April 21, 2024

Jolie’s Choice

Hollywood celebrity Angelina Jolie was hailed this week for her bravery in revealing that she has had a preventative double mastectomy.

Hollywood celebrity Angelina Jolie was hailed this week for her bravery in revealing that she has had a preventative double mastectomy. The New York Times published her explanation as a scoop on its op-ed page:

“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.”

Susceptibility to breast and ovarian cancer runs in Jolie’s family. Her mother died at 56 of breast cancer and she carries the BRCA1 gene. Doctors told her that she had an 87% chance of contracting breast cancer. After the operation, she said, the risk is now only 5%.

The news was reported widely, so widely and extensively that columnist Brendan O’Neill, of Spiked, complained that it had overshadowed “everything from the savagery in Syria to the tussle over the future of the EU”.

Will the publicity help breast cancer sufferers? Daily Mail columnist Amanda Platell criticised Jolie for making the difficult and exhausting surgery seem too easy. Her doctor at the Pink Lotus Breast Center in Beverly Hills posted the whole procedure on her blog. It was staged over three months and it takes many weeks to recover. However, the doctor said that Jolie was filled with “bountiful energy”, worked hard on directing another film and took time out to visit the Congo to highlight violence against women.

“To imply, as she has done, that it is possible to bounce back in a few days places an unfair burden on those women who struggle physically and mentally in the aftermath of such major and life-changing surgery.”

There was a political edge to her essay as well. It appeared to be an attempt to influence the US Supreme Court to rule against Myriad Genetics’s patents on the BRCA 1 and 2 genes.

“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.”

Media coverage, though, hardly scratched the surface of the complex ethical issues involved in Jolie’s decision to remove both breasts even though were no signs of cancer. According to the US government’s National Cancer Institute, “preventive mastectomy should be considered in the context of each woman’s unique risk factors and her level of concern.” In other words, worry itself is a factor. Many women with the BRCA gene fret so much about their future that they come to think that a mastectomy is the only solution. But there are other options, like frequent surveillance from an early age.

In fact, one study from the University of Michigan has shown that nearly three-quarters of women who decided to have one breast removed were actually at very little risk of developing cancer in the healthy breast. They were driven more by fear than by good medical reasons.

Jolie has had a very difficult personal history with a number of partners, including a lesbian relationship, estrangement from her father, adopting as a single parent, global fame as the world’s most beautiful woman, and intense scrutiny of her personal life by the media. Her case is obviously unique. While it is clear that she is brave and determined, it is far from clear that other women should take her as a role model.

Michael Cook
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breast cancer gene
prophylatic mastectomy