Angelina Jolie and Every Woman's Choice

What her preventative double mastectomy teaches us about courage and control.

If you knew you had six months to live, what would you do?

Many of us have asked that question at some point in our lives, whether hypothetically or not. Now scientific discovery is giving us the ability to ask the question in a new way: If you knew you were at high risk for developing a terminal illness, what would you do?

The disease may not exist yet, the prognosis might not been ascertained, but developments in cancer research have made it possible for high risk individuals to determine their genetic predisposition and take preventative measures.

Yet in the wake of her choice going public, I worry some women will misinterpret what Jolie is really advocating.

In an op-ed for the New York Times on Tuesday, May 14, Hollywood star Angelina Jolie shocked the masses by writing about her recent choice to undergo a double mastectomy after genetic testing revealed she had a defective BRCA1 gene, giving her an 87 percent risk for breast cancer and 50 percent risk for ovarian cancer. She explained that her mother died of cancer at 56; getting genetic testing and choosing preventative surgery gave her and her family the peace of mind in knowing that she had done all she could to prevent developing the disease.

Jolie's decision to undergo such extreme preventative measures is a brave one, and being heralded by many as such. Not just because amputating and reconstructing one’s breasts is a hard decision in itself, but because while making a tough decision, she also chose to do so publicly, capitalizing on her celebrity status in an effort to help women make more informed decisions about their health. She works in an industry that places high premium on physical beauty ideals, but she sacrificed that for what she deemed more important: her physical health, a longer life with her family of eight, and the possibility that despite all the criticism she might receive for it, it might yet reach women who are high risk for cancer and are not sure what to do about it.

These are admirable aspirations. Yet in the wake of her choice going public, I worry some women will misinterpret what Jolie is really advocating. It might be tempting for readers to take Jolie's decision as a prescriptive measure for all women, believing that any sign of high-risk or early detection gives reason to undergo the preventative surgeries, but that would miss Jolie's point entirely. Jolie took the test, sought counsel from geneticists and doctors, and chose a course of action that correlated with the degree of her personal risk. She is not encouraging all women at risk of cancer to do exactly as she has done. She is encouraging all women to be informed about their health and make informed choices, whatever those choices may be.

And a recognition of varied choices for varied conditions is important, since there are many types of cancer. Jolie's condition, for example, is extremely rare, making up only 5 to 10 percent of breast cancers and 10 to 15 percent of ovarian cancers among white women in the United States, as pointed out by a follow-up article that the Times posted later that same day.

Studies show that there has been a growing trend in recent years of prophylactic, or preventative, surgeries, and this is where experts in the medical field are concerned. Chief of Surgical Oncology at the University of Minnesota Todd Tuttle reported to NPR on Tuesday that his 2011 study revealed women who had cancer in one breast believed they had a 31 percent chance of getting cancer in the other breast in 10 years. But for most women, cancer in one breast does not predict cancer in the other.

Readers should feel empowered by Jolie's choice to educate and advocate for themselves and choose the course of action that correlates with their personal risk.

In fact, breast cancer researchers take that one step further than the Times and NPR stories mention. BRCA genetic testing does not determine a person’s risk for systemic cancer. In other words, finding out whether you have a BRCA mutation will not tell you whether or not your hypothetic cancer will metastasize; that is determined by tumor size, hormone receptor status, nodal status, and possibly multi-gene tests such as Oncotype DX and Mammaprint. So the effectiveness of preventative surgeries is limited to that rare five to 10 percent of people like Jolie who have the BRCA1 gene.

In other words, cancer is a complex disease. This is why it's important for women to be cautious and remember the real purpose behind Jolie's op-ed and very public decision. Jolie's choice was right because it was right for her, not because it's what all women should do. Readers should feel empowered by Jolie's choice to educate and advocate for themselves and choose the course of action that correlates with their personal risk. Not all women are exposed to the same level of risk for the same reasons, therefore not all women should seek preventative surgeries.

Take me and my mother, for example. My mother died of metastatic breast cancer in January 2012. She had mastectomy when she was first diagnosed in 1997, but when the cancer metastasized it did not spread to her other breast, but to other parts of her body like her soft tissue, vital organs and bone marrow. A preventative surgery would not have helped her because of the type of breast cancer she had.

People have often asked me, given my family history, if I will get the genetic testing and how I might respond to the results. Knowing what my mother went through, and that I am surrounded by cancer on both sides of my family, I have determined that I don't really need an expensive genetic test to tell me that I’m high risk. And while we're on that track, I'm also high risk for heart disease, Alzheimer's, and even a couple of extremely rare disorders like acromegaly, the syndrome more popularly known as giantism that has affected three of my family members, as well as Factor V Leiden, a blood-clotting disorder that has caused women in my family to suffer miscarriages and strokes. It’s clear that my odds aren't good—for anything.

