Angelina Jolie’s Decision


by Diana Zuckerman, PhD, president of the Cancer Prevention and Treatment Fund

When I read about Angelina Jolie’s announcement this week, I cringed.

I have greatly admired her willingness to speak out on important issues over the years. Her public announcement about her mastectomies will certainly reassure some women that losing a breast to breast cancer isn’t quite as frightening as it had once seemed. But Ms. Jolie is a powerful role model to millions of women. What are the unintended consequences of the role she is modeling regarding breast cancer?

Is breast cancer so frightening that it is better for a woman to remove her breasts before she is even diagnosed? Obviously, that isn’t what Ms. Jolie is saying. She has one of the breast cancer genes (BRCA1), and that greatly increases her chances of getting breast cancer.

However, the extremely high risk that she quoted from her doctor (87 percent chance of getting breast cancer) was based on old, small studies. Newer studies have found that the risk of getting breast cancer for an average woman with BRCA1 is 65 percent. Since being overweight and smoking increase the risk and exercising and breastfeeding lower the risk, Ms. Jolie’s risk of breast cancer, even with the BRCA1 gene, could be considerably lower.

Of course, the lifetime risk of breast cancer would still be high, but it wouldn’t be nearly as high a risk during the next 10 years or even 20 years. According to experts, a 40-year-old woman with the BRCA1 gene has a 16 percent chance of getting breast cancer before she turns 50. That’s not nearly as frightening, and with regular screening and all the progress in breast cancer treatments, the survival rate from breast cancer is higher than ever. Many breast cancer patients live long and healthy lives. And, it is possible that by the time Ms. Jolie (or any other woman with BRCA1) got breast cancer in the future—if she ever did—the treatments available would be even more effective than they are today.

Thanks to mammograms, women are getting diagnosed with breast cancer at much earlier stages, making it safe to undergo a lumpectomy (which removes just the cancer) rather than a mastectomy (which removes the entire breast). And yet, American women are undergoing mastectomies at a higher rate than women in other countries—many of them medically unnecessary. Breast cancer experts believe that many women undergoing mastectomies don’t need them and are getting them out of fear, not because of the real risks.

As an actress whose appeal has focused on her beauty, surgically removing both her breasts when she didn’t have cancer was a very gutsy thing to do. But if we care about women’s health, we need to stop thinking of mastectomy as the “brave” choice and understand that the risks and benefits of mastectomy are different for every woman with cancer or the risk of cancer. In breast cancer, any reasonable treatment choice is the brave choice.

Nobody can second-guess Angelina Jolie’s choice—it’s hers alone to make. Fortunately for her, she has access to the best reconstructive surgeons in the country, and they will keep her breasts looking as natural and beautiful as possible, an advantage that most implant patients don’t have. If she has any of the common problems with her breast implants, she can afford to get those problems surgically fixed whenever she wants to. She can also afford breast MRIs every other year ($2,000 each), which the Food and Drug Administration recommends as a way to make sure that the silicone from the implants is not leaking into the lymph nodes.

Angelina Jolie is not in any way an average woman, and what felt right for Angelina Jolie might not be right for most women who are afraid of getting breast cancer, and not even for most women with the BRCA1 or BRCA2 gene.

I thank Ms. Jolie for speaking up about her decision, and I thank the many cancer experts who are doing their best this week to explain why double mastectomies are not the best choice for most women. Let’s use this teachable moment to have a frank discussion of the treatment choices for breast cancer and to encourage women to make decisions based on their own situations, not on the choice of a celebrity, however admirable she is. For each woman, it’s important to weigh her own risk of cancer—in the next few years, and not just over her lifetime—and the risks of various treatments, and to make the decision that is best for her.

 

Diana Zuckerman is the president of the National Research Center for Women & Families and the Cancer Prevention and Treatment Fund. She received her PhD in psychology from Ohio State University and was a post-doctoral fellow in epidemiology and public health at Yale Medical School.  After serving on the faculty of Vassar and Yale and as a researcher at Harvard, Dr. Zuckerman spent a dozen years as a health policy expert in the U.S. Congress and  a senior policy adviser in the Clinton White House.  She is the author of five books, several book chapters, and dozens of articles in medical and academic journals, and in newspapers across the country

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13 Responses to Angelina Jolie’s Decision

  1. Julia Maria daSilva May 16, 2013 at 1:16 pm #

    Thanks for the information . Very useful.

  2. Yen May 16, 2013 at 10:27 pm #

    I agree with you completely. I hope this article gets to more women so that they have good info for their choices that are not just celebrity based

  3. Lara May 22, 2013 at 10:40 am #

    I support her decision wholeheartedly and would do the same in a heartbeat, in her shoes. She watched her mother die of this awful disease at a young age and would do anything in her power not to have the same experience happen to her kids. That’s a very powerful motivation to reduce your risk from “?” to zero point zero!

  4. Shira Nahari May 22, 2013 at 11:03 am #

    Marie, you write “Thanks to mammograms, women are getting diagnosed with breast cancer at much earlier stages,” You have missed a sterling opportunity to point out that “thanks to mammograms women are getting MISdiagnosed by the thousands., resulting in unnecessary mutilation, extreme exposure to harmful X-rays, and expense.” The jury is in on the topic. There are far safer and more accurate tests, magnetic resonance imaging heading the list.

  5. Shira Nahari May 22, 2013 at 11:05 am #

    Correction: Sorry, I mean Diana, not Marie.

