No-Brainer

I'd be the first to tell you that Angelina Jolie is just that little bit (or a lot, sometimes--that whole vial of blood necklace thing) too weird for me.  Staggeringly beautiful woman and all (although she desperately needs to eat a hamburger or twenty) but about as relatable to me as an alien.  That said, I've been taken aback by the criticism she's received for her decisions to prophylactically remove her breasts (two years ago) and ovaries (recently) because of her discovery that she carries a mutation in the BRCA1 gene.

Breast cancer research was my professional field for years.  The BRCA1 gene (a massive one, by the way) is considered a tumor suppressor gene and its protein product helps to repair damaged DNA or trigger self-destruct pathways in cells with DNA that cannot be repaired.  Hundreds of distinct DNA mutations in this gene have been identified, many of which are associated with an increased risk of cancer.  Logical: some DNA damage is inevitable, and failures in any part of the repair/cell death pathways are never a good thing.   A mutated BRCA1 gene generally results in a protein that is either abnormally truncated (shortened) or full-length but non- or only partially-functional.  It's worth noting that there is another similar gene called BRCA2, the protein product of which performs a similar function and is often also associated with failures in DNA repair and therefore cancer development.  Certain variations in BRCA1 and BRCA2 gene sequences are associated with absolutely staggering risk increases for breast and ovarian cancer in particular: depending on the mutations in question, over 80% risk of developing breast cancer and 55% risk of developing ovarian cancer.  These mutations are typically hereditary, which is why doctors ask about family history for these cancers (and other cancers in general) and why people with strong family histories of breast and ovarian cancer should strongly consider being tested for the presence of these mutations.

Ms. Jolie's mother, aunt and grandmother were all lost to ovarian cancer.  She had herself tested for BRCA1 mutations, and the test came back positive.  That put her at a huge risk for developing one or both of these cancers, and probably at a relatively young age (her mother died of ovarian cancer at 56) but at least she knew that.  Information is power.  Breasts are relatively easy to monitor through imaging, and they are conveniently located on the exterior of the chest wall, where they can be palpated.  Ovaries, on the other hand, are not conveniently located.  What's more, there are currently no truly reliable markers for ovarian cancer in blood testing.  CA-125, the most commonly used one, is especially poor at identifying the presence of early-stage ovarian cancers, which are the only kind that are really curable or even treatable.  Ovarian cancers generally are asymptomatic until very advanced, so watching for symptoms is pretty much useless and that blood test isn't much better.

Nobody wants to have to make decisions to have what appear to be normal, functional body parts removed.  I can't even begin to imagine all the body image and sexuality and gender associations there would have to be with choosing to have a good chunk of your female reproductive system removed, never mind all the practical aftereffects (hormone replacement, etc) that come into play post-surgery, since ovariectomy catapults you into menopause.

That said??  If it were me, I'd have those suckers off/out in a heartbeat.  I'd be on the phone scheduling the surgery the day the DNA test results came in.  And I'm pretty sure I wouldn't have waited the two years between the mastectomies and the ovariectomies if I were her, either, knowing that my mom had died of ovarian cancer and that ovarian cancer is both terrible and hard to detect.  Why live with the knowledge that there is a ticking time bomb inside you with a high-percentage chance of explosion when you don't have to?  She made some tough decisions, but I'd have done the same damn thing, and I applaud her courage and also her decision to make the surgeries public information.

I am, in general, notoriously ANTI-celebrities delivering any kind of health message whatsoever (see e.g. that dipshit Jenny McCarthy and all the damage she has done to legitimate autism research and vaccination percentages) but in this case, I think her message is measured, scientifically legitimate, and a genuine public service.  If so much as a single person read one of her NY Times articles and said, "You know, there have been a lot of breast and ovarian cancer deaths in my family: maybe I should go get screened," that's a victory regardless of what decisions they make after they receive the DNA test results.  In the end, health information is power, and sometimes what you don't know can have devastating consequences.