Angelina Jolie’s announcement that she had had a prophylactic double mastectomy prompted a thoughtful piece on NPR today. In it, Todd Tuttle, chief of surgical oncology at the University of Minnesota, discussed the motivations underlying such decisions. The number of women choosing this extreme form of preventive medicine has risen dramatically in recent years and is also much higher in the US than in Europe, although women there have the same access to surgery and reconstruction.
One cause, he said, was that women tend to greatly exaggerate their breast cancer risk when extrapolating from genetics or family history. Why is this? The NPR piece suggests that “the ubiquitous pink-ribbon campaigns may be fueling the rise in mastectomies.” We’d like to see the evidence, but it’s a profoundly ironic notion:
Could the campaign to “Save the Ta-Tas” in fact be reducing their numbers?
In an age of super-sensitive, ever more powerful diagnostics and a culture that favors preventive medicine, it becomes increasingly important for people to actually understand abstract concepts such as risk and probability.
7 thoughts on “Killing off the Ta-Tas?”
I am married to a woman who chose to have a double mastectomy. She is a nurse and pretty good at math. She had developed one cancer in her breast with lymph node involvement. Her chances of developing more cancers were above 60%. For both of us, there was simply no choice in the matter and not much interest in saving her “ta-tas” despite the fact she had particularly nice ones.
I found your blog entry offensive, uninformative a little light in the sneakers when it comes to intellectual depth. Bad cess to you. We need more intelligent, informed discussion on the subject, not light, stupid comments such as yours.
I can’t imagine how wrenching that decision must have been for you as a couple. It sounds like you are not among those who grossly overestimate the risks of genetics; therefore, you ought not to take my observation personally.
This post is not long and analytical, true, but it makes a serious point. You’re aware, I’m sure, that I didn’t make up the “ta-tas”– “Save the Ta-Tas” is a nationwide breast cancer “awareness” (irony quotes) campaign, popular on college campuses. It deeply offends me. I think it objectifies breasts and turns medicine into a frat-house game. I insist that there is a deep and tragic irony to the fact that a simplistic bumper-sticker campaign could be having the opposite effect it intends.
If you read this blog you know that it frequently uses black humor. As with most cynicism, underneath it there is usually a broken heart.
There are women and men who really need preventive medical procedures, but sometimes I feel like there is too many “necessary” and “must be done” procedures all because of the propaganda imposed by medical and pharmaceutical lobbies. The only sure thing here is that there is more money to be made for doctors if more people are convinced doctors, medical procedures and products must be used as soon as possible!
This potential correlation between breast cancer awareness and a rise in prophylactic double mastectomies is fascinating indeed (pending evidence, of course). You mention access to surgery and reconstruction as one of the many confounding factors of this hypothesis. Along these lines, do you think that the recent Supreme Court ruling, which will likely knock down the prices of BRCA genetic testing and permit greater access to this kind of information, could also potentiate this trend? The overall prevalence of actual BRCA mutations ought not change, but I wonder if an increase in the availability of BRCA awareness and the amount of BRCA testing – similar to the plentiful, almost inescapable pervasiveness of pink ribbons these days – could contribute to this apparent societal push toward preventative mastectomy.
As a side note, I’m not sure if subscribers are allowed to request blog post topics, but I’d cast my vote for a piece on today’s big decision! Bittersweet news, in my opinion: we’ve finally wrapped our heads around genes as “naturally occurring,” but cDNA didn’t quite make the cut. Ah well, maybe next time around.
Interesting point. I think it could go either way. The cynic in me (What?!?) fears that the SCOTUS decision could create incentives for high-pressure marketing for BRCA testing, raising anxiety and thus prophylactic surgery. My hope is that it will work the other way: that women tempted to have surgery based only on family history will be tested and learn that they are not at increased risk and so stay out from under the knife.
Which way it will go depends on two things: 1) effective regulation of the genetic testing industry, so that health interests are placed above economic ones; and 2) public education, on the nature of risk and the biology of cancer, so that patients can make good decisions. It’s all about the patients.
And yes! Subscribers are welcome to make requests! Genotopia has taken a bit of a break due to circumstances beyond even our control, but look for more posts soon. Thanks for reading.
I see. I concur that patients hold most of the power over which way this goes, but it concerns me that marketing (at the individual and systemic level) holds such profound sway. I have only one more question worth consuming more of your time. I agree with your astute comment about public education on genetic risk and disease. I’m curious – when and how do you think this type of education should take place? Secondary education? University (which is obviously self-selecting and problematic)? During clinic visits? High-level literature? (Blogs are a great start, as are beautifully-written, accessible, and page-turning history of medicine books)! Still, the logistics of circulating this critical information seem almost as complex and unclear as the information itself. Perhaps if the rhetoric was taught early and the interpretative skills later, we could have a public more ready to tackle the scientific jargon that awaits them.
I’m shocked to hear that you have a cynical side, and perhaps even more so that Genotopia has limited influence over worldly happenings. Don’t leave us for too long; navigating these uncertain, post-SCOTUS decision genomic waters alone can be intimidating. Also – not to be trivialized – where will I get my latest DIY, DNA spoofing tips on successfully evading genomic surveillance? I might be caught by the time you next post something.
Seriously, though, I enjoy your blog. Look forward to reading more.
Thanks for your kind words and your patience. I hope you feel it at least somewhat rewarded by today’s modest offering. We caught the eye of the Charlotte Observer, which will be running a little feature on us soon. Better clean the house for company!
We agree–if such was indeed your implication–that evading genetic surveillance might be accomplished in other ways. We’ll put that one in the ideas file. Thanks for reading.
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