Skip to main content

Jolie's choice carries risks along with benefits

By Aaron E. Carroll, Special to CNN
updated 10:12 AM EDT, Thu May 16, 2013
STORY HIGHLIGHTS
  • Aaron Carroll: Jolie op-ed on elective double mastectomy was brave, raised consciousness
  • Women have more info today to make such a decision, but it also has downsides, he says
  • He says other women, such as Peggy Orenstein, have written about opting not to do it
  • Carroll: Jolie's decision was brave, but Orenstein's was, too

Editor's note: Dr. Aaron E. Carroll is an associate professor of pediatrics at the Indiana University School of Medicine and the director of the university's Center for Health Policy and Professionalism Research. He blogs about health policy at The Incidental Economist and tweets at @aaronecarroll.

(CNN) -- Angelina Jolie stunned many people with an op-ed Tuesday describing her reasons for choosing to have a preventive double mastectomy. Her mother passed away at the age of 56 after battling ovarian cancer. Moreover, Jolie found that she had the BRCA1 gene, which significantly increases the lifetime risk of breast cancer. In fact, she reports that her doctors estimated that she had an 87% chance of developing breast cancer.

I have no doubt that this piece is causing many women across the country to think about their own health and chances of developing the disease. Thanks to many successful organizations, breast cancer awareness is at an all-time high in the United States. A person of Jolie's stature publicly discussing such a personal and difficult decision will likely weigh on the minds of many women who have similar concerns. Breast cancer is a real disease, it's not rare, and it can potentially strike almost anyone. I have no doubt that her op-ed in The New York Times will help many women who would not have considered this procedure to do so now.

Five reasons we love Angelina Jolie

In one sense, that is a good thing. There are legitimate and real reasons for some women to consider a preventive, or prophylactic, mastectomy. Some women who have had breast cancer in one breast elect to have a mastectomy of the other breast to prevent the cancer from spreading there. Some women who have a family history of cancer, especially before age 50, might consider the procedure.

Aaron E. Carroll
Aaron E. Carroll

More recently, women who have been able to learn through genetic testing that they have the BRCA1 or BRCA2 gene, both of which make it more likely that they might develop cancer, have been given new information that may help them make a decision.

It's a personal decision. It's also a serious one, because there are downsides to a preventive mastectomy as well.

First of all, it's still a major procedure, and it carries all the risks of one; one should never minimize the risks of a big operation. It's also irreversible, and some women do suffer psychological or physical consequences afterward. No one should ever judge another woman's decision in this area, but it would serve individual patients poorly for doctors not to discuss with them both the potential harms as well as benefits.

Opinion: Angelina Jolie's brave message

Explaining Jolie's cancer gene
CNN anchor: I have breast cancer
CNN archives: Jolie on her mom's cancer

It's also important to recognize that even a preventive mastectomy is not a guarantee against cancer. Studies show that it's about 90% effective in preventing breast cancer in moderate and high-risk women. That still leaves a 10% chance of developing cancer in the chest wall, armpit or even in the abdomen. That's because it's pretty much impossible for even the best surgeon to remove all breast tissue from a woman.

Because of this, some women choose not to have the procedure done, even when they are at high risk. Just a few weeks ago, Peggy Orenstein wrote a compelling account of her decision not to undergo the procedure after her first brush with breast cancer. Her reasons are just as valid and important as Jolie's but may not make the same splash in our national discussion.

Part of the reason for that is that there are few stars with Jolie's fame who could claim this sort of attention. But there's a larger current here that is worth considering. We in America sometimes are risk averse. We favor trying to reduce the chance of something bad happening to as close to zero as possible. We also tend to err on the side of doing something rather than nothing. There's nothing inherently wrong with this type of behavior. But we should recognize it.

My preventive mastectomy: Staying alive for my kids

We tend to screen more than other countries. We tend to push for more invasive and technologically driven solutions. We do these things, sometimes, at the expense of both health and money. In the last few years, there has been some pushback against the potential over-use (and detriment) of mammograms and prostate specific antigen tests. Such debates are controversial but important.

You can't reduce risk to nothing. Trying to do so will lead to practices none of us would support. After all, someone could make the argument that we should remove all breast tissue from all women because you never know where breast cancer will strike. That's hyperbolic, and no one is suggesting it, but it shows that this is really a personal, and individual decision.