  6. iola May 22, 2013 at 12:05 pm #

    Mammorgrams???? not a fan, ultra sound, ideally MRI, which only a few can afford at this time. I also don’t believe in the numbers game, just a deep intuitive thing about medical studies sorry, as the buddists say, the only constant is change, with that, who’s to imagine what will develop or make it’s way to our awareness in regards to healing our fears and finding less invasive ways of protecting our womanly parts….I would love to share the DVD by Sat Dharam Kaur N.D. called A CALL TO WOMEN, Healthy Breast Kundalini Yoga and Rebounding… one must listen to their own inner guidance in the end…
    blessings :)

  7. Holly May 22, 2013 at 10:07 pm #

    I am 51. I had a mastectomy at 31. I have had 20 cancer free years and pray for 3O more. She faced something I pray most never have to and made the decision she felt was right for her. No judgement needed.

  8. dk May 26, 2013 at 1:51 pm #

    I feel this is all wrong in so many ways. But what do I know I’m just a guy and I don’t have breast. Wait, do I? I do have X chromosones. I’ll guess I’ll just call them pecs. Guys, can have this BRCA1 mutation and can also get breast cancer. Do I have it? I don’t know and I do not care to know. I’m not going to cut off my nose to spite my face anymore then cut off my breast (pecs) to spite a possible cancer. There are so many natural ways to cure cancer, (if you have done your homework), but it will not be cured by the medical establishment anytime soon as long as it is a multi-(multi) billion dollar business, and that is just in donations alone. Now add hospital, doctor and drug cost and the cancer business is $taggering.

  9. dk May 26, 2013 at 2:35 pm #

    I forgot to mention in my last comment; that Nobel Laureate Dr. Otto Warburg (for his studies in cancer) was quoted in saying in 1969 Hanburg, Germany, in front of his peers, “When society is ready to cure cancer, they will”. What does that tell you about cancer being a big money business?
    I have to agree with Shira Nahari in part and iola in full, and not with you Diana Zuckerman (though I love your past writings) that Mammorgrams are as old as high button shoes and whale bone body corsets and should have gone the way of blood leeching and frontal lobotomies.
    For one thing they miss over 89% of anything they are looking for. Another reason is the radiation they produce and just exacerabetes any cancers problems from yearly check ups. Thirdly, putting one’s breast in a vice can easily rupture a cancerous tumor and cause it to spread. Who wants that?
    Solution, “ultra sound”, less invasive from a health perspective and does a 99.8 % detection job.
    Better solution, Mustard Seed family to prevent and cure. Mustard seeds are from the mustard plant, which belongs to the Cruciferous plant family. That family consist of Broccoli, Cauliflower, Cabbage, Brussel Sprouts. At least one of them once a week should help.

  10. dk May 26, 2013 at 2:57 pm #

    More alternatives than removing one’s breast. Naturally one has to get off of all simple sugars and simple carbohydrates, since cancer thrives on it.
    There is a banana tasting fruit that grows wild and domestic in the SouthEastern United States that will cure all cancers and is 40 times more potent than Graviola. That fruit is Paw Paw. How come we don’t see it at the market?; Oh, it cures cancer…can’t have that!
    Graviola was tested for 10 years by a top cancer drug company and proved positive for curing all cancers, but they could not synthesize it. Natural products cannot be sold as a drug, no drug, no $$.
    Just like apricot seed, aka laetril, aka B-17.
    Here is an interesting fact to ponder about apricot seeds; The FDA (whereas the US Government is now in the drug business) says that Apricots has cyanide and it shouldn’t be used…so here goes, Laetril, vitamin B17 is a natural cyanide-containing compound that gives up its cyanide content only in the presence of a particular enzyme group called beta glucosidase or glucuronidase. Miraculously, this enzyme group is found almost exclusively in cancer cells. If found elsewhere in the body, it is accompanied by greater quantities of another enzyme, rhodanese, which has the ability to disable the cyanide and convert it into completely harmless substances. Cancer tissues do not have this protecting enzyme.
    So, if you did not quite understand the first part, (like I first did) hopefully this will explain it better; according to past scientific knowledge, cancer cells are faced with a double threat: the presence of one enzyme exposing them to cyanide, while the absence of another enzyme found in all other normal cells results in the cancer’s failure to detoxify itself. Leave it to nature to provide a form of cyanide that can naturally destroy a cancer cell. The cancer cells that are unable to withstand the cyanide are destroyed, while the non-cancerous cells are not threatened by the cyanide, and, therefore, remain unharmed. Never underestimate the body’s potential!
    Yes, Apricot seeds can be purchased on the net, and unlike almond seeds (thanks to the FDA) are not pasterized (destroying all the natural enzymes and other nutrients) have a pleasant sweet taste and make a wonderful snack.
    Oh, almost forgot, other foods with laetrile; (the FDA as hard as they try, can’t get them all), Watercress, Spinach, Bamboo sprouts, Alfalfa sprouts, Lentil sprouts, Whole nuts, Mung bean sprouts, Ground nuts, Garbanzo sprouts, and Apple seeds.
    Good eating and good Health!

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  12. Breast Cancer August 19, 2014 at 5:06 pm #

    I assist her decision totally and would do the exact same in a heart beat, in her shoes. She saw her mom die of this dreadful condition at a youthful age and would certainly do anything in her power not to have the exact same encounter take place to her children. That’s a really highly effective inspiration to minimize your threat from.

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