Melissa versus Angelina: What’s Wrong With This Picture?

When I first heard about Angelina Jolie’s breast surgery (how could you not hear about it?  The news seeped in everywhere, even if you never read a newspaper or watch TV), I thought, “Really?  An op-ed in the New York Times? National and international headlines??  Really?!”

Never mind the fact that, when discussing the news, the announcer on the Yahoo channel mispronounced two rather important terms: preventive (not preventative) and mastectomy (not massectomy).

Never mind the fact that it seemed the New York Times has skewed priorities for its opinion pages. (I wonder what our soldiers in Afghanistan had to say about their lives on that particular day).

And never mind that every time people look at Ms. Jolie now, they will see not just the luscious lips, the dark eyes, and her skeletal figure. Even more so than before, their eyes will move to her breasts, with judgment, and they will whisper to their friends, “You know they’re not real.”  (Stay tuned to see if Jolie’s career takes a hit as Hollywood may now see her as “damaged goods.”)

The ripples from Jolie’s announcement continue to work their way toward shore.

Some say Jolie was brave to put herself out there and describe rather intimate details of her life. Her decision is one grounded in the anguish that arises when a woman learns she has one of the genetic mutations (BRCA 1 and BRCA 2) that can lead to breast and ovarian cancer. But this is a decision thousands of unknown women have had to make in their own quiet, desperate ways, without the advantages (or pressures) of the spotlight.

The myriad comments by readers and viewers worldwide show that Jolie’s choice resonates with many people, and that’s good. But it does raise the repeated problem of a celebrity becoming the intact, smiling, healthy-looking poster child for a particular illness:

  • Think Christopher Reeve recovering from his spinal cord injury
  • Think Michael J. Fox wrestling with a body ravaged by Parkinson’s disease
  • Think Robin Roberts after her recent bone marrow transplant

Their integrity is remarkable. But so is that of the average person whose struggle with illness is never so much as commented on in the local newspaper.  Even Christina Applegate, an actress who went through a similar procedure several years ago, didn’t rate above-the-fold headlines in the national newspapers.

Maybe the celebrities give us hope. Maybe they’re also guilty of putting a pretty face on conditions that are devastating for most of us on a daily basis, making it all seem so easy, so manageable.

The latest opinion – once again reported in headlines — comes from Melissa Etheridge, who is no stranger to the topic of breast cancer, having been called equally brave for appearing bald onstage at the Grammy awards in 2005 while undergoing treatment for breast cancer. I don’t agree with much of what she says in her confusing response to Jolie’s situation (which was even more confusing once she tried to clarify her comments), but I do agree with her opinion that Jolie is not brave.

As has been reported widely, Jolie has a strong family history of breast cancer and carries a defective gene that could lead her down the same path as her mother and her aunt. Her choice to remove and rebuild her breasts decreases the likelihood of her developing breast cancer by as much as 85% or more. To seal the deal of prevention, she will also need to undergo an oophorectomy to remove her ovaries.

Jolie has six children who count on her presence in their lives. And though science still has a long way to go on the topic, it has at least presented people like Jolie with some options before cancer develops. What she did was not the brave thing. It is not “brave” to do the thing that can save your life. It is simply the thing you must do.

But Jolie’s is not the experience of most women who face breast cancer. Genetic mutations account for only about 10% of breast cancer cases. The other 90% of us have no warning, no predictors, no scientific data to arm us for the enemy when it comes. We’re simply blindsided and left to figure out what to do in response.

I’ve been waiting for the press to report what I anticipated would happen after Jolie’s announcement:  the spike in fear from women everywhere as we are all once again terrified by the threat of this disease, and the spike in demand for a genetic test that is extremely expensive and not covered by insurance, unless you can demonstrate a medical necessity for the test. (Fortunately, the good news from the Supreme Court recently that Myriad Genetics cannot patent the breast cancer genes should force that company to relinquish their monopoly, and their huge profits, on the genetic test.)

Finally, an article by Kevin O’Reilly in the American Medical News, a newsletter published weekly by the American Medical Association brought these ripples to light:

  • The confusion the story created for women everywhere, who fear they will be one of the more than 200,000 women diagnosed with breast cancer every year
  • The flood of phone calls to doctor’s offices by these frightened women
  • The onerous task of already overburdened physicians and nurses trying to separate facts from the fears for the patients who call.

The article summarizes the point well:  “[S]ome medical experts are voicing the concern that the Oscar-winning actress’s story could lead to inappropriate use of genetic testing and prompt women without hereditary cancer risk to demand prophylactic contralateral mastectomy when less invasive treatment options are as available.”

Jolie has been, and will remain, in the spotlight for a long time to come. Maybe she can now turn that light not on “the choice,” not on “the cure” but on the real problems:

  • Our continued reliance on mammography as the “gold standard” tool, when it clearly fails many women, either by missing the cancer or implying it’s there when it’s not. We need something better.
  • Our continued heavy emphasis on finding “the cure” to the exclusion of finding the causes. A cure is necessary, but the greater miracle would be finding – and stopping – the causes, including the causes of genetic mutations.

Jolie’s article in the Times, instead of focusing on the real problems women (as part of ALL humanity) face, focuses on breasts, and not the breasts of the average woman. Jolie herself distracts attention from these real problems by talking about “empowerment.” The comments supporting Jolie show that we are much too willing as a society to accept that cutting off breasts to prevent cancer is acceptable, even normal, which contributes to the idea of breast cancer as just another rite of passage for women, like marriage or childbirth.

