This is the Woman You Want as Your Doctor

So, still on Angelina here. And why, aside from her marriage to Brad Pitt and her right leg having its own Twitter account, you and I are not like her. This clip from CNN is the best and most responsible summations I've seen over the last week. http://www.youtube.com/watch?v=P32GgL2n03g

I love it because  Dr. Monica Morrow from Memorial Sloan-Kettering is smart, calm and clear. She explains not only what you need to know but what you should ask your own doctor  if 1) you're concerned about a genetic mutation or 2) you are a woman of seemingly average risk diagnosed with breast cancer in one breast and think you should respond by having a double mastectomy "just in case."

The other reason this clip is great is because of the intelligence and sensitivity of the interviewer,  Zoraida Sambolin, who is herself dealing with a breast cancer diagnosis (though she doesn't reveal the nature of her cancer). When she starts talking about her decision-making process her voice shakes. I can see how hard this is for her to talk about on camera. But she sees it through in a way that is real, beautiful and, yes, brave.

Some key statements Dr. Morrow made that bear repeating:

Most women, even those with a mother or sister with breast cancer, don’t have a BRCA mutation.

also:

In the U.S. we’re seeing an incredible increase in double mastectomy in women [diagnosed with cancer in one breast] paradoxically at the same time that the risk of cancer in the other breast has gone steadily down because the medicine we use to treat the cancer you already have reduces that risk.

I am, you may recall, one of the beneficiaries of that risk reduction. I take a drug every day called tamoxifen, which I'll be on for a total of five years. It is not perfect--its side effects range from annoying night sweats to a small increase in your chance of uterine cancer--so you wouldn't want to take it without real cause. But you also wouldn't want to do chemo without cause. You take a drug because you need it. And I need it. Tamoxifen reduces my risk of cancer in my healthy breast to that of an average woman. As I wrote in  the New York Times Magazine

Average risk, after all, is not zero. Could I live with that? ...What did doing “everything” mean, anyway? There are days when I skip sunscreen. I don’t exercise as much as I should. I haven’t given up aged Gouda despite my latest cholesterol count; I don’t get enough calcium. And, oh, yeah, my house is six blocks from a fault line. Is living with a certain amount of breast-cancer risk really so different? I decided to take my doctor’s advice, to do only what had to be done.

Back to the CNN piece. Another crucial statement by Dr. Morrow:

It’s important for women to understand that having your other breast removed does not prolong your life. Many women believe that’s true. Unfortunately, it’s not. Breast cancer doesn’t spread from breast to breast so removing one breast doesn’t reduce your risk of the cancer spreading.

When you are diagnosed with breast cancer I know, believe me I know, you want it out yesterday. But in most cases there's really no rush. Take a few weeks: gather information, ask questions, find the right doctor. You will live with these decisions for the rest of your life which will hopefully be long and fruitful. Make them from a place of knowledge, not emotion. Find out what your true risk is not only of breast cancer but of metastatic disease (which is the kind that kills you) and how removing your breast or breasts will affect that.  Recognize that in many cases lumpectomy and radiation are as good and possibly better than mastectomy in terms of survival. Remember that what you do to your breast will not affect your survival as much as what you do systemically. To any  physicians reading this: I know that today's sensitive docs are taught to "listen" to their patients. But you are still responsible for educating them completely and fully. You can correct misinformation; you can give your opinion and argue for it.

Remember: Primum Non Nocere.

Finally, my favorite thing Dr. Morrow said,  something I may have tattooed right across my fake breast (since it's numb, I wouldn't feel the needles---bonus!) :

SURGERY IS A BAD WAY TO TREAT FEAR.

I respect Angelina Jolie's decision, but the take-away ought to be that it was a lousy choice to have to make. I'm not so sure having surgery makes her "brave," but what she does next might: like whether she becomes a voice against gene patenting, something you can find out more about from in this video from the ACLU or from groups like Breast Cancer Action or Breast Cancer Consortium (you will see nothing about gene patenting on  Komen's site, by the way, perhaps because Myriad Genetics, which owns YOUR genes, is a donor!).

http://www.youtube.com/watch?v=ywj_a0Mulvk&feature=player_embedded

Anyone can have body parts cut off; courage comes from asking why the choices are so grim; bravery from becoming an agent of change. So far, the only beneficiary of Jolie's revelation had been Myriad, whose stock rose in the wake of her announcement. I can't believe that was her intent.

Angelina, don't you want better choices for your children?

 Shiloh Jolie-Pitt, Angelina and Brad's 6-year-old daughter, February 2013