Did Angelina Do the Wrong Thing?

A woman’s mother dies at age 56. A blood test is done. The woman finds out she has a genetic pre-disposition to cancer. She takes what action she thinks she needs to take. A familiar story repeated over and over again every day. I’ve met many women who have made this choice. While not “normal”, it is a familiar situation. These women’s difficult choices go unheralded. But not Angelina. She has a voice and she’s not afraid to use it.

I am of two minds about Ms. Jolie’s announcement. Unlike double mastectomies for ductal carcinoma in situ (DCIS), which isn’t necessarily a cancer and can be treated with a lumpectomy, BRCA1 gene mutations can’t be treated any other way. Unless I hear differently from my breast surgeon friends, I’d say she probably did the right thing. Her decision to talk about it is probably encouraging to women who have or will have to make that choice. It raises awareness of the gene mutation. It puts breast cancer on the front page of the New York Times. Again.

Here’s my problem: double mastectomy is not a benign procedure. Ms. Jolie seems to have had a remarkably easy time of it. Yes, she says she was right back to her normal life soon after, but since Jolie’s life is not normal that’s hard to generalize. The truth is there is significant pain involved, a long period of waiting while the tissue expanders do their work, then there’s further procedures for the implants, which can develop capsules around them, or rupture, or get infected. If Angelina had chosen breast reconstructive surgery there would be the risk of the flap losing blood flow, multiple drains, overnight stays in recovery rooms or ICUs, and many many surgeries for revision, nipple creation, etc. And the results are not always beautiful. I understand that it is not Ms. Jolie’s role to scare people, but to encourage them. I would just warn against falsely rosy expectations.

I am not trying to discourage double mastectomy. Sometimes it is necessary. I do think that people who have extraordinary access to public attention must pay extraordinary attention to what they say. I wish Angelina all the best for a complete, and beautiful, recovery.

Shirie Leng, MD is a practicing anesthesiologist at Beth Israel Deaconess Medical Center in Boston. She blogs regularly at medicine for real.

5 replies »

  1. The other problem with this blog post is that it conflates mastectomy with reconstruction. I had a double mastectomy due to BC lesions in both breasts, but I opted not to have reconstruction. The operation lasted about 2 hours, there was very little pain, I was out of the hospital the next day, the bandages were off within three days, the drains were out after 10 days. It wasn’t a walk in the park, but it wasn’t the extended process involving repeat surgeries and increased risk required by reconstruction. Reconstruction is the right choice for many women, and I agree that it should be covered by insurance. But it’s a choice: it should not be considered to be the default or required or assumed follow-up to mastectomy.

  2. Dr Leng is not a breast surgeon, and thus her opinion on this matter is entirely irrelevant.

    It would be the same thing as asking my internal medicine primary care doc to opine on the pros/cons in using versed vs propofol for a pediatric trauma case.

  3. I disagree completely. This was an informed choice, made with plenty of scientific evidence, by a woman who weighed the options and outcomes and decided. It’s her choice, it’s her body, and carping about what she chose serves NO ONE.

    I’ve had breast cancer. I don’t know if I carry the BRCA1 or BRCA2 genes (likely not, based on family history), and have not been tested since I couldn’t afford said testing. However, there are a number of women I know personally who have deep, disastrous family histories of breast and ovarian cancer who have been tested and who have elected to have prophylactic mastectomy or oophorectomy or hysterectomy. Again, informed choice.

    I applaud Ms. Jolie’s going public with this, since she says the reason she did was to make women’s health a global focus. She’s got the Q-rating throw-weight to make a huge difference. I personally have no problem with that – do you? Really?

  4. This article uses a attention getting headline to lure readers to no intelligent content. Anjelina Jolie was careful about what she said. She did not whine or complain about what she went through. And in being careful and stating her decision process she helped decrease the thousands of articles that would have been written speculating on her level of discomfort when information and misinformation about her procedure was leaked to the press. Dr. Leung seems to suffer from the same fear of loss of power many of my fellow physicians have when a patient clearly makes a decision based on what is right for them rather then relying on their doctor to make their decision for them. Ms. Jolie did not imply that her decision was right for anyone else. We did not need Dr. Leung to tell us the obvious – that Ms. Jolie’s life is not the same as the average woman’s. Tell me Dr. Leung, did the attention you got from writing the article sooth your pain? Female physicians have no more right to take away a women’s power to make decisions about her own body then male physicians do. Ms. Jolie made her own decision and her article supports other women do the same. Other women are not going to run out and get their breasts cut off just because Ms. Jolie did not wallow or complain of how difficult her decision or recovery was. This article was a useless way to grab attention by using a famous name in the title.