If you want to really empower women, put more of them in the House and Senate, put more on boards of the major corporations, those very corporations guilty of the pollution that harms all of us. Statistics show that women tend to be very concerned about health and safety issues, especially those that affect their families. TRUE power (not the passive type that only reacts to an event) is the ability to make decisions to stop harming our citizens for profit, which our government and businesses should be doing. Telling women to get mammograms (and haggling over who should, who shouldn’t, and when) isn’t going to get it done. Having people like Jolie “come out” about her actions also isn’t going to get it done.

Angelina – you have the spotlight. Be the actress – act, and turn that spotlight where it should be.

And Melissa – keep those great tunes coming.


5 Responses to “Melissa versus Angelina: What’s Wrong With This Picture?”

  1. Kim Says:

    In my opinion, the brave part is coming forward and going public with her story. She certainly didn’t need to do that and, as you mentioned, there is a possibility that it will negatively impact her career. And making the choice to have the surgeries, while perhaps not brave exactly, is still a huge decision that is not made lightly. No one can know what they would do in that situation. And while it does seem to be simply what one must do, the fact is, the majority of women with gene mutations still don’t opt for the prophylactic surgeries. Mentally, it can be a big hurdle to get over to decide to have surgeries to remove body parts which do NOT have cancer.

    I applaud her decisions, both to take control of her health and to come forward. I think that, while there will undoubtedly be women who panic unnecessarily, there are still far too many women and men who are uninformed about their genetic history or their options if they do know their history. She will save many lives by coming forward.

    • Julie Yamamoto Says:

      Kim –
      I agree that many women will benefit from her stepping out, and that no one undertakes such decisions lightly (at least I hope not). Jolie is lucky to have the advantages of financial security that can buy the best health care and see her through should she lose her work status because of her situation. Regardless of her outcome, she will have many, many fans and supporters for many years to come. So, even though it’s a difficult decision even for her, her stakes in making such an announcement are likely lower than they are for most women.

      Because she has gone public, perhaps she should also help to dispel the confusion and fear by educating people about the facts — that the vast majority of women who get breast cancer do NOT have a genetic mutation, and even though there is a test for those who do, it checks only for BRCA 1 and 2, not for other mutations that might also lead to breast cancer that we don’t yet know about. And because only 5%-10% of breast cancers stem from these mutations, even a negative result on the test does not guarantee lifelong freedom from breast or ovarian cancer. (I know you know all this already. Part of my agenda here is to educate others.)

      It’s all a knotty problem, made more complex by the media’s need to garner headlines. My own consultation with a genetic counselor outlined for me just how complex genetic influences are. The Mayo Clinic site is very helpful for understanding the complexity of genetic testing for breast cancer, and laying out the options if one should test positive:

      • Kim Says:

        It’s true – the genetic influences are complicated, not very easy to understand, and only account for a small percentage of breast cancers. Many doctors don’t understand them – and I would venture to say, even some genetic counselors! Mine almost didn’t test me because she thought it was so unlikely to be positive, but I think I knew more probability and statistics than she did! And that knowledge is tremendously powerful for those who do have known mutations. And there is NO question that the available treatments, whether preventative or post-cancer, are unenviably harsh.

  2. lat Says:

    A friend whose mother, aunt, sister all had the diagnosis of breast cancer and death took some of those family members; before going to Guatemala (where medical treatments are not as advanced) with her husband and three children for a 4-year mission stint. It was decided by her to do exactly what Jolie did to prevent her from suffering the same fate as other female family members. It did not make the news. She did not become a poster child for braveness. She quietly (as far as the press goes) did what she felt she had to do and has gone on with her life. There is little doubt that many women have been faced with the same decision, but the world does not hear of their stories.

    Celebraties date, get married, get divorced, have new romances, have baby bumps… or has problems with family, money, drink or drugs… what they wear, how they look, what they said… it is all a world of show with all the glamour and media frenzie. Yet every day, every hour, each passing minute there are people who live the same experiences but never get the lime-light. It is only considered news worthy when someone famous does these every day things. If the good works or inspiration of the famous helps recognize deficiancies in our world, and there are plenty of them, then let them come forward and put the spot light on the conditions that 90% of the rest of the world are faced with each and every day. While celebraties are just as human as any of us, their facing of life’s situations should be no more celebrated or problematic than any common human being. Yet the reality is, most of the time they live on a different plane of life than we do and life just isn’t that fair for everyone. Their stories are no more entertaining or newsworthy than the person next door, except that the media believes it is.

    So where is the proof that Jolie’s “brave” decision has done anything to help “the little people” facing the same choices? Where is the media on that follow-up? From what I have seen, she is the only one who has since made the news on this one.

    • Julie Yamamoto Says:

      We probably won’t hear much follow-up from the press on the true impact of Jolie’s announcement on the general population. The only follow-up I found was the article in the AMA newsletter, which I mentioned in the post, and that’s the fallout on the medical community who has to answer questions from callers. I wonder if doctors don’t secretly roll their eyes in frustration every time a celebrity announces a health problem. I saw more press recently on James Gandolfini than on Nelson Mandela, who seems to be quite ill at the moment. Such are the priorities of our national media.

      If the celebrity announcement brings attention to a problem and serves others, that’s great. If the media look to make headlines based on that announcement, well shame on them. And more shame for not following up on the story once the thrill has passed. I’m not sure why Jolie chose to announce her situation in the NYT. That hardly seems appropriate. And I’ve seen no explanation by the editors of the NYT to explain why they thought it appropriate to print it. They did at least clarify some of the information about genetic testing a few days after they published Jolie’s editorial:

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