Don't Judge Her! - Pacific Standard

Don't Judge Her!

Angelina Jolie's decision to undergo a double mastectomy was a tough one, but it was her decision to make. What would you have done in the same situation? And is there even a "same situation," when different doctors might offer different approximations of your chances of developing breast cancer?
Author:
Publish date:
Angelina Jolie and Brad Pitt at the Deauville American Film Festival in Deauville, France, September 2007. (PHOTO: EFLOCH/WIKIMEDIA COMMONS)

Angelina Jolie and Brad Pitt at the Deauville American Film Festival in Deauville, France, September 2007. (PHOTO: EFLOCH/WIKIMEDIA COMMONS)

Before this morning, I never won­dered what it’s like to walk in Angelina Jolie’s shoes. Like many, I woke up to the news—pre­sented in the form of an op-​​ed in the New York Times—that one of the world’s most beau­tiful and famous women recently had bilateral mas­tec­tomies to reduce her risk of devel­oping breast cancer.

It turns out the 37-year-old actress carries a BRCA1 mutation, a genetic variant that dra­mat­i­cally ups her risk of devel­oping breast and ovarian cancers. Her mother, Marcheline Bertrand, died of cancer at the age of 56 years. Jolie would have been 31 years old when her mother died.

As Jolie tells it, doctors esti­mated her risk of devel­oping breast cancer to be 87 percent. As she points out, the risk is dif­ferent in each woman’s case. As an oncologist-​​journalist-​​patient reading her nar­rative, I can’t help but know that each doctor might offer a dif­ferent approx­i­mation of her chances. It’s likely, from all that Jolie has gen­er­ously shared of her expe­rience and cir­cum­stances, that her odds were high.

What’s great about this piece, and what’s wrong about it, is that it comes from an indi­vidual woman.

“Cancer is still a word that strikes fear into people’s hearts, pro­ducing a deep sense of pow­er­lessness,” Jolie wrote in today’s Times. To take control of her fate, or at least to mit­igate her risk as best she could upon con­sul­tation with her doctors, she had genetic testing for BRCA and, more recently, decided to undergo mastectomy.

The decision was hers to make, and it’s a tough one. I don’t know what I’d have done if I were 37 years old, if my mother died of cancer, and I had a BRCA mutation. There’s no “correct” answer in my book, although some might be sounder than others.

I know physi­cians who’ve chosen, as did the celebrity, to have mas­tec­tomies upon finding out they carry BRCA muta­tions. And I’ve known “ordinary” women—moms, home­makers, librarians (that’s fig­u­rative, I’m just pulling a stereotype) who’ve elected to keep their breasts and take their chances with close monitoring. I’ve known some women who have, perhaps rashly, chosen to ignore their risk and do nothing at all. At that opposite extreme, a woman might be so afraid, ter­rified, of finding cancer that she won’t even go to a doctor for a check-​​up, no less be tested, examined, or screened.

What’s great about this piece, and what’s wrong about it, is that it comes from an indi­vidual woman. Whether she’s made the right or wrong decision, neither I nor anyone can say for sure. Jolie’s essay reflects the dilemma of any person making a medical choice based on their cir­cum­stances, values, test results, and what information they’ve been given or oth­erwise found and interpreted.

How to con­clude? Mainly and first, that I wish Jolie the best and a speedy recovery after surgery. And to thank you, Angelina, for raising this issue in such a candid fashion.

As for the future, Angelina’s decision demon­strates that we need better (and not just more) research, to under­stand what causes cancer in people who have BRCA muta­tions and oth­erwise. My hope is that future women—children now—needn’t resort to, nor even con­tem­plate, such drastic pro­ce­dures to avoid a poten­tially lethal con­dition as is breast cancer today.

Related