Wednesday, May 15, 2013

Angelina Jolie's Breasts, Modern Science, and The Critical Mom

Fifty years hence, mothers will be sitting down with daughters and saying, "There was an actress, sometime around 2011, or a year or so later--I can't remember her name--who had her breasts cut off because she thought it would prevent her from getting breast cancer.  And it didn't.  You know, they used to just cut everything out--"
And the daughter's jaw will drop.  She'll say, "Really, Mommy?"
  Journalists applaud Angelina Jolie for her bravery in parting with her breasts.  She appears to be acting in good faith on the advice of her doctors, who have informed her of the likelihood that she will, like her mother, contract breast cancer. Her mother died at 56--my age--from breast cancer, and Jolie herself has a "genetic variant" that her doctors have told her makes her likely to come down with the disease.  Her aunt, at 61, just succumbed as well.  Women with BRCA1 or BRCA2 mutations have a risk of 60-90% or of 87% depending upon which medical authority one asks.  Their children have a fifty percent chance, says the medical opinion of the hour. 
But unless you can act on it immediately and knowingly, such information remains harmful.  A so-called 87% chance might as well come out of my sixth-grade Math textbook, How To Lie With Statistics.  The Spring 2013 issue of Columbia Magazine offers an article on pre-natal genetic testing, asking the question whether genetic markers indicating potential problems in a fetus should be discussed with parents.  Yes and no.
It all depends.  Even things that are true can be proved.  Women worry when they are pregnant.  Why give them more to worry about especially when the squiggle in the genetic material suggesting a possible problem may just be a slightly sloppy hunk of human material meaning absolutely nothing?  They can't really tell whether certain squiggles are pathological or merely idiosyncratic.  Should a mother worry that her fetus might have developmental delays when the geneticists find something unusual?  Should Angelina Jolie really have had her breasts removed just because her mother died of breast cancer and Jolie herself has the "genetic variation?"  
She regards her own mother idealistically:  ‘I will never be as good a mother as she was. She was just grace incarnate. She was the most generous, loving — she’s better than me.’  Meanwhile her mother-in-law, a health advocate, insisted she go get tested.   What if Jolie's decision is a contorted way of mourning her mother?  If Jolie is terrified, then maybe she has a reason to be, but it is she who should evaluate the sources of her terror. Not her doctor. Did her mother breast feed?  Jolie breastfed her twins.  Breastfeeding is one of nature's protections against cancer, but of course it's not foolproof.  Nothing is.  But the hunches of the woman diagnosed with problems or potential problems are more important than the diagnosis.  A pregnant friend dreamed repeatedly that her baby was being strangled.  She told the doctor her dream and he laughed at her.  The child had the cord around his neck.  I told my doctor that my second child was enormous.  With the most sophisticated ultrasound equipment then available, my doctor insisted that he was anything but--"maximum, 3,700 grams," insisted my doctor, who had done his Ph.d in ultrasound.  P.S. My son weighed 4,200 grams (9 1/2 pounds) and was 56 centimeters long (over 22 inches).  At birth, he'd outgrown the baby clothes mailed him by well-meaning friends.  
Now, my doctor knew much more about medicine than I did.  I know nothing.  But I was right.  I had a strong feeling and I did not tell myself "Oh, well, the doctor knows more than I do."  I wonder about Angelina Jolie.  Did terror or her own good sense drive her decision?

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