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?

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?

17 Comments

JonandIvy Jones

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JonandIvy Jones commented…

I often wonder if the writers here are even Christian at all. Jolie's condition? She didn't even have a condition. The only thing she had was risk, and that is what we all face with a daily measure. I have read many articles on this website. And after this one I think that I am finally fed up. I think that finally I have realized how callus and liberal the editorial staff must be to allow such diatribes to be written with a huge swing to the political left, and all in the name of God. If this is your version of Christianity, to deny the power of Christ and take up the mantle of worldliness and unbelief, then you can keep it.

Hansie Fernandes

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Hansie Fernandes replied to JonandIvy Jones's comment

Jon,
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!

Esther Aspling

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Esther Aspling commented…

I think you are right, in the end we need to know that we will all die eventually, and we must live our lives accordingly.
There are always things we will do to extend our lives. I think taking many types medication is in fact a way we extend our lives, whether for heart conditions or other organ diseases. We wear seatbelts when we drive because we know it increases our chance of survival if we crash. We run on treadmills, not because they are so exciting and fun, but because we're trying to live longer.
I don't think any of these things are denying the power of Christ, or taking up worldliness.

Caitlin Muir

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Caitlin Muir commented…

I applaud Jolie's transparency. She reminds me of an Amazon of old - the fierce women warriors who cut off their breasts to fight better. Jolie is fighting against cancer and for time with her children. Her choice isn't for everyone. I don't know what I would do if I faced the odds she did. But I'm glad she's speaking up.

Adam

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Adam commented…

while everyone is susceptible to cancer and has a risk, i can understand how some are more prone to it for genetic reasons. i also understand that most cancer can be prevented or thwarted based on lifestyle, diet, exposure to toxins and how often people do cleanses to rid of the toxins. alternative medicine has already came to the conclusion that cancer is caused by toxins and parasites that take over the body, thus causing candida overgrowth and bacteria which then feeds the parasites, which cause more toxins, which causes your immune system to be compromised, which caused candida,the more candida you have, the more sugar you crave so you consume sugar and the vicious cycle continues, parasites and toxins to grow and wipe out your good gut bacteria which will then lead to a "leak" into your bloodstream which allows the toxins, yeast and parasites to travel to different organs, and which eventually after some time leads to or results in either cancer or an autoimmune disease. (usually depending on your genetics and your blood type)

we don't live in our grandparents world anymore, this world is polluted and their are higher risk factors (more specifically toxins) for cancer. our food, water,and air isn't like it used to be. .it's heavily polluted with carcinogens, unreal mercury levels and fluoride. most of our food today is made from GMO corn/soybean seed and antibiotics and hormones are injected into most livestock. all your favorite cosmetic, deodorants are full of aluminum/lead and God knows what else.

alternative medicine and nature has all the answers and/or cures for all the ailments we have today in this busy, polluted world. the answers are out there but most people do not think for themselves and their health and rely on doctors to give them the runaround and throw medications at them that only masks the problem/illness.

our modern world is too "busy" and "distracted" by social media outlets, reality shows among several other worldy trends and life suckers. we think we are so "advanced" because of all of our technology, progression of tolerance and evolution as human beings but we don't know anything. human beings have gotten away from their roots, common sense and our connection with God and nature. we don't take the time to stop, listen and i mean really listen to our bodies or lives.

do most people know that people with type A blood are more prone to most cancers? and that type O blood are more proned to autoimmune diseases?? No. because modern medicine is about prescribing medication, saving face and shuffling people from doctor to doctor without finding the root cause to any disease. in other words, doctors don't educate their patients and we just accept it and give up.

so my point of this rant is that angelina jolie did a bold thing. .was it entirely necessary?? i don't believe so, but i can't say exactly because i'm not in her shoes. the cure for cancer has already been found and if more people were aware and educated themselves on their health, we wouldn't have tons of people take chemo/radiation which not only kills bad cancer cells, it kills ALL cells, including good ones you need to fight off the cancerous ones. so how can your body win, how can your body have a fighting chance to survive when the chemo is slowly killing you?? the answer is not chemo/radiation. .the answer is cleansing your body and organs regularly and nutrition. even more so if you are already diagnosed with cancer.

it's a sad thing to see people suffer but what i'm saying is that people need to wake up and stop believing everything they're told, put your faith in God and as well known natural physician Dr Mercola would say. .take control of your health!

nchoirnmind

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nchoirnmind replied to Adam's comment

is there a cure for "virus?"

