Friday, May 17, 2013

Angelina Jolie, mastectomies and choice

People keep asking me what I think of Angelina Jolie's prophylactic mastectomy and subsequent op-ed in the New York Times. I've let my thoughts simmer a little before putting them into words. It's hard not to react viscerally to such a dramatic story.

I wonder who'll play Angelina in the movie?

First and foremost, I want to say that what any woman does to her own body and to preserve her own health is her own damn business. Unless we are in her exact pair of shoes there are limitations on the right to comment. 

Secondly, I think Ms. Jolie's choice to go public, especially given her status as a Hollywood sex symbol, is very brave. Having a mastectomy is shame-laden for so many of us and discussing the procedure openly does a great service. I love that she chose to emphasize how, most of the time, the mastectomy is not major surgery and recovery can be fairly smooth. A woman without her "natural" breasts can adjust and go on living her life as she did before - even when her husband is Brad Pitt and what she did before was star on the big screen.

I think that Ms. Jolie made the right decision for herself, based on her situation and the resources at her disposal. How do I know it was the right decision? Because she is happy with it.

That being said, I do have a few things I need to get off my (ahem) chest. These are my thoughts, in no particular order:

  • The vast majority of women would not benefit from genetic testing. We have no family history of breast cancer and do not belong to ethnic groups most likely to carry the gene.

  • Reconstruction is major surgery. Some of us would never put ourselves through a much more serious operation, that may not be successful, just to meet a societal definition of "beautiful", or even "normal."

  • The kind of nipple preserving surgery Ms. Jolie had is still new and not yet widely offered. In Canada, a group called Be The Choice is trying to change that. Melanie Adrian,the founder of Be The Choice had to see many doctors and fight hard to obtain this procedure for herself in 2011.  

  • Many women do not have the resources to get the quality of care that made the process so easy for Ms. Jolie. Even in Canada, where we have theoretically universal health care, there are geographic and socio-economic discrepancies that affect treatment and recovery.

  • Access to testing is also very restricted, largely because the BRCA1 and 2 genes (the ones that can mutate and cause breast and ovarian cancer) have been patented by a company that restricts its use and ensures that the cost remains high. The patenting of genes is an odious and frightening practice. I'll elaborate on that and share some resources in a future post.

Every woman needs to make her own decision about prevention, surgery and treatment. What we all should agree on is that these decisions ought never to be restricted by available resources, ignorance or the greed of big corporations.

Want to read more? Here are some of my favourite posts, offering insight from different perspectives:

"Still Boobless", on Insert Boobs Here, a blog by Sarah Merchant who was diagnosed with metastatic breast cancer at 28.

"Angelina Jolie's choice not the only one" by Joan Walsh, on

"Angelina Jolie's Bilateral Prophylactic Mastectomy - If She &  I Could Chat", on Nancy's Point, by Nancy Stordahl who lost her mother to breast cancer in 2008 and went through the illness herself in 2010.


deb said...

Thank you so much for posting this. I reacted on a number of levels when I first heard about the story. Mostly from a class basis, thinking that many women do not have the resources at their disposal as Ms.Jolie does.

But the story also gave me unique opportunities to have interesting conversations about how friends and family reacted. Some couldn't understand why someone would voluntarily choose this option when breast cancer hadn't appeared yet. I think never having experienced cancer up close can protect you from thinking about these potential decisions.

Having the opporunity to reduce the risks of getting cancer always seem worth consideration.

Hopefully, our country will adopt a more preventative approach to health and wellness to give women a few more options.

laurie said...

Hi Deb! I reacted on a number of levels as well, which is why I had to mull things over for a couple of days before answering. I still ended up saying "on the one hand" and "on the other hand" and "on the third hand"...but it really does come down to providing choices and, as you point out, actually working towards prevention so we can stop needing this conversation.

Unknown said...

I think she made the right choice for herself and her family in her specific situation and I am glad she is starting a public dialogue about her experiences, given her sex symbol status.

However, given her status, I don't think NOT reconstructing was ever really an option for her. Sadly, her body is a big part of her bread and butter, and Hollywood can be very unforgiving.

That said, I find it ironic that so much attention is being given to her making the choice to have the mastectomy and then reconstruction, given how many fake boobs are already jiggling about in tinsel town. :p

Unknown said...

Er, no idea what the hell kind of handle that is or when it is from, but it's me, Laurie. ;) (Melissa Dimock)

laurie said...

Ha! Melissa, I would never have made the link to between you and "rusty halo"! You're right that reconstruction was a given for AJ. And you've raised an interesting point, that hadn't occurred to me: how real were her boobs to begin with? :)

Unknown said...

Oh, I'm pretty sure *hers* are real.. but I don't think the same applies to most of the other Hollywood women in her demographic. I think "fake boobs" are the new "casting couch". :/

Nancy's Point said...

You make excellent points. Like you, I worry about the disparity issues and the gene patenting issue. I'm hoping Ms. Jolie takes these on too. I hadn't thought about the nipple preserving surgery being a limited option, and you're right about that. And of course, the reconstruction option isn't a choice some make for whatever reasons.

I do think Angelina being so frank opened up a great deal of discussion which is always a good thing. As with any discussion, there's a lot of "sifting" that needs to be done.

Thanks for adding to this discussion and thanks for the link to my post.

Facing Cancer Together said...

Very good post and very good points, Laurie. There are so many aspects of reconstruction (and not reconstructing too) . . . I can understand why Angelina didn't dive into them for her article, but as you've shown here - there's still much to consider. ~Catherine

Anonymous said...

Excellent points! I am going to check out the links you shared, too. Rock on

Finola said...

I think that Angelina Jolie was very brave in choosing this surgery and then sharing her story. And an additional positive outcome is that women will now be more aware that the type of surgery that she chose is possible. More people will know there are other options available.

Thanks for linking to Be the Choice too Laurie. Much appreciated :)

amyboughner said...

Theoretically universal health care – I think that's what I'm going to refer to it as from now on

laurie said...

Yeah- not that I haven't been saved by socialized medicine but there are SOOOO many discrepancies and inequities. I fear that there are more all the time.