Breast Wishes: Angelina Jolie’s double mastectomy is not for everyone

Photo Courtesy of Aliza Zevari

Photo Courtesy of Aliza Zevari

Most of us know someone who has been diagnosed with breast cancer. Some of us even are that person. Although Angelina Jolie does not have cancer, her late mother Marcheline died at 56 of breast and ovarian cancer. When Jolie found out she carries a gene that increases her cancer risk, she had a double mastectomy as a preventive measure. As she wrote in The New York Times on Tuesday, “I can tell my children that they don’t need to fear that they will lose me to breast cancer.” Due to the surgery, her breast cancer risk has decreased from 87% to under 5%.

Preventive double mastectomies are on the rise in North America. According to The Journal for Clinical Oncology, from 1998 to 2005 they rose 188%. With Jolie’s public confession, that number will likely increase, whether it should or not.

By all appearances, the breast cancer awareness campaign has been a raging success. Early detection by mammogram and clinical exam has purportedly saved countless lives and women have been encouraged to begin screening as early as their early 20s.

The problem with the rampant screening is, in addition to the lives it saves, it alerts women to potential cancers that would never metastasize and become dangerous. Jolie took a costly test to find that she carries a gene marker for cancer. In her case, the prophylactic surgery appears to be a prudent decision. There’s a general and hazy belief out there that early screening helps all women, yet research does not bear this out. Studies show  mammograms and clinical exams reduce breast cancer death rates by 25%—but only for women over 50. The chances of a woman in her 20s getting breast cancer in the next 10 years is about the same as a man in his 70s.

Further, there are a variety of cancers, from the easy-to-treat ones to the really awful, usually terminal ones. The most mild form is ‘ductal carcinoma in situ’ (DCIS). It is only a risk factor for breast cancer and is therefore referred to as ‘Stage Zero’. It might metastasize; it might not. Since universal screening took effect, rates of DCIS have skyrocketed. Once diagnosed, these women submit themselves to painful and toxic treatments, including mastectomies. Unfortunately, mammograms are poor at detecting the most aggressive and lethal form of cancer. Called ‘triple negative’, it accounts for 20% of breast cancers.

Then there is the uneven quality of screening. Cancer Care Ontario just published a mammoth study that found a quarter of the mammography devices in use are 20% less effective at detecting breast cancers than others. The province is currently planning to replace the computed radiography (CR) machines at a cost of $25 million. It is, of course, up to the patient to find out what type of equipment the hospital has been used on her.

For all the apparent successes of early screening and increased detection of breast cancer, there have also been some costs. As Peggy Orenstein, a breast cancer survivor, points out in her excellent feature in The New York Times, the explosion in breast cancer diagnoses without the distinction among types of cancer, leave the impression that breast cancer is everywhere and that one’s own breasts are a ticking time bomb of cancerous cells just waiting to pounce and destroy us.

Given her family history and her gene marker, Jolie’s breasts were indeed ticking. But, as most women know all too well, sigh, we are not Angelina Jolie.


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