Bpwesterfield1

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Bpwesterfield1 replied to Adam's comment

David some of your rhetoric is dangerous. It's easy to say that x is bad when you're shouting from the shadows but when you are giving direct advice to a patient you have to give them advice based on evidence. Your rant is full of examples of treatments that are lacking substantial evidence. BRCA1 gene is the root of the problem, your cells have certain properties that kill off bad cells, this gene prevents that; allowing your body to produce more and more bad cells.

Alternative medicine draws conclusions all day long, some of them are good some of them are bad, just because its 'natural' doesn't mean it is good medicine or even safe.

Adam

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Adam replied to Bpwesterfield1's comment

viruses are a tricky animal. .they are constantly evolving and changing so "cure" is a strong word, although did you see in the current issue of relevant magazine about the Dr who apparently "cured" someone of HIV/AIDS??

i'm speaking more about cancer, autoimmune diseases, heart disease and other conditions as such.

i believe viruses can be cured but it's a complex ordeal. .. not against all modern medicine, just saying that common sense and nature is always the better and safer way to treat anybody with any condition

Adam

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Adam replied to Bpwesterfield1's comment

not sure who "david" is but i assume you're replying to my post. .explain to me how my rhetoric is dangerous? i'm studying alternative medicine and all i do is read, read and read. do you think i'm making this stuff up or that this is like my "philosophy" on health/life? all this information is documented by experts in these areas who have been doing endless research for 40+ years. so how is this stuff not based on evidence? i would feel very confident prescribing people this so called "rhetoric" as you put it. doctors go to school to learn how the human body works and can name you every condition/disease that exists and how to treat it with drugs but most don't know how to actually "help" their patients as in getting to the root of the disease/illness, they aren't taught to think outside the box in medical school, only what's in the textbook and what the pharmaceautical companies pressure them into prescribing as they start their practice.

so i'm ranting about examples and treatments that are lacking substantial evidence? reread my first paragraph, this is coming innovators of science backed my 30-40yrs of research. .that's not substantial?? so i guess you need cold, hard evidence that Jesus Christ died on the cross and raised from the dead and that God exists? or is it just common sense, faith or a "feeling" that christ arose and God does exist in just the things you see in everyday life and the pattern all throughout nature.

what is dangerous is how people put their blind trust in doctors and hospitals. now i apologize if i sounded somewhat insensitive in my earlier post and i'm not saying that all modern medicine is wrong, i understand there are special circumstances where modern medicine would be the right call. everyone's situation and health are different so i'm not stating an absolute that alternative medicine is the answer to everything, all the time. i believe it is for the majority though but once again, read my article above. .it's common sense.

ever since i've been on my studies and quest for knowledge i can boldly say i know more than doctors do sometimes. when i've went to the doctor they would tell me to get a meaningless test or they would always try to push meds on me, or explain what was happening to me or cause of my symptoms. .then i opened my mouth and let the and told them what i thought i should do and they were amazed at what i told them and my astuteness in health knowledge. of course, they discredit my knowledge/theories once they snap back into their "doctor reality" because what good does my knowledge or self awareness of my own health do for the doctors? the hospitals? the pharmaceutical companies? they don't make money off of me if i already have all the answers to my own health. so ultimately, most doctors will ignore what you are saying even if they know what you're saying is right. .there is a hidden agenda here people. it's all about capita and money for them. now, i'm not saying ALL modern doctors are like this, but the majority are and that is a sad, sad thing.

