Angelina Jolie did something important for her children when she decided to have a preventive double mastectomy. And she did something important for other women when she explained her decision in an op-ed in the New York Times this week.
After Jolie’s doctors calculated that she had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer, of course she had the surgery and reconstruction. Maybe there is a woman somewhere who would ignore odds like that, but I can’t think why.
Still, though I guess I shouldn’t be surprised, various A-cup controversies followed her announcement:
First, mastectomy envy: What is she doing having surgery other women can’t afford, since even the genetic testing that informed her decision costs several thousand dollars? Goodness, people; Jolie herself noted that this life-saving option is largely unavailable to lower-income women, and that we need to figure out how to change that. But meanwhile, though she and her “partner, Brad Pitt” support a lot of good causes, expecting her not to find out because others can’t is punitive in the extreme. If you don’t like her, by all means don’t see her next movie. But the inference that she should die rather than have an ‘elite’ surgery says a lot more about our twisted feelings about movie stars than it does about her.
Then there are the professionals who worry that this new information could cause a lot of anxiety — you know how flighty we are — or even launch a trend. But if women channel their anxiety into learning what they can do to protect and discover more about their breast health, how is that not an unalloyed positive? Angie looks good, but the allure of major surgery is minor.
I know several women who have made this same decision — including my own fearless mother, Freida Henneberger, who had the surgery at 43 and is 80 now. Back when she did it, both prophylactic mastectomy and simultaneous reconstruction were new; she was among the first to have the mastectomy and the reconstruction done at the same, at the Mayo Clinic.
Though genetic testing wasn’t available then, she’d had many benign breast tumors, and had been advised that she was all but certain to develop breast cancer if she didn’t get out ahead of it. Of course she went through with it, and after the surgery, spoke to any women’s group that would have her, in and around our small town in Southern Illinois.
A teacher and antique dealer, she’d never really done any other public speaking, but went on the road with just her handy prop — a silicone implant — and the message that women did not have to be “mutilated” post-mastectomy. (All these years later, it’s outrageous how many people still see it that way, though; some stories about Jolie even referred to her “voluntary amputations.”)
All of the women I’ve known who headed off cancer in this way have said the same thing: Being around for their kids made new breasts a no-brainer.
And though I don’t happen to know any non-moms who’ve done it, wanting to stick around for yourself, your loved ones, and to see how the rest of the story goes are all darn good reasons, too.
My friend Lisa Friedman, a management consultant in Palo Alto who is writing a book about genetic risk, objects to the language about “removing breasts” — when thanks to reconstruction, this is not what happens. When someone needs a hip replacement, she notes, the question isn’t whether he or she is willing to “live without a hip.” And talking that way, about “living without breasts,” she argues, makes the whole thing scarier than it has to be.
Her husband, Herman Gyr, just returned from a trip to his native Switzerland, where the headlines about Jolie’s surgery read, ‘Brutal cut,’ and ‘Radical cut.’ But the talk about how women might prefer not knowing the odds were against them infuriated him even more:
“For an at-risk woman the choice to know is not primarily about her breasts — after all, today she has the option of tissue-replacement, using artificial tissue or her own tissue from another part of her body. Her choice is most importantly about living a full life.” Five years after Lisa’s surgery, he’s so grateful that “today my wife is alive and as beautiful as ever, something that would probably not be the case” had she not made the same decision Jolie made.
When I myself had a double mastectomy 10 years ago, after cancer, I found the language of “choice” — phony choice, mostly — ubiquitous in Cancerland. “What happens now is all up to you,” one doctor told me after the diagnosis. (Great, can I pick none of the above?)
Yet on another level, there are so many decisions to be made, not only about treatment, but about how to treat the whole experience, and it’s a cliche but also true that the physical changes are the least of it.
Probably because of my mother’s experience, I never second-guessed or even bemoaned what I had to do; it’s such an easy trade, given the alternative, and one that any number of women haven’t been fortunate enough to get to make.
For Jolie, who makes her living in part from her looks, the decision had other dimensions, of course, and she deserves extra credit for her openness. She lives in a world where elective surgery usually means something very different, and her decision to be proactive and public will save other lives.
When her children are older, they’ll be as grateful to her as I am to my mom. And as proud to know that her sacrifice was not just good for her, but good for all of us.