I may get the genetic testing, discover that I do in fact have a BRCA1 mutation, and choose to have a preventative bilateral mastectomy and hysterectomy, but only time will tell if that choice actually prevented cancer. Physical health is undoubtedly important—and, as men and woman made in the image of God, we should care for it well. But this truth must also be balanced out by another: that we are all mortal, and in the end, we are not in control. At some point I have to draw the line, come to terms with the choices that will give me the best quality of life, accept that I will die of something at some point.

In my own deliberation on this, I’ve been forced to ask a few deeper questions: At what point do these test results and preventative measures keep us from living full lives? At what point do our informed decisions become attempts to escape death, or play God? How do these ideas affect our quality of life psychologically, emotionally, spiritually?

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So I have made my choice. Jolie has made hers. And you must make the choice that's right for you.

We will all die, whether from heart disease or cancer or some really rare incurable, untreatable disease, or perhaps a tragic accident. It is only natural for us humans to want to stop the vehicle in time, to treat the disease preemptively, to know our prognosis and prevent it somehow. And it's wise to get medical information in an effort to take care of our bodies. It's also equally wise to do this in the awareness that life has a 100 percent mortality rate.

You may think that’s a morbid way of looking at it. But maybe seeing it from this perspective gives us the very freedom we need to steward our numbered days well, to make the choice that's right for us, and to trust God with the outcome, because that was never really in our control to begin with.

So, back to that first question: If you knew you were going to die someday, how would you live your life now?

Top Comments

Hansie Fernandes


Hansie Fernandes replied to JonandIvy Jones's comment

I hope my response to your claims will be grace-filled. Although, I might err along the way (I'm human and quite young). If I do, do forgive me.

If I'm right, you claim that the Bible teaches that Jesus died so that we may have salvation (from our sins) AND healing of our bodies if only we believe. In short, I disagree that this is what the Bible teaches (about your point on physical healing). However, surprisingly, this view is quite rampant in North America and this false 'gospel' is being taken over to other countries, namely, India (where I hail from), and it has devastating effects.

First of all, from your comments, I can see that you do desire to honor the Word of God and be obedient to Jesus in all things. That is amazing. We need to get the Word right and sometimes due to culture and popular opinion, things get mixed up and we tend to read too much into a few scriptures. Interestingly, your view is quite liberal (in terms of departing from scripture and common tradition) since it started around the 1940's. Before that, no one preached that if you believed in Jesus you would receive salvation, health, wealth/success. The conservative view is that Jesus has come to give us eternal life. He came to "seek and save the lost". He came "that they may have eternal life", that "they may know you, the only true God". John 3:16 - For this is the way that God loved the world: He gave His only son that whoever believes in Him has eternal life.
In those few scriptures, it is clear that Jesus came so that we may be reconciled with God (2 Corinthians 15:19, I believe?). It is simply untrue that Christ came that we may have success and be free from sickness and any kind of struggle in life. Jesus himself says that the servant in not above his master, and that we will be persecuted and that we are to carry our cross as passers-by to this current world inflicted with sin (as you rightly pointed-out).
And we can see that the apostles suffered and died. Missionaries and christians in countries other than North America suffer persecution and many times are killed. There are tons of Christians in India who are poor and in sickness. And what has been given to them? You need to believe in Jesus more for your healing. As if we can twist the arm of God.

God chooses. Romans 9 talks about this. He chooses whom he may save according to his divine wisdom (divine unconditional election, some may disagree with me). He chooses whom he heals, for His purposes in His incomprehensible wisdom. It is a mystery. Whether the propitiation of sins if for the whole world (potential) or in fact those whom he elected (decided before the world began) is left to debate, which many do still. Also, the scripture " God is no respecter of persons (acts 10:34) refers to the fact that salvation is for the whole world and not only for the nation of Israel (which Peter initially believed but his eyes opened when he saw the vision). And that is what I believe I john 2:2 is alluding to when he says: " and not for ours only: but for the whole world." and not necessarily salvation potential applied for every person (which is almost universalism).
When I had injured my knee, my parents, pastors, and many people I knew told me to pray hard and believe that God can heal me. I did and nothing happened. Did God fail in his apparent duty since He is apparently obliged to because of what happened at the cross? Not at all. God, in His wisdom, let me remain in that injury but I learnt so many things in that time that caused me to focus back on Him again (after I had let other things be a priority). God had a different purpose in mind.
Did God punish me with sickness? No. It was my mistake and it is an effect of original sin. However, God uses sickness and pain to work a beautiful thing in our life that will focus our attention on Him.
Does God still heal? Yes. We ought to pray and ask Him for healing as we ask Him for other things but there is nothing we can really do more than that. It is His will.

God isn't offering us immortality but eternal life with Him to know Him forever.

Now to make this Relevant (no pun intended), this post is definitely helpful in asking important questions to find the right balance between how much should we value prolonging our lives, in order to live for the glory of God (hopefully) or to instead let mortality take its toll on our bodies.

Hope this was useful to you, Jon. :) God truly is good to us!


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