This Is What 70 Looks Like: “Angelina’s Breasts”

Angelina Jolie, the 21st century’s sex symbol, makes a public statement about her breasts and ovaries, and it turns our world upside down about how we think about, talk about and react to breast cancer.

Angelina has clout that pours off her status as the Hollywood icon. Beyond being Brad Pitt’s partner and mother of six, she’d already been a 10-year veteran as a globe-trotting UNHRA Ambassador, a front and centre spokesperson at the United Nations on war rape  and a generous humanitarian.

So on Feb. 16 of this year,  at the age of 37, forewarned by doctors that she had an 87 per cent risk of developing breast cancer due to a defective gene identified as a BRCA1, Jolie underwent a preventive double mastectomy.

Jolie’s mastectomy lowered her chances of developing breast cancer to less than five per cent, which is about the same as the female population in general.

By April 27, when she went public, Jolie had already had reconstructive surgery involving implants and allografts. So there was really nothing – or everything  – to see, depending on your point of view.

So why did she choose to go public about her decision? For sure, it lent her impressive heft to open the door for women to access the expensive BRCA testing in America. It was an acknowledgement that this testing – at $1,500 a test – isn’t readily available to millions of American women. Even though the gene accounts for less than one per cent of breast and ovarian cancers, it carries a devastating trajectory, killing women every year and well before their time.

When and if Angelina will walk the same path is a matter of speculation, though it’s likely she won’t overvalue her status as a sex-goddess icon to the detriment of her life. Leaving that swell of fame – one of the world’s most beautiful women – to become a crone ahead of her time is something that one can see this bred-in-the-bone radical doing with impunity.

But it’s clear that being post-menopausal isn’t conducive to the image of what Hollywood demands in its sexually sensational All-Stars. Angelina will have to forgo her persona to save her life. After all, she is only 38 years old. Is there a hint of such a shift already? She has recently announced her second directorial project – the story of the 1936 Olympic marathoner Louis Zamperini whose life has been retold in Laura Hillenbrand’s feature film, Unbroken.

For the moment we have no way of effectively predicting the onset of ovarian cancer even in high-risk women such as Jolie. The standard recommendation in these high-risk women is to remove the ovaries and tubes, certainly by the early 40s.

Many studies have been devoted to monitoring “serial Ca125”, doing pelvis ultrasounds every six months to detect changes and conducting regular clinical pelvic examinations. All have failed to reassure the very women most in need of this information so that they can plan for such definitive and conclusive surgery as prophylactic removal of the pelvic organs that virtually defines femaleness.

And so, many years and research papers later, are we any further ahead in knowing how to stay alive with breast cancer?

The star power of Jolie is a plus in bringing the issue of genetic testing, its limits and costs, its value and its rarity to the attention of millions of women around the world. Her public face can only help diffuse the secrecy about mastectomies and reconstructions and raise the profile of the choices that are open to women. But it underscores the still serious limitations, even now, that genetic models can create a whole new world of treatment and prevention for breast cancer. The vast majority of women as they age, because they age, will find that breast cancer will continue to dog them well past menopause. In that, they will have common ground with Angelina.