Angelina Jolie and I started a revolution — and it’s not over yet

The doctor who treated Angelina Jolie when she chose to have a double mastectomy in 2014 is among a group of advocates urging for reform to Australia’s ‘backwards’ approach to breast cancer screening.

Angelina Jolie’s surgeon Kristi Funk urges more screening in Australia for the BRCA breast cancer gene.

It was more than 11 years ago that my patient Angelina Jolie – a carrier of the BRCA gene mutation – provided me with an opportunity to save thousands of lives.

As this brave woman and I prepared for surgery to remove her breasts, I already had an inkling that this moment could start a revolution in women’s health. And so it came to be. Merely weeks after her final operation, Ms Jolie shared her story in an extraordinary opinion piece in The New York Times. Millions of women around the world who had never heard of the BRCA gene became aware that this mutation links to devastatingly early deaths in generation upon generation of affected families – and knowing about it could be the key to saving their lives and those of their children.

The BRCA gene mutations significantly increase the likelihood of developing cancer, with carriers facing up to an 87 per cent lifetime risk of breast cancer and up to a 50 per cent risk of ovarian cancer. These gene variants, BRCA1 and BRCA2, also elevate risks of pancreatic cancer and melanoma in both sexes, and prostate cancer in men, making their impact far-reaching across genders and cancer types.

Actor Angelina Jolie in London in 2013, the year of her mastectomy surgery. Picture: Oli Scarff/Getty

Since Ms Jolie – who later also had her ovaries removed – brought prominence to the BRCA gene variants, millions of women around the world have been screened for the mutations. When detected as carriers, these women have the opportunity to choose preventive action to avoid cancer, which is otherwise highly likely to develop.

It’s an extraordinary legacy for a Hollywood actor and humanitarian – one that extends far beyond the spotlight. I am proud to continue this mission through the work of my breast centre, Pink Lotus, and in collaboration with Australian advocacy powerhouse Krystal Barter, founder of Humanise Health. This global partnership testifies to the power of collective advocacy in transforming hereditary health awareness and creating a future where prevention is prioritised.

Advocate Krystal Barter was diagnosed with the BRCA gene mutation when her second child was just one year old and now leads a national push for access to genomic medicine. Picture: Nikki Short

Yet I feel our legacy remains incomplete and more work is needed. In the US, many women with BRCA1 or BRCA2 mutations remain unaware of their risk due to under-utilised genetic testing. In Australia, as many as nine in 10 BRCA mutation carriers do not know their status.

This lack of awareness prevents countless individuals from taking proactive, potentially lifesaving steps. It underscores the urgent need for greater access to genetic screening and education to ensure no one is left in the dark.

Women with a strong family history may access publicly funded BRCA genetic testing, including cascade testing for relatives. However, for the majority, access to such critical preventive measures often comes too late – only after a cancer diagnosis. This fairly backwards approach forms the core of Australia’s public health policy regarding breast cancer screening.

This policy gap is both frustrating and disheartening. Dr Mary-Claire King, who first identified the BRCA1 gene mutation, encapsulates this frustration perfectly: “I will not be satisfied until genetic screening for BRCA1 and BRCA2 is offered to all young women, regardless of family history of cancer.”

Thirty-five years after Dr King’s discovery, her words still resonate. That such a monumental breakthrough in genetic science remains under-utilised in preventive care is staggering. It’s a missed opportunity to save countless lives, and one we can no longer afford to ignore.

Population-based genetic screening presents significant complexities, including the need for robust data infrastructure, stringent security measures, and thoughtful consent protocols. It is equally critical to ensure that individuals are not burdened with genetic information that lacks actionable steps for prevention or treatment, as this could lead to unnecessary anxiety without any clear benefit.

However, the time for caution to turn into action is long overdue. Governments worldwide – including Australia – must recognise that every month genomic screening and personalised medicine remain sidelined from the top of the national health agenda, lives are needlessly lost. Elevating these tools is not just an opportunity; it activates an urgent responsibility to harness science and save lives.

Currently, only 2 to 3 per cent of government healthcare budgets globally are allocated to prevention – a glaring oversight in the face of what we know about risk reduction and early intervention. Prevention is no longer a vague concept; it overflows with deeply personal opportunities to control one’s health destiny. For BRCA mutation carriers, risk reduction encompasses education and interventions involving breast density, genetic risk factors, nutrition, lifestyle, environmental exposures and proactive health decisions. When we know better, we can do better.

Angelina Jolie captured this urgency perfectly in her op-ed: “The truth is, I carry a ‘faulty’ gene, and I will not passively watch as it strikes. I choose to act.”

Now, we must demand that governments and healthcare systems worldwide act as well – placing prevention where it belongs: at the heart of the health agenda.

Kristi Funk is a breast cancer surgeon, author, speaker and women’s health advocate based in California.