That's how it should be. Jolie's relating her decision to have a preventive mastectomy is no more or less brave than Orenstein's decision not to have one. But both are welcome in their bringing to the forefront that these are discussions that every woman should have with their physicians, their loved ones and themselves.

Follow us on Twitter @CNNOpinion.

Join us on Facebook/CNNOpinion.

The opinions expressed in this commentary are solely those of Aaron E. Carroll.

ADVERTISEMENT
Part of complete coverage on
updated 6:10 PM EST, Mon November 24, 2014
If Obama thinks pushing out Hagel will be seen as the housecleaning many have eyed for his national security process, he'll be disappointed, says David Rothkopf.
updated 8:11 AM EST, Tue November 25, 2014
The decision by the St. Louis County prosecuting attorney to announce the Ferguson grand jury decision at night was dangerous, says Jeff Toobin.
updated 3:57 AM EST, Tue November 25, 2014
China's influence in Latin America is nothing new. Beijing has a voracious appetite for natural resources and deep pockets, says Frida Ghitis.
updated 4:51 PM EST, Mon November 24, 2014
Iranian President Hassan Rouhani speaks during a press conference in the capital Tehran on June 14, 2014.
The decision to extend the deadline for talks over Iran's nuclear program doesn't change Tehran's dubious history on the issue, writes Michael Rubin.
updated 2:25 PM EST, Fri November 21, 2014
Maria Cardona says Republicans should appreciate President Obama's executive action on immigration.
updated 7:44 AM EST, Fri November 21, 2014
Van Jones says the Hunger Games is a more sweeping critique of wealth inequality than Elizabeth Warren's speech.
updated 6:29 PM EST, Thu November 20, 2014
obama immigration
David Gergen: It's deeply troubling to grant legal safe haven to unauthorized immigrants by executive order.
updated 8:34 PM EST, Thu November 20, 2014
Charles Kaiser recalls a four-hour lunch that offered insight into the famed director's genius.
updated 3:12 PM EST, Thu November 20, 2014
The plan by President Obama to provide legal status to millions of undocumented adults living in the U.S. leaves Republicans in a political quandary.
updated 10:13 PM EST, Thu November 20, 2014
Despite criticism from those on the right, Obama's expected immigration plans won't make much difference to deportation numbers, says Ruben Navarette.
updated 8:21 PM EST, Thu November 20, 2014
As new information and accusers against Bill Cosby are brought to light, we are reminded of an unshakable feature of American life: rape culture.
updated 5:56 PM EST, Thu November 20, 2014
When black people protest against police violence in Ferguson, Missouri, they're thought of as a "mob."
updated 3:11 PM EST, Wed November 19, 2014
Lost in much of the coverage of ISIS brutality is how successful the group has been at attracting other groups, says Peter Bergen.
updated 8:45 AM EST, Wed November 19, 2014
Do recent developments mean that full legalization of pot is inevitable? Not necessarily, but one would hope so, says Jeffrey Miron.
updated 8:19 AM EST, Wed November 19, 2014
We don't know what Bill Cosby did or did not do, but these allegations should not be easily dismissed, says Leslie Morgan Steiner.
updated 10:19 AM EST, Wed November 19, 2014
Does Palestinian leader Mahmoud Abbas have the influence to bring stability to Jerusalem?
updated 12:59 PM EST, Wed November 19, 2014
Even though there are far fewer people being stopped, does continued use of "broken windows" strategy mean minorities are still the target of undue police enforcement?
updated 9:58 PM EST, Mon November 17, 2014
The truth is, we ran away from the best progressive persuasion voice in our times because the ghost of our country's original sin still haunts us, writes Cornell Belcher.
updated 4:41 PM EST, Tue November 18, 2014
Children living in the Syrian city of Aleppo watch the sky. Not for signs of winter's approach, although the cold winds are already blowing, but for barrel bombs.
updated 8:21 AM EST, Mon November 17, 2014
We're stuck in a kind of Middle East Bermuda Triangle where messy outcomes are more likely than neat solutions, says Aaron David Miller.
updated 7:16 AM EST, Mon November 17, 2014
In the midst of the fight against Islamist rebels seeking to turn the clock back, a Kurdish region in Syria has approved a law ordering equality for women. Take that, ISIS!
updated 11:07 PM EST, Sun November 16, 2014
Ruben Navarrette says President Obama would be justified in acting on his own to limit deportations
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT