In May 2013, Angelina Jolie shocked the public with an opinion piece explaining why she chose to surgically remove both her breasts. “I have a ‘faulty’ gene, BRCA1,” she wrote, “which sharply increases my risk of developing breast cancer and ovarian cancer.”
After the article was published, the number of women asking for genetic tests skyrocketed in what has been dubbed the ‘Angelina effect.’
Last month, she followed up with another article on her decision to have her ovaries and fallopian tubes removed.
With it has flared up the debate over whether the ‘Angelina effect’ is a good or bad thing. Despite applause for her bravery and honesty, the overall sentiment of responding opinion pieces is against Jolie. Most of the women who want genetic testing don’t actually need it, critics say, and few can afford the expensive medical bills like Jolie can.
Tempting as it is to sling mud on celebrities who seem to have it all, her critics are wrong. Excessive BRCA gene testing can be a problem, but Jolie is doing the public a service by calling for women to get informed about cancer prevention and available treatment options. The benefits of raising public awareness about breast and ovarian cancer far outweigh the side effects that her critics are choosing to focus on.
A mutated version of the BRCA1 gene makes Jolie susceptible to breast and ovarian cancer because her cells are prone to turning cancerous. Adding in a family history with her mom, aunt, and grandmother dying of cancer, her doctors calculated that she had an 87% risk of getting breast cancer and a 50% risk of developing ovarian cancer.
The combination of genetic testing and preventive surgery lowered Jolie’s chances of getting cancer to just 5%.
Her journey reads as a success story of modern medicine, but it is far from typical. BRCA1 mutations are rare. They occur in approximately 1 in 800 people and account for only 10% of breast cancers.
The benefits of raising public awareness about breast and ovarian cancer far outweigh the side effects that Jolie's critics are choosing to focus on.
With a surge of women seeking genetic testing in the wake of Jolie’s articles, doctors are right to be concerned. The BRCA mutation is rare enough that most women shouldn’t worry about getting tested.
With any test, there’s a chance of false positives in which results show genetic abnormalities where there are none. These false positives then prompt unnecessary stress and further testing.
Genetic testing and subsequent treatment are also costly. Screening for BRCA mutations costs over $3,000 in the United States. This is a significant burden, especially for people who don’t have adequate health insurance. And in developing countries, where most breast cancer cases occur, genetic testing is simply out of the question.
But it’s unfair to blame these problems on Jolie. In her articles, she encourages women who have a family history of breast or ovarian cancer to “seek out the information and medical experts” that will help them “make [their] own informed choices.”
What she did after getting her genetic test results isn’t the right choice for everyone. Already a mother of six, she could remove her reproductive organs; she was done having children. For younger women, the desire to bear children can complicate this decision.
But knowing the available options helps women make the best choice. Women with BRCA mutations can at least be vigilant about getting screened for breast and ovarian cancer, increasing their odds of catching signs of disease early on.
The best way to avoid excessive genetic testing for women is through better education. Women need to understand what BRCA mutations are, the purpose of genetic testing, and that these concerns are relevant only if they have a strong family history of breast or ovarian cancer. Then they can make informed decisions.
Finally, it’s silly to shame Jolie for being able to afford the costs of genetic testing and preventive surgery. The financial squeeze is real and should become an impetus for health care providers to find cheaper detection methods. Fears over rising health care costs cannot be the reason women do not get testing that could save their lives.
What Jolie has done is admirable. Her opinion pieces have raised awareness and started conversations about breast and ovarian cancer. People are now talking about what women with BRCA mutations can do to get informed and make the best decisions for themselves and their families. The process is challenging, Jolie concludes, but “knowledge is power.”