A WOMAN’S breasts have always been regarded very precious, a symbol of femininity, sexiness, sensuality, and during the child-bearing age, the wonderful breasts of a mother have yet to be equaled, even with today’s great advances in science and technology, in their ability to naturally produce, not only life-sustaining milk for the baby, but one that contains vital ingredients to nurture, protect and bolster the immune system of the child. More often than not, our society in general perceives a woman’s breasts to be an important part of her total aesthetic appeal, especially to men. Some women even feel they are defined by their breasts.
All this, and more, makes it very tough for a woman to accept the mutilation or loss of a breast (mastectomy), even for cancer. Worse, losing both breasts, with no pathology, no actual disease in either of them, can be a devastating catastrophe.
But not to famous actress and activist Angelina Jolie, who at age 37, felt great relief after her preventive double mastectomy February 2013, which was precipitated by her strong family history of cancer. Her mother died of cancer at the age of 56. An aunt was said to have cancer. But for Angelina, the laboratory finding that she carries a defective version (mutation) of BRCA1 gene fortified her decision to undergo the double mastectomy, and later, the surgical removal of her ovaries, since these are also target organs, like the breasts, among those with this faulty gene. The double mastectomy was followed by reconstruction, insertion of breast implants. Her equally famous actor-husband, Brad Pitt, supported her decision all the way.
One can easily imagine how a discovery of this type of gene could shatter the life of a woman, especially the younger ones, strangling them with fear, anger, and depression – all normal human reactions. Whether Angelina experienced any of these, we do not know, but in her op-ed article, she stated it was a very tough decision that she had to make to save the mother of her six children, “to reassure them that she is doing everything possible to avoid the disease that took her mother’s life: cancer,” according to the papers.
“I wanted to write this to tell other women that the decision to have a mastectomy was not easy,” says Angelina. “But it is one that I am very happy I made. My chances of developing breast cancer have dropped from 87 percent to under 5 percent. I can tell my children that they don’t need to fear they will lose me to breast cancer….I hope that other women can benefit from my experience.”
Around the world, Angelina’s decision is hailed for her wisdom, prudence, bravery, and her “heroism,” for revealing her most intimate personal situation, sacrificing her own privacy “to save the lives of others.” She has indeed succeeded in raising awareness about this issue and the discussions that follow would be good for women around the world.
Angelina says she does not feel less of a woman, but rather “an empowered woman” for being strong and courageous, and for having made the right decision. She is indeed a role model, respected globally as a top actress and a genuine humanitarian, together with her husband, both making a big difference to society.
Should women get tested for these faulty genes?
While Angelina’s particular case of an inherited genetic mutation puts her at a high risk for the development of breast and ovarian cancer “was very specific, her decision and course of action make sense for only a small category of women,” according to cancer surgeons and genetic counselors, who quickly pointed out that “these hereditary cases of breast cancer account for only about 5 percent to 7 percent of all cases diagnosed each year…and so women should not just run off and get tested for those genes.”
What would be a prudent and practical approach?
Living a healthy lifestyle, which includes diet (less red meat and more vegetables, nuts, fiber, and grains is better), daily physical exercise and abstinence from smoking and alcohol abuse, is essential. Knowledge with one’s own family health history is important, and with this issue, medical consultation and genetic counseling are the next step, instead of simply opting for the genetic testing.
How much does the test cost?
The cost is prohibitive, around $3,000 USD. In the United States, this test is covered by most health insurance, when medically justified.
If the test is positive, then what?
This is the crux of the matter and a controversial one, highly charged with emotion. Can the woman deal with the bad news? If a woman values her breasts more than life, or not psychologically and emotionally ready to lose both of her breasts, perhaps she should not even get tested, and just have regular intensive screening like physical examination, mammograms, MRIs. Some women have opted to have only their ovaries removed. But to live daily with that uncertainty and fear about the high (87 percent) probability of acquiring cancer of the breasts could rob a woman and her loved ones peace of mind. Obviously to Brangelina, that was no life.
How about a woman with breast cancer?
As we alluded to earlier, losing one breast, even because of cancer, is devastating enough, and to lose two healthy breasts is much much more so. A common knowledge in surgery are cases where women with cancer in one breast who were advised to have the normal one also removed because of a strong family history had refused because of their own or their husband’s objection, only to return a year or two later with cancer of the other breast. The risk in this situation could be higher. However, each individual personal and medical situation is different and should be treated as such.
How can a woman decide?
The dilemma of losing a part of one’s body, especially a woman’s breasts, is terrifying, to say the least. Not only to her but to the entire family. However, the medical statistics in the case of defective versions of the BRAC1-BRAC2 genes are so overwhelmingly convincing among the very few women found to carry them that the decision appears to be straightforward for them, realistically speaking: either double mastectomy or a prematurely shortened life. In her own case, Angelina had obviously decided that life was more important to her than any part of her anatomy. For a sexy woman to strongly feel that way is a triumph of wisdom and love of life over vanity. Indeed, Angelina Jolie is a hero to her husband, Brad, and their six children, to women in general, and an inspiration to all of us.
This and other health articles are compiled in a book listed in the US Library of Congress which you could view at www.philipschua.com
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Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. He is the chairman of the Filipino United Network – USA, a 501(c)(3) humanitarian foundation in the United States. Email: [email protected]
