Men ordinarily don’t like writing about women’s breasts, but I had so many emails asking me why Angelina Jolie decided to part with hers that I felt we had better take a look.
Where better to start than with her own words? In the New York Times (D—though they are so far in cahoots with that party we could easily write ‘DD’) in a piece called “My Medical Choice“, after informing us that her mother died from cancer, she said:
[T]he 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.
If a woman has this variant of the BRCA gene, observations suggest she has a higher risk of breast or ovarian cancer than woman who do not. Jolie informs us that this risk is 65%. But then she tells us that her risk is 87%. Not 86% or 88%, but 87%, a number which is suspiciously precise.
Jolie’s medical history (“her reality”) is different than the “average” woman’s, and generally those with cancer in the family line also have higher risk. And she may possess other traits which led her doctor to tell her she had an “87% chance” of breast cancer. This number is scarcely believable in its precision and hints some mathematical model was employed. Stating numbers with unfounded exactness leads to over-confidence, and that makes for weaker decisions.
These numbers are also lifetime risk; that is, the chance of developing these cancers by the time a lady dies. They are not, for instance, the chance the woman will develop cancer (say) next year: that chance would be much lower.
Lifetime risks are very tricky to interpret (and vary by disease). The day-by-day, or year-by-year, risk is not constant, but increases through time, gradually at first and then more rapidly later. Think of the difference in risk (still assuming the female with this variant of the BRCA) between a 13-year-old and a 70-year-old; obviously, the latter has much higher risk. Jolie is 38, an age which is not considered to be especially dangerous (for “average” women).
Everybody dies. Therefore, Jolie will die of something. Might be cancer, might be a worn-out heart, or by apoplexy brought on by reading the NYT. Jolie will not now die from breast cancer (almost certainly), though she might exit via ovarian cancer—or maybe by some other cancer (colon, skin, pancreatic, etc.). Her liver might fail or she may stroke out. Anyway, she will die, though she may (only may) live longer and then dye from something else. All she has done, then, was to remove one of these many, many choices of death.
And then even if she developed breast cancer, it was not certain she would have died from it. Breast cancer is in many cases curable; sometimes by mastectomy. In other words, she could have sweat it out and then gone to the docs when and if she ever developed symptoms. She could have kept her attributes for a longer time, or even until death. But the cancer, assuming she got it, also could have killed her (instead of something else).
Point is: the decision to undergo this most painful and prolonged sequence of procedures is not as simple as noticing you have this variant of BRCA and traipsing down to the two-holed guillotine. The surgery itself has risks: doctors make mistakes, infections sneak in, though rarely. A young woman’s looks—a thing of utmost importance to women—have been forever lessened, though the replacement fakes are looking better all the time. Gone too is the possibility of breast feeding. This is not, and should not be, an easy choice.
It was an easy forecast to say that the legion of women who follow the lives of celebrities, after hearing the news yesterday, would mount their horses and ride immediately to their doctors and ask whether they should have their breasts removed, too. Jolie’s very public announcement was the hyper-equivalent of the pharmaceutical ad which ends “Ask your doctor is sassaffrassium is right for you.” It always is, particularly if the doctor does not enjoy being harangued.
The New York Post (R) reported:
City oncologists yesterday were flooded with calls about genetic screening and the kind of preventative double mastectomy Angelina Jolie revealed she underwent after testing positive for a gene mutation that indicates a likelihood of breast and ovarian cancer.
“This morning, I got two phone calls from women who had tested positive for the BRCA mutation in the past but had not decided to go forward with the surgery yet,” said Dr. Deborah Axelrod, 55, a top breast-cancer expert at NYU’s Langone Medical Center
“They said they wanted to now because they had read the Angelina Jolie article,” said Axelrod…
Ladies, before you head to the hospital, recall the existence of false positives. These are instances where a goof has been made or when a test is not precise. The screening for the BRCA1 variant is imperfect, and so too are screenings for breast cancer itself. You could be told you have the BRCA1 when you do not, and that you have breast cancer when you do not. See this Decision Calculator for more details. (Incidentally, only about 5-10% of breast cancers have this variant; slightly higher in women with ovarian cancer).
Too often, the possibility that “I might die from breast cancer” overwhelms all other knowledge, particularly is all that is talked about is the surgery and the good that can come from it. But there is a chance bad can come from surgery, most egregiously in cases where nothing was really wrong. And there is also good that can come from doing nothing save having frequent checkups. Do not rush to judgment.
We only hit the highlights here; many details were ignored because of space. For example, we didn’t get to cover Jolie’s “holistic doctors”, a term which is might be overheard on Duck Dynasty. More another time.