yes, we have the technology that shows the BRCA1 gene is a precursor for the likliness of developing cancer but that's why you use common sense and nutrition to prevent it from happening, instead of doing some type of radical procedure to a beautiful woman like Jolie. the bad cells might be reproducing with this gene defect but nutrition and cleansing the body of toxins will prevent from any further bad cells from forming, which would lower your risk greatly. inflammation, which is the process of the body fighting off bad cells is key to control. when there is an overload of inflammation in the body, that's when cancer, heart disease and auto immune diseases show up. nutrition/diet are key and their is a book on diets for each of the 4 blood types everyone should read (a certain food for one person, is poison to another), cleansing your body of toxins, keeping away from toxin exposure and being connected to nature. .meaning your skin touching the ground (look up the term "earthing". .it's a breakthrough discovery in the past decade that's very interesting. .there's a book on it that's a must read)

i'm not saying everyone should start treating themselves with random and odd herbs or concoctions. .that is why there is a growing of naturalpathic doctors in the world because the secret is out. .modern medicine and doctors are not helping the sick and faint because all they do is give them pills and tell them to "get by" in life. naturopathy medicine addresses the "whole body" and gets to the root of the illness, addresses it, and ultimately cures it or to a point where the patients symptoms are almost unnoticeable.

sounds like to me, you got alot of reading and educating to do along with the rest of our country

Bpwesterfield1

5

Bpwesterfield1 replied to Adam's comment

ever since i've been on my studies and quest for knowledge i can boldly say i know more than doctors do sometimes

Adam, With this statement I realized this discussion was a waste of time. It's clear your knowledge of pathophysiology is minimal, not trying to be a jerk. I'm also not saying all homeopathic remedies are wrong.

Also, she wasn't at a slightly increased risk she had an 87% chance of developing breast cancer. Beyond that I'm done, I'm writing on an ipad and quite frankly have better things to do.

Annie Biondi

1

Annie Biondi commented…

I also found this story challenging. I also have a family history of breast cancer - my great-great-grandmother, great-grandmother, grandmother and mother have all fought this disease; my grandmother is positive for the BRCA mutation, and so is my half-aunt. I too, had always just figured that at some point in my life, I will have to deal with this disease. Not trying to be negative, and trusting God to move as He wills, but also trying to be realistic. After my mother's successful lumpectomy and radiation treatment (13 years cancer-free, go Mom!), she asked me if I wanted her to take the gene test. I said no, for the above reasons.

Then a conversation with my very excellent ob/gyn about three years ago started a change in my heart. He commented that one of the advantages of having a gene-positive test is that many insurance carriers will then cover more early-detection procedures. For instance, instead of having to wait until I am forty for routine screenings, I can begin this year when I turn thirty. Many companies will also allow me to get an MRI screening in addition to a mammogram (a much more accurate way to detect tumors early). Early detection means much, much better odds of survivability. So last year I asked my new ob/gyn about getting tested. She told me that it actually is more useful for my mother to get tested, because they know what type of cancer she fought and can rule out some things based on her history. As a result, this year my mother will be doing the testing, and I will be beginning my early-detection routine.

Please, ladies, pray these things through if you have a history of this disease. I do not believe it shows a lack of faith to use the gifts of medicine to help us be healthy and whole people who are able to serve God. Now, once I have the test results, will I take the same course of action as Ms. Jolie? I don't know. I will undertake that decision with much prayer and conversation with my husband, and will bear in mind that acting in fear is not acting in faith. But we are also commanded to act in wisdom, and I will certainly be seeking that.

(Side note: only 13% of women diagnosed with breast cancer have an immediate family member with a history of the disease. This is why routine screening for ALL women is so important! Do your self-exams and get your age-appropriate mammograms, ladies! ;-)

Bpwesterfield1

5

Bpwesterfield1 replied to Annie Biondi's comment

Now that is great advice.

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