Brian Edwards Media

On whether Angelina Jolie made the right decision to have a double mastectomy.

index

 

‘Absolutely heroic!’  That was Brad Pitt’s description of his wife Angelina Jolie’s decision to have a double mastectomy and subsequently to tell the world about it. I thought the description entirely apt. No one, least of all one of the world’s most famous and  glamorous movie stars, makes a decision like that lightly. And it is hard to imagine any woman deciding on such a drastic course of action without compelling cause.

That cause, in Jolie’s case, was that she had been diagnosed with the faulty BRCA1 gene, a common predictor of breast cancer and ovarian cancer. Her doctor put the risk of her developing breast cancer at 87 percent and of ovarian cancer at 50 percent. The assessment was in part based on hereditary factors. After a decade-long battle with cancer, her mother had succumbed to the disease at 56. Jolie is 37.

Last Wednesday the Herald republished a Telegraph Group story in which Jolie told of her reasons for having the double mastectomy, described the process in detail and explained her reasons for going public:

‘I wanted to write this to tell other women that the decision to have the 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.

‘On a personal note, I do not feel any less of a woman. I feel empowered that I made a strong choice that in no way diminishes my femininity.’   

Less impressed than me with Jolie’s actions was Weekend Herald columnist John Roughan whose piece ‘Genetic Risk Poses Dilemma’ effectively questioned whether Jolie had made the right decision to have a double mastectomy to prevent breast cancer.

I thought the question itself presumptuous. Only the  person facing a possible lingering death from cancer, or any other crippling disease, can decide whether a particular course of action is right for them or not.

In his column Roughan questioned the medical evidence behind Jolie’s decision and took issue with her expressed motivation in writing about her experience – ‘To any woman reading this I hope it helps you to know you have options.’  There were, he argued, other less drastic options.

But it was the chauvinistic and condemnatory tone of parts of Roughan’s piece that most concerned me:

‘Isn’t it a little disturbing that genetic science has caused Angelina Jolie to remove a perfectly fine pair of breasts…

‘Men too can inherit the BRCA2 mutation, increasing their risk of prostate cancer. I don’t know what I would do, but I hope I would choose to keep any organ for as long as it remained healthy. The idea of excising living tissue that has not yet let you down seems like a betrayal somehow, a premature surrender to what might never happen…

‘Angelina Jolie saw her mother die at age 56 after 10 years of treatment for breast cancer. Now she writes, “I can tell my children they don’t need to fear they will lose me.”

‘That is one less fear for them but her article did not mention whether they also carry the gene mutation. How sad if a girl or a boy should come to maturity regarding an organ of their developing sexuality as a death sentence unless they get rid of it. Sad and unnecessary.’

Reading these comments it seems to me that Roughan, a religious conservative, approaches the topic of Jolie’s ‘perfectly fine pair of breasts’ almost as if their removal were in the same category as an abortion: ‘disturbing, excising living tissue, a betrayal somehow, a premature surrender to what might never happen, a death sentence unless they get rid of it, sad and unnecessary.’

And the question as to whether Jolie made the right decision to have a double mastectomy to prevent breast cancer, has echoes at least of the question of whether the terminal cancer sufferer has the right to end his or her own life or to be assisted to do so. Those who oppose voluntary euthanasia argue the sanctity of human life; Roughan seems to argue the sanctity of human flesh.

Suffering and the fear of suffering and a premature death are central to such matters and it is my submission that any decision on the right course of action must ultimately rely first and foremost on the informed wishes of the person directly facing the dilemma. Courage comes easily to the unaffected.

, , ,

29 Comments:

  1. 1

    Angelina Jolie’s decision was the right one for her and her family. John Roughan is getting more and more shrewish. Maybe he needs a prostate check?

  2. Jolie showed great courage and practical action. Roughan demonstrated the limitations of a religious extremist. However the bigger question facing us all, is that we will soon be able to have advanced notice, of all sorts of predispositions to diseases and hereditary ailments. That is scary for us all.

  3. Roughan’s not had an opinion worth considering since the Beatles formed. His comment on this was pure boobie envy. A 12 year old could have come up with something more sophisticated.

  4. Jolie and Pitt have three biological children and three adopted children. So half of their family do not have to sorry at all about inheriting the gene from her.

  5. “any decision on the right course of action must ultimately rely first and foremost on the informed wishes of the person directly facing the dilemma. Courage comes easily to the unaffected.”
    Yes very true and its too easy for those of us unaffected to make judgement on another decision but…
    This was a very public decision made by a very public and famous person. Like it or not the opinions and actions of movie stars carry’s weight with many people. Jolie is quoted recommending the surgery option.

    It doesn’t take much looking to find the mutant BRCA1 gene problem is still early research based on limited studies.

    The National Cancer Institute report on BRCA1 and BRCA2 gene mutations carries a clear warning the estimates of risk do not have firm evidence behind them yet and may change.

    http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA

    Prophylactic Surgery is one of a few options, I wonder if it may be more useful to discuss the other options.

    I say when a individual’s decision becomes so public its valid to debate that decision

  6. I haven’t read John Roughan for years; his poor reasoning made me angry. Seems like nothing has changed.

    While I respect AJ’s decision as her decision I also agree with Richard Aston that breast cancer research is not as straightforward as the pink ribbon machine would have us believe.

