Her Breasts, Her Choice

Women in the World Summit 2013

Yesterday, Angelina Jolie revealed that she had a preventive double mastectomy. A genetic test found that she carries a BRCA gene, which greatly increases the chances of breast cancer:

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.

Rebecca Mead applauds:

Jolie’s medical decision says again what shouldn’t need re-saying: that a woman’s body is hers, that breasts are for something other than ogling, and that hard choices are made for strong reasons. Her decision to make her choice public is bold and brave and admirable. It is what celebrity is for.

Aaron Carroll emphasizes that these types of medical decisions are highly personal:

[E]ven a preventive mastectomy is not a guarantee against cancer. Studies show that it’s about 90% effective in preventing breast cancer in moderate and high-risk women. That still leaves a 10% chance of developing cancer in the chest wall, armpit or even in the abdomen. That’s because it’s pretty much impossible for even the best surgeon to remove all breast tissue from a woman.

Because of this, some women choose not to have the procedure done, even when they are at high risk. Just a few weeks ago, Peggy Orenstein wrote a compelling account of her decision not to undergo the procedure after her first brush with breast cancer. Her reasons are just as valid and important as Jolie’s but may not make the same splash in our national discussion.

Elaine Schattner is on the same page:

I know physi­cians who’ve chosen, as did the celebrity, to have mas­tec­tomies upon finding out they carry BRCA muta­tions.

And I’ve known “ordinary” women—moms, home­makers, librarians (that’s fig­u­rative, I’m just pulling a stereotype) who’ve elected to keep their breasts and take their chances with close monitoring. I’ve known some women who have, perhaps rashly, chosen to ignore their risk and do nothing at all. At that opposite extreme, a woman might be so afraid, ter­rified, of finding cancer that she won’t even go to a doctor for a check-​​up, no less be tested, examined, or screened.

What’s great about this piece, and what’s wrong about it, is that it comes from an indi­vidual woman. Whether she’s made the right or wrong decision, neither I nor anyone can say for sure. Jolie’s essay reflects the dilemma of any person making a medical choice based on their cir­cum­stances, values, test results, and what information they’ve been given or oth­erwise found and interpreted.

Sarah Kliff notes that the BRCA test isn’t recommended for everyone:

The [U.S. Preventive Services Task Force (USPSTF)] recommended against widespread BRCA screening in 2005 and reiterated that stance in draft recommendations made last month. The task force gave widespread screenings a “D” grade, meaning that it would expect “no net benefit.”

“For women whose family history is not associated with an increased risk for potentially harmful mutations in the BRCA1 or BRCA2 genes,” the task force wrote, “there is moderate certainty that the net benefit of testing for potentially harmful mutations in the BRCA1 or BRCA2 genes and early intervention ranges from minimal to potentially harmful.”

Florence Williams explains why she didn’t get tested for BRCA:

Both my counselor and I thought I should get tested for the BRCA genes, but my insurance carrier firmly disagreed. At over $3,000, Myriad’s test is too expensive for me and most other women to get, regardless of what they and their doctors may think.

So why didn’t I just cough up the money? Isn’t my health and life worth it? A couple of reasons. For one thing, I learned that our fear of breast cancer is clouded by misconceptions. We tend to think of breast cancer as a heritable disease, but in the vast majority of cases, it’s not. Straight hereditary factors only account for about 10 percent of all breast cancers. And while the BRCA genes are the well-known poster children of risk,  they get more credit than they deserve. In families with histories of breast and ovarian cancer, about half do not have BRCA mutations at all.

Claudia Wallis shares her experience with the BRCA test:

The news was good: I did not carry the mutation. I wept with relief. But then the counselor told me that I should not give too much weight to the finding.

My negative result “would be more meaningful,” she told me, if one or more first-degree relatives (a sister, mother, first cousin) tested positive for one of the BRCAs. Then I would have evidence that the familial cancer pattern was due to this particular genetic mutation. Without that knowledge, it could be that my family’s crazy burden of breast cancer was due to another gene defect—either a less common one that’s known to researchers or one that has yet to be discovered. Sigh.

This was in some ways the hardest news to deal with. How would I tell my two sisters that I wanted them to get tested, too—and that, if they turned out to be BRCA carriers, it would be bad for them but good for me?

Amanda Hess defends Jolie against misogynists:

Said one commenter on a Jezebel post about the op-ed, “How many guys stopped reading as soon as they realized Angelina Jolie has no breasts—she’s dead to me!”

I’d like to dismiss these commenters as trolls, but their attitudes are unfortunately pervasive in our culture, and they don’t just represent a personal affront to Angelina Jolie, a veteran of such inappropriate body commentary. These comments affect every woman who has undergone a similar procedure—every woman who has overcome the pain, the fear, and the constant and casual reminders that her breasts are more valuable than her life. Really, these comments affect all women who have seen their bodies reduced to mere objects for others to consume. As scholar of the stars Anne Helen Petersen says, “Remember: What we talk about when we talk about celebrities is, as ever, ourselves.” Some of us are not speaking very highly of the women in our lives today.

Alyssa hopes that Jolie won’t shy away from nude scenes in the future:

If Jolie has decided that she’s done with nude scenes or with sex scenes, that’s entirely her decision, and all of us should respect that. But if she does accept such roles in the future, I hope that she, and the writers and directors she works with, see her scars as a feature of her body, rather that some sort of grotesquerie to be hidden by shot angles or erased in post-production. Mastectomy scars should be treated like a physical characteristic that could inflect characters Jolie plays in the future without requiring major plot alterations or commentary. And it would be good for audiences, particularly of the kind that snarked on Jolie today for her brave revelation, to see that they don’t make her any less stunningly gorgeous.

And Michelle Cottle, who also recently had a double mastectomy, praises Jolie’s courage:

Whatever her acting gifts, Jolie would not have become the megastar/tabloid darling she is if she were not damn near every man’s fantasy. … By discussing her mammary travails so openly, Jolie runs the risk of messing with the fantasy. And for this reason, her willingness to go public with her surgeries strikes me as a genuine act of bravery—and one that will hopefully provide comfort and even inspiration to many women out there facing similar challenges.

After all, if Jolie can boldly and publicly trade-in such prime assets, what are the rest of us so anxious about?

(Photo: by Daniel Zuchnik/Getty Images)