的一幕。不过，手术后几天你就可以恢复正常的生活了。

9个星期以后，随着用假体填充，重塑胸部，最后一个手术完成了。最近这几年里，这种手术取得了许多进展，结果堪称惊艳。

我写这篇文章是想告诉其他女性，决定去做双侧乳腺切除手术并不容易。但是这个决定却是我非常乐意去的。因为我未来罹患乳腺癌的几率从先前的87%下降至不到5%。我现在可以让孩子们别再担心乳腺癌会夺走妈妈。

让我宽慰的是，手术结束之后，孩子们不会看到任何让他们不舒服的地方。他们会看见一道小疤痕，那就是全部了。除了它，一切都还是原来的那个妈咪，她和过去一 模一样。他们知道我爱他们，妈妈会为了尽可能久地陪伴在他们身边而去做任何事情。就个人而言，我不觉得自己失去了任何女人味，我感觉我所做的坚强选择在哪 一方面都没有减少我的女性特质。

我非常幸运地拥有一位伴侣：布拉德.皮特。他是那么的爱我，那么的支持我。所以，所有那些有女友或者太太将要经历这一切的男人，你们要知道自己在这个过程里非常重要。布拉德一直呆在我接受治疗的Pink Lotus Breast Center医院里，在手术过程的每一分钟里他都在。我们努力找到可以彼此调笑的片刻时光，我们知道这是为了我们自己的家庭所做的正确的事情，这一切会把我们拉得更近。最后事实也正是如此。

对于那些读到这篇文章的女性，我希望这篇文章能让你知道：你有选择。我想鼓励每一位女性，特别是那些有乳腺癌和卵巢癌家族遗传史的女性，你们应该去寻找相关的资讯，和能够帮助你们了解这种人生隐患的医学专家。在充分了解的前提下，做出你自己的决定。

我得知现在有许多全方位医疗流派的医生在为了手术替代治疗方法而努力工作，我自己的调养方法也会在Pink Lotus Breast Center医院的网站上定期刊载。我希望这些能够帮助到其他女性。

根据世界卫生组织统计，单是乳腺癌每年造成45万8000人死亡，这些人大多数分布在中低收入国家。无论贫富和背景，不管她们在那里，我们必须提高优先级以保证更多妇女能够得到基因检测和挽救生命的预防性治疗。针对BRCA1和BRCA2的基因测试费用在美国超过3000美金，这是无数女性现在获得这一检测的最大障碍。

我选择公开我的私事是因为太多妇女根本不知道自己可能生活在癌症的阴影之下。我希望她们也能和我一样得到基因检测的机会，如果她们中有人也有罹患癌症的高风险，也能够知道知道自己拥有选择。

生命总是伴随无数挑战，唯有那些我们可以承担和掌控的挑战，才不会让我们心生恐惧。

朱莉《纽约时报》发表原文

My Medical Choice

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 option

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.