Angelina reveals dramatic cancer dilemma

Out of the shadows: Jolie is helping other women be more open about cancer © Getty Images

Film star Angelina Jolie opted for radical surgery to prevent breast cancer, which an inherited genetic defect makes more likely. Her frankness has been hailed by health campaigners.

Not much about the life of Angelina Jolie, world-renowned beauty and Hollywood star, is ordinary. She has three children with fellow-celebrity Brad Pitt, and three more who are adopted. In between multi-million dollar movie projects, they live in a selection of mansions around the globe, and Jolie also appears regularly with politicians on tours of international trouble spots as a United Nations goodwill ambassador.

But this week the 37-year-old actress told a shocking story about her own health that brought a rush of sympathy and a chorus of congratulation from other women: after discovering earlier this year that she was very likely to develop the same cancer that had killed her mother, Jolie decided to have both breasts surgically removed.

Medical screening had revealed the inherited faulty gene BRCA1, and doctors calculated that Jolie had an 87% chance of getting breast cancer and a 50% chance of ovarian cancer. Now, three months of elaborate surgical procedures have reduced her risk of breast cancer to 5%.

The revelation was greeted with delight by cancer charities, who want to encourage women with a pattern of such cancers in their family to go for screening: the ‘proactive’ treatment Jolie decided on will not be right in every case, experts said, but it is one of several options to extend lives that would otherwise be cut short.

Although every woman with BRCA1 (or its sister faulty gene BRCA2) has a different probability of developing the diseases, their average chance of getting breast cancer is 65%, which is about five times higher than the average. Many of these women do not know they are in increased danger.

Other cancer sufferers rushed yesterday to say they were heartened that someone as ‘glamorous yet sensible’ as this Hollywood beauty had become the figurehead for women facing a ‘heart-wrenching’ dilemma: whether to have healthy body parts removed to prolong the time they are likely to enjoy with family and friends.

Her greatest role?

Some may wonder whether one half of the international showbiz brand ‘Brangelina’ can really be an inspiration to other women grappling with similar challenges. After all, they point out, the screening for these faulty genes, let alone the radical preventative surgery, is not available to everyone that needs it: the blood test alone can cost several hundred or even several thousand dollars in America.

Maybe so, others say. But for such a superstar to raise the profile of cancer prevention is a gift to the rest of the world’s women. And by challenging, through her frankness, every commonplace perception of what makes a woman feminine and attractive, Jolie has proved herself brave enough to earn anyone’s admiration, whatever their previous opinion about the actress or her celebrated body.

You Decide

  1. Angelina Jolie’s decision to have both breasts removed: drastic, sensible or both?
  2. ‘Mastectomy involves more than enough pain without the prurient and ghoulish interest of millions,’ wrote Hadley Freeman in The Guardian. Are we interested in this story for the right reasons?

Activities

  1. Only 10% of breast cancers are caused by genetic faults like Angelina’s. Research the incidence, causes and survival rates of breast or ovarian cancers around the world (tip: start with the World Health Organisation website).
  2. Probabilities: If there’s an 87% risk of Jolie developing breast cancer and a 50% risk of her developing ovarian cancer, what is her overall risk of getting cancer?

Some People Say...

“Screening makes people more, not less, scared of getting cancer.”

What do you think?

Q & A

Do all women need to get screened?
No. In the UK the NHS provides blood tests for this faulty gene in about 7,500 women every year, if they have more than one relative who has had either breast or ovarian cancer. But these genetic defects cause only 5% of the total 50,000 breast cancers diagnosed annually in Britain.
So how many have the same surgery as Angelina?
There is no figure, but NHS experts estimate just over 1,000 have this radical double mastectomy to prevent cancer. Mastectomies after a cancer diagnosis are much more common, but are often unnecessary if a lump can be removed instead. A few men also develop this disease, and for both sexes, the risk increases with age.

Word Watch

Faulty gene
Everyone has the genes BRCA1 and BRCA2 , which suppress tumours. People who have inherited a mutated or ‘faulty’ version of either of these genes are therefore more vulnerable to cancers developing.
Screening
Modern medicine uses targeted tests for a wide range of diseases and conditions to discover who might need either further monitoring, treatment, or both. It can be controversial because it uncovers diseases that might not have caused enough problems without the screening to require intervention, and encourages some anxious people to worry needlessly about their health.
Cost
In America, campaigners say some women who do not have health insurance, or whose insurance is not adequate, cannot afford the test. In European countries with socialised medicine, like the NHS, testing and treatment is expected to be provided according to need, but there are often debates about whether cancer treatment is being rationed because of cost: the breast cancer drug tamoxifen is not available to all those who might be helped by it, for example.

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