Angelina Jolie's surgical removal of her breast tissue - action of panic or life-prolonging act?

Hollywood star Angelina Jolie has attracted much attention with her surgical removal of the tissue of both breasts, called double mastectomy, to significantly reduce the chance of developing breast cancer. She received much encouragement and is already a model for some people. However, in the following week an open discussion raised if this step was necessary and applicable to other people with similar problems.


On April 27 Angelina Jolie finished a three month of medical treatment that involved three critical steps: a procedure known as ‘nipple delay’, which targets the breast ducts behind the nipple with the purpose of saving the nipple, the major surgery, during which the whole breast tissue is removed and filled with temporally filling material instead, and the final reconstruction of the breast with an implant. Two weeks later she was sharing her story with the public that “women can benefit from (her) experience”  publishing it in The New York Times under the title ‘My Medical Choice’.1 “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,” the actress said. This induced a worldwide reactions most paying their respect for her brave behavior, both in doing the surgery and sharing this private matter with the world: “Brave, honest strong,” said Oscar winner Marlee Matlin. “She’ll have empowered millions of women all over world. She is sexier than ever,” said Sharon Osbourne, who did the same preventive procedure. “Angelina Jolie, thank you for sharing your story and helping women around the world inspirational,” wrote singer and breast cancer survivor Kylie Minogue.
However, there were also people that had concerns about the wide-spread discussion like H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice and a co-author of "Overdiagnosed: Making People Sick in the Pursuit of Health." In an article published on CNN he cited a research fellow at the International Agency for Research on Cancer, who summed up the general risk: "I fear that this disclosure will motivate other women to undergo preventive mastectomy, even though they do not need it."2 And indeed there is a higher activity since the story was published: "Before the news of Angelina Jolie once a week a woman called, now there are five a day," Dr. Ines Schönbuchner says, working at the Center for Familial Breast and Ovarian Cancer at the University Hospital in Regensburg, Germany. Also Peggy Orenstein recently wrote about her own experience and the downsides of cancer awareness in a much talked about cover story for the Times' Sunday Magazine called "Our Feel-Good War on Breast Cancer."3 She says: "I feel that it's really important that women recognize that Angelina Jolie is in this very particular group of women that has this genetic mutation. She's not a woman of average risk, and to take her experience and generalize it either to ordinary women of average risk or even women with a family history, that concerns me."
The mutation she mentioned is located on the gene BRCA1. And even though the risk to develop cancer is significantly increased with this mutation, two things are important to mention: first, faults in the BRCA1 gene are rare and in most cases were linked to family history. Dr Richard Francis, head of research at Breakthrough Breast Cancer: "Though Angelina decided that a preventative mastectomy was the right choice for her, this may not be the case for another woman in a similar situation.”4 Second, the moment of onset can vary considerably. A study by Sylvia K. Plevritis and coworkers conducted at the Stanford University and published last year in Cancer Epidemiology, Biomarkers & Prevention showed that the removal of both breasts and ovaries (prophylactic mastectomy and oophorectomy) after a positive BRCA1 test results in a gain of life expectancy of up to 10.3 years. However, adding annual breast screening provides also gains up to 9.9 years.5 Thus technically the difference between prophylactic surgery and annual breast screenings is inconsiderable.
Alice Schwarzer, the most prominent contemporary German feminist and founder and publisher of the German feminist journal Emma argued from another point of view: "This alienated, mechanical relationship to her own body does not account for the complex interplay of a body, including the role of psychological influences. Jolie's operation is neither courageous nor cowardly, it is a panic action and panic is a bad counselor."6 Other people criticize the position of the women in this discussion. “To me, the bitter thought that not possible illness, but the image of how you look, is at the forefront of the debate. How preposterous that a woman's value is to be adjusted according to what happens to her breasts. Maybe Jolie will help with her story, to solve one or another of its fixation. Women are not innocent in this picture, because many of us are very embarrassed if our breasts are too small, too flabby, too big or whatever natured,” Hatice Akyün commented in Der Tagesspiegel titled “Breasts in the head”.7 The tacky offer of the ‘Playboy’ to pay any amount of money to pose for their magazine as soon as Jolie’s breasts are healed from her reconstructive surgery underlines that the image of the woman rather than the illness is the real topic of this discussion.8

5 Sigal BM, Munoz DF, Kurian AW, Plevritis SK. Cancer Epidemiol Biomarkers Prev. 2012 Jul;21(7):1066-77.

written by: Dr. Sascha de Vos
PhD: drug discovery, breast and prostate cancer
find him on facebook
                       


Abidin Balan