    Your readers may find this interesting:
    http://www.nytimes.com/2013/04/28/magazine/our-feel-good-war-on-breast-cancer.html?pagewanted=all&_r=0

    • Interesting NYT article MeToo.
      The whole area of screening is fraught with issues, false positives are the worst and the fact screening does pick up the more aggressive cancer fast enough.
      I am skeptical of the new science behind genetic screening as well .

  7. 7

    The decision was Jolie’s and hers alone and we should respect it.
    However, I’m concerned that some people may have the operation now, just because they think it’s fashionable. And there are, no doubt, surgeons who would carry it out.

    • That was my point John , big name celebs have a lot of sway over peoples decisions .

    • By the time you’ve got 6 kids (even if 3 are from TradeMe) one’s boobs are resigned to be largely ornamental thereafter, so if there’s a risk that they’re going to get you into trouble (more trouble than they already have, of course) I can’t see the problem with having the risk neutralised. After all, its her body, as we all seem to agree.

      Good on her for making it public, but I hope it doesn’t become some kind of badge of honour….far too many women mutilate themselves with alterations they consider to be selling points – gross implants, hideous tattoos, those ghastly trout pouts, etc etc…

  8. Worryingly, I’m developing man-boobs. Should I be worried?

  9. I find it interesting that this discussion is taking place mainly amongst males. “Worryingly, I’m developing man-boobs?” I don’t think cancer is ever fashionable – what I do think is that more and more women face cancer in the breast, in the cervix and that looking for alternative solutions in merely their right.

    If big name celebs have a lot of sway, I would bet they wouldn’t want cancer of any kind and the difference is really that they are in a financial position to make bold and often misunderstood decisions.

    Really boys – cancer is aggressive and deserves the same respect.

    • Anahera you seem to be saying if its a woman’s cancer men should be respectful of a woman’s choice and not say too much about it. The same of course could be said for male cancers – prostrate etc.
      Where does that get us?
      Yes cancer can be aggressive and yes it does deserve respect. I have lost three close male friends to cancer and they all made different choices.

  10. 10

    Agreed, Brian. Roughan’s piece was presumptuous and unperceptive, possibly of his own blind spots.

  11. When Roughan wrote,

    “‘Isn’t it a little disturbing that genetic science has caused Angelina Jolie to remove a perfectly fine pair of breasts…

    ‘Men too can inherit the BRCA2 mutation, increasing their risk of prostate cancer. I don’t know what I would do, but I hope I would choose to keep any organ for as long as it remained healthy. The idea of excising living tissue that has not yet let you down seems like a betrayal somehow, a premature surrender to what might never happen…”

    – the man’s fixation on breats is, in itself, “a little disturbing”.

  12. Of course, prophylactic removal of the prostate gland and prophylactic removal of breasts are two very different things, but not on planet Roughan.

  13. Ms Jolie has, like other mothers, recognised that she has a job to do raising her family and wants to be around for them as they grow.

    I’m with Brad Pitt: it is heroic, in a primal way.

  14. In NZ more men die each year from Prostate cancer than women do from Breast cancer. Slightly connected.
    But brave is Angelina Jolie.

  15. Anyone who has experienced Breast cancer or has had someone close to them suffer or be taken by Breast Cancer would understand Angelina’s plight.I agree with her decision and hope it saves her from this terrible disease.While Science still argues the pros and cons of this action she may well have prolonged her life .

  16. It’s her decision. Once she’s done her breeding, boobs are of no practical use, and for many women they get in the way. I have trouble gettinbg a harness for my brushcutter, none are designed to accommodate mammaries. And its an ongoing expense and waste of time getting bras to house the damn things.

    • I don’t suppose Jolie’s just going to dispense with the hazardous bits and leave it at that, lettice: I’m anticpating a return to form. I’m also sure the end result will enhance her ability to don a Jimmy Choo brushcutter harness though, and I doubt she’ll lack the professional help she’ll need to sort out the housing issue.

  17. So she will not be having any breasts? it may look uglier than!! will their be nipple?

  18. The move has been praised for drawing attention to the issue of breast cancer and mastectomy, with Bupa’s Consultant Breast Surgeon Nicola Roche saying: “Angelina’s decision to speak out will without doubt help other women to make this decision.

  19. A New Jersey kindergarten teacher with a strong family history of breast cancer blasted Angelina Jolie for giving everyday working women false hope that they, too, can prevent cancer by removing their breasts.

  20. Yeah, so it’s going to be an ongoing debate. These are individual decisions. This is part of what we call personalized care and the good news with the lumpectomy and radiation therapy or with the lumpectomy is you get to keep your breast and if you are in the hands of a good surgeon, cosmetically hopefully you are going to look good. You have the right to have the other breast perked up if that what it takes. Legally you have that right to have evenness on both sides. What’s the bad news with lumpectomy, well you do need some kind of radiation therapy in most cases, not necessarily all and there are different options for that and because the breast is there depending on your age, you have got anywhere from may be a 0.5% to 0.7% chance per year and up to 1% chance per year of the cancer coming back again. So and some woman say, oh, that’s too much for me or another many women say, hey look that sounds fabulous that means to me that in 10 years I got a 90% chance it isn’t going to come back and I say absolutely, spot on, and I will tell you, Lisa, in the next 10 years our ability to diagnose and treat breast cancer is going to change a lot.