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 4:06 PM EDT, Tue October 21, 2014
Timothy Stanley says Lewinsky is shamelessly playing the victim in her affair with Bill Clinton, humiliating Hillary Clinton again and aiding her critics
updated 9:02 PM EDT, Mon October 20, 2014
Imagine being rescued from modern slavery, only to be charged with a crime, writes John Sutter
updated 12:00 PM EDT, Tue October 21, 2014
Tidal flooding used to be a relatively rare occurrence along the East Coast. Not anymore, write Melanie Fitzpatrick and Erika Spanger-Siegfried.
updated 7:35 AM EDT, Tue October 21, 2014
Carol Costello says activists, writers, politicians have begun discussing their abortions. But will that new approach make a difference on an old battleground?
updated 9:12 AM EDT, Tue October 21, 2014
Sigrid Fry-Revere says the National Organ Transplant Act has caused more Americans to die waiting for an organ than died in both World Wars, Korea, Vietnam, Afghanistan and Iraq
updated 2:51 PM EDT, Tue October 21, 2014
Crystal Wright says racist remarks like those made by black Republican actress Stacey Dash do nothing to get blacks to join the GOP
updated 6:07 PM EDT, Tue October 21, 2014
Mel Robbins says by telling her story, Monica Lewinsky offers a lesson in confronting humiliating mistakes while keeping her head held high
updated 9:29 AM EDT, Mon October 20, 2014
Cornell Belcher says the story of the "tea party wave" in 2010 was bogus; it was an election determined by ebbing Democratic turnout
updated 4:12 PM EDT, Mon October 20, 2014
Les Abend says pilots want protocols, preparation and checklists for all contingencies; at the moment, controlling a deadly disease is out of their comfort zone
updated 11:36 PM EDT, Sun October 19, 2014
David Weinberger says an online controversy that snowballed from a misogynist attack by gamers into a culture war is a preview of the way news is handled in a world of hashtag-fueled scandal
updated 8:23 AM EDT, Mon October 20, 2014
Julian Zelizer says Paul Krugman makes some good points in his defense of President Obama but is premature in calling him one of the most successful presidents.
updated 10:21 PM EDT, Sun October 19, 2014
Conservatives can't bash and slash government and then suddenly act surprised if government isn't there when we need it, writes Sally Kohn
updated 8:28 AM EDT, Mon October 20, 2014
ISIS is looking to take over a good chunk of the Middle East -- if not the entire Muslim world, write Peter Bergen and Emily Schneider.
updated 9:00 AM EDT, Mon October 20, 2014
The world's response to Ebola is its own sort of tragedy, writes John Sutter
updated 4:33 PM EDT, Fri October 17, 2014
Hidden away in Russian orphanages are thousands of children with disabilities who aren't orphans, whose harmful treatment has long been hidden from public view, writes Andrea Mazzarino
updated 1:22 PM EDT, Sat October 18, 2014
When you hear "trick or treat" this year, think "nudge," writes John Bare
updated 12:42 AM EDT, Sat October 18, 2014
The more than 200 kidnapped Nigerian schoolgirls have become pawns in a larger drama, writes Richard Joseph.
updated 9:45 AM EDT, Fri October 17, 2014
Peggy Drexler said Amal Alamuddin was accused of buying into the patriarchy when she changed her name to Clooney. But that was her choice.
updated 4:43 PM EDT, Thu October 16, 2014
Ford Vox says the CDC's Thomas Frieden is a good man with a stellar resume who has shown he lacks the unique talents and vision needed to confront the Ebola crisis
updated 4:58 AM EDT, Sat October 18, 2014
How can such a numerically small force as ISIS take control of vast swathes of Syria and Iraq?
updated 9:42 AM EDT, Fri October 17, 2014
How big a threat do foreign fighters in Syria and Iraq pose to the West? It's a question that has been much on the mind of policymakers and commentators.
updated 8:21 AM EDT, Fri October 17, 2014
More than a quarter-million American women served honorably in the Iraq and Afghanistan wars. Now they are home, we have an obligation to help them transition back to civilian life.
updated 4:27 PM EDT, Thu October 16, 2014
Paul Begala says Rick Scott's deeply weird refusal to begin a debate because rival Charlie Crist had a fan under his podium spells disaster for the Florida governor--delighting Crist
updated 12:07 AM EDT, Thu October 16, 2014
The longer we wait to engage on Ebola, the more limited our options will become, says Marco Rubio.
updated 7:53 AM EDT, Wed October 15, 2014
Democratic candidates who run from President Obama in red states where he is unpopular are making a big mistake, says Donna Brazile
updated 12:29 AM EDT, Thu October 16, 2014
At some 7 billion people, the world can sometimes seem like a crowded place. But if the latest estimates are to be believed, then in less than a century it is going to feel even more so -- about 50% more crowded, says Evan Fraser
updated 12:53 PM EDT, Mon October 20, 2014
Paul Callan says the Ebola situation is pointing up the need for better leadership
updated 6:45 PM EDT, Wed October 15, 2014
Nurses are the unsung heroes of the Ebola outbreak. Yet, there are troubling signs we're failing them, says John Sutter
updated 1:00 PM EDT, Wed October 15, 2014
Dean Obeidallah says it's a mistake to give up a business name you've invested energy in, just because of a new terrorist group
updated 7:01 PM EDT, Wed October 15, 2014
Fear of Ebola is contagious, writes Mel Robbins; but it's time to put the disease in perspective
updated 1:44 PM EDT, Tue October 14, 2014
Oliver Kershaw says that if Big Tobacco is given monopoly of e-cigarette products, public health will suffer.
updated 9:35 AM EDT, Sat October 18, 2014
Stop thinking your job will make you happy.
updated 10:08 PM EDT, Tue October 14, 2014
Ruben Navarrette says it's time to deal with another scandal involving the Secret Service — one that leads directly into the White House.
updated 7:25 AM EDT, Tue October 14, 2014
Americans who choose to fight for militant groups or support them are young and likely to be active in jihadist social media, says Peter Bergen
updated 9:03 AM EDT, Mon October 13, 2014
Stephanie Coontz says 11 years ago only one state allowed same sex marriage. Soon, some 60% of Americans will live where gays can marry. How did attitudes change so quickly?
updated 4:04 PM EDT, Tue October 14, 2014
Legalizing assisted suicide seems acceptable when focusing on individuals. But such laws would put many at risk of immense harm, writes Marilyn Golden.
updated 9:07 AM EDT, Mon October 13, 2014
Julian Zelizer says the issues are huge, but both parties are wrestling with problems that alienate voters
updated 6:50 PM EDT, Mon October 13, 2014
Mel Robbins says the town's school chief was right to cancel the season, but that's just the beginning of what needs to be done
updated 11:43 AM EDT, Sat October 11, 2014
He didn't discover that the world was round, David Perry writes. So what did he do?
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT