Monday 27 January 2020

Anjana Ahuja: Angelina's biggest victory is helping women use science to shape destiny

Every woman should have the same choice as Angelina Jolie
Every woman should have the same choice as Angelina Jolie

IF this was Angelina Jolie's masterplan to divert attention away from her upper thigh, which she flashed to worldwide acclaim last year at the Oscars, it was an extraordinarily dramatic one.

On Wednesday, in an article for the 'New York Times', Jolie revealed that, in order to avoid developing breast cancer, she had undergone a double mastectomy. Her chances of succumbing to it had been surgically felled from 87pc to just 5pc.

As a result, the disease that took Jolie's mother, Marcheline Bertrand, at the age of 56 after a decade of illness, would no longer cast a dark shadow over the 37-year-old actress and her family. "I can tell my children that they don't need to fear they will lose me to breast cancer," she wrote.

But Jolie's sentiments were about more than just survival. The power of what she wrote lies in the fact that she is feted for her looks and sexual allure – and that, while a lesser mortal might feel desexualised by the experience of losing her breasts, this icon of beauty apparently does not: "On a personal note, I do not feel any less of a woman. I feel empowered that I made a strong choice that in no way diminishes my femininity. I am fortunate to have a partner, Brad Pitt, who is so loving and supportive."

Along with reassuring us about the state of her body and the ongoing health of the Brangelina partnership, she does something rather surprising: she champions science as a means for women to shape their own medical destiny. And, while she's at it, she takes a much-needed swipe at the genetic testing industry for pricing breast cancer tests beyond the reach of most women.

Certainly, Jolie's account of how and why she came to lose her breasts constitutes a milestone in the public acceptance of what has tended to be seen as a rather extreme act of self-preservation.

In life's genetic lottery, Jolie has so far been an enviable winner. Beautiful, rich and talented, she has a film-star lover and six children, plus a creditable record as a UN special envoy for refugee issues. But her mother's battle with breast cancer, which started when she was only in her 40s, must have led Jolie to suspect the possibility of a genetic imperfection.

The uncommon mutation in her BRCA1 gene could have been inherited from either her mother or her father, the actor Jon Voight. A family history of breast cancer, however, does not always mean that the smoking gun is a genetic one.

In fact, at least 95pc of breast cancers are not associated with any specific genetic mutation. Instead, they are thought to result from a complex interplay of milder genetic risks and lifestyle factors, such as smoking and delayed motherhood.

Interestingly, Jolie opted for the technique that is most like a standard boob job. First, she underwent a procedure to save her nipples – after first checking that they were disease-free – and then had expanders put in to replace the removed breast tissue.

But there are two modern techniques that result in a more natural look. The first is autologous flap reconstruction, which involves replacing the removed breast tissue with the patient's own tummy tissue.

Essentially, it's a tummy tuck and breast reconstruction rolled into one: "This is the most lifelike option because it uses your own tissue: your breasts age with you, and when you lose or gain weight, your breasts lose and gain with you."

The other technique borrows muscle, skin and subcutaneous fat from the back. This tissue can be supplemented with an implant, if need be.

In cases where the nipple can be saved, about 60pc of its sensitivity can be preserved; breastfeeding, though, isn't possible because the breast tissue is no longer present to generate breastmilk.

Perhaps the biggest public service that Jolie has done, though, is to highlight the stranglehold that one company continues to exert over the domain of breast cancer testing. As she writes: "The cost of testing for BRCA1 and BRCA2, at more than $3,000 (€2,300) in the United States, remains an obstacle for many women."

The patents are held by Myriad Genetics, a Utah-based company that owns, and enforces, the worldwide rights to genetic tests relating to BRCA1 and BRCA2.

Myriad's monopoly is being challenged in the US Supreme Court by, among others, the American Civil Liberties Union, a battle Jolie, in her own way, may help to win.

Irish Independent

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