I never thought I'd be writing about Angelina Jolie on my blog.
Beyond us both being mothers, there are few people I have less in common with than the actress. But after her announcement this week that she had a proactive double mastectomy to avoid the breast cancer that killed her own mother at the age of 56, well, here we are courtesy of cancer, the great unifier.
Jolie wrote about her decision and the radical mastectomy-followed-by-reconstruction procedure in an OpEd piece for the NY Times. After it went viral, Facebook and Twitter were full of people discussing her & her decision -- people with a cancer connection, as well as the general public. I even turned on NPR at lunchtime yesterday and heard Tom Ashbrook discussing it with callers (again, some with a cancer connection, and some without).
Some people were shocked she'd undergo such a radical procedure. Others applauded her for not only taking the step, but also sharing her decision publicly. Still others thought her move highlighted the divide between those with money and those without.
A few people asked my opinion, so I thought I'd take a few minutes to react.
First and foremost, if your family has no history of breast or ovarian cancer, you don't need to consider this surgery anymore than you'd consider removing any other body part. Jolie writes that her decision to remove her breasts was motivated by testing positive for the BRCA1 gene. When I was diagnosed with breast cancer at 35, this was one of the first tests my oncologist ordered. It would be nice to have a smoking gun, to say, "There! That's why I have cancer so young!"
But for me, the test (a simple saliva swish test) came back negative. It doesn't mean that I don't have a gene mutation somewhere in there that caused me to have cancer. After all, we all have cancer cells in our bodies, we just won't all develop cancer. I suspect that probably some day down the road, a test will be developed and the gene mutation I do have will be discovered.
And then my daughter may find herself facing the same decision Jolie faced this year: Would removing her breasts give her a better chance of survival?
Would I recommend she do it?
Deciding to remove a body part is drastic, and not to be taken lightly. Jolie writes that removing her breasts reduced her chances of getting breast cancer from 87% to 5%. It doesn't mean she is no longer at risk for another type of cancer, but at least she can cross this one off her list.
I suspect that her mother's fight with cancer and her subsequent death has haunted her. I bet that every day she looked into her childrens' eyes and felt the shadow behind her, wondering if she'd be alive to see her children grow up, to see her grandchildren. If that was the case, then removing her breasts has given her back an immeasurable quality of life. And you have to weigh that in this decision. Everything with cancer is balanced against quality of life, not just quantity. Tests, treatments, procedures -- and even the decision not to act -- it comes down to, what can I live with, day in and day out?
For comparison, your chance of dying in a car accident today is 47% higher if you are not wearing a seat belt. I'm betting it is a no-brainer for you to buckle up. But buckling a seat belt doesn't cost us anything. A mastectomy, particularly with no personal cancer present, is a hard decision and involves body image issues, sexual function (remove the breasts, and you remove a large erogenous zone), childbearing concerns (done breastfeeding forever?), the risk of the surgery itself, the added risk of complications with the implants (though not all women who undergo this surgery will opt for reconstruction).
And there is the cost to consider, however I think this is one of the most misunderstood pieces of the Jolie story -- insurance will cover the cost of the BRCA test if you have a higher chance of having the gene (breast cancer history in your family, for example). And insurance will help with the cost of a mastectomy due to BRCA results and/or cancer. Insurance will even help with reconstruction.
In the end, it is a very personal decision.
I considered it myself. I considered removing my healthy breast at the time of my single mastectomy. But for me, the time was not right: I still hope to need that breast to feed another child. However, once that possibility or opportunity passes, I will be back to considering it. If removing it would mean I don't feel like I have a ticking time bomb strapped to my chest, then I'll do it.
And if Nia faces this choice one day, and asks my opinion, I will tell her this:
It is a deeply personal decision. You have to weigh both sides -- how you will feel with your breasts, and how you feel without them. If removing them, no matter how important they are to you, makes you feel safer, do it. Maybe it is something you do at twenty because you are more terrified of breast cancer than you are of not being able to breastfeed. Maybe you have your own children, and remove them at forty. Either way, it is completely up to you. And if you choose to keep your breasts, that is your choice too. I would not judge you for either decision.
For more information about BRCA and more analysis of Jolie's decision, go here.
And for a beautiful photography project collecting images of women who've had mastectomies, visit the ScarProject.