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Editorial: Jolie’s Mastectomy

Angelina Jolie possesses a good brain, voluptuous beauty and, for now at least, Brad Pitt. Her creative talents, as an actress and film director, as well as her humanitarian work on behalf of poor children the world over, are noteworthy. She lives large — and largely in public view.

So when Jolie, 37, announced last week that she had had a double mastectomy earlier this year in a bid to prevent breast cancer, news outlets jumped on the story. The New York Times published her op-ed piece, in which she explained her rationale for having radical surgery in the absence of apparent disease.

In a way, it’s curious that the announcement proved so riveting. Jolie is hardly the first woman to choose prophylactic surgery in order to reduce the risk of breast cancer, the leading cancer killer among women and a disease that women say they fear most. The use of such surgery doubled between 1998 and 2005, according to Harvard Women’s Health Watch, in part because of the prevalence of genetic testing. A third of women who have gene mutations elect to have preventive mastectomies.

But Jolie, whose mother died at 56 after fighting both breast and ovarian cancer, may be the first mega-celebrity to make such a choice and then publicize it. We suspect the flurry of attention reflected less an interest in breast cancer and the agonizing decisions women make than a prurient fascination with Jolie herself — a woman who’s been known to don a décolleté gown and flaunt a leg for the benefit of an admiring public. If a Hollywood femme fatale can live without her natural breasts — powerful symbols of femininity and sexuality — then anyone can.

In fact, Jolie implied as much in her commentary for the Times. If I can get through this ordeal, so can you, she seemed to say. She described three months of medical procedures for breast reconstruction in the hope that other women might benefit from understanding aspects of her experience. While her message was directed mainly to women who, like her, carry a rogue gene, she urged all women to educate themselves about the disease and understand their individual risk. That’s good advice, and Jolie’s story may lend courage to women with a genetic predisposition to the disease. “On a personal note, I do not feel any less of a woman,” she wrote. “I feel empowered that I made a strong choice that in no way diminishes my femininity.”

The danger, however, is that some women may come to believe that preventive mastectomies are the only reliable way to reduce the likelihood of breast cancer, or to prevent death from the disease. While many doctors do recommend mastectomies for those with genetic mutations who want to minimize their cumulative risk — estimated to be about 65 percent to age 70 — it’s important to keep in mind that genetic breast cancers are relatively rare, causing between 5 and 10 percent of all tumors. Furthermore, those who do have genetic mutations don’t have to submit to preventive surgery; they can opt for frequent and rigorous diagnostic screening, including mammograms and MRIs.

At a time when many doctors are trying to educate women about non-life-threatening breast cancers and the dangers of so-called overdiagnosis, it would be regrettable if Jolie’s story ignited more fear and anxiety about a disease that already causes plenty of both.