In 1974, Betty Ford changed the breast cancer game by announcing that she was battling the illness, introducing breast cancer as an acceptable conversation (and possibly spiking that year's then-record increase in women seeking breast cancer screening). In 1979, Tamoxifen changed the game by providing an effective non-surgical treatment for "hormone-positive" breast cancer. In 1998, Herceptin changed the game by providing an effective "targeted" therapy for a particularly aggressive form of the disease affecting 20 to 30 percent of all breast cancer patients.
On May 14, 2013, Angelina Jolie announced that last month she had both of her breasts removed after testing positive for the breast cancer gene. Her announcement, in the form of a New York Times op-ed, may well be the greatest game changer that the war against breast cancer has seen in more than a decade.
No, Angelina Jolie did not discover a cure or even a treatment for breast cancer. But she did what Betty Ford did in a way that only Angelina -- a woman with a body like Jessica Rabbit, a charitable heart like Mother Teresa's and an Oscar on her mantle -- could do. With all due respect to Betty Ford, Angelina Jolie is more than the wife of a U.S. president. With all due respect to Christina Applegate, Sheryl Crow, Cynthia Nixon, Kylie Minogue, and several of TV's former "Charlie's Angels" -- celebrity breast cancer survivors whose candor about their experiences with breast cancer helped further raise breast cancer's profile -- Angelina Jolie is more than an A-list celebrity. Angelina Jolie is one of the most beautiful, talented and influential women on the planet. Her partner is one of the most beautiful, talented and influential men on the planet. She is the mother of six children, and she is a tireless advocate for human rights.
As such, the fact that she made the announcement at all is significant. She could have kept her health issues private, just as she had done for the past several months. If and when the media learned of her surgery, she could have refused to comment. In doing so, she would have contributed to the stigma that to this day continues to act as an obstacle to proper medical care for women who feel uncomfortable discussing their breasts with their friends and partners, let alone with their doctors and insurance carriers. In doing so, she would have deprived the world of a valuable resource: the juxtaposition of her jaw-dropping femininity and power with a disease that can make women feel ruined as women and powerless as people.
The underlying messages within her announcement are even more significant.
The text of her announcement makes only passing reference to the notion that her femininity might have been at stake, and when she does so it is only in the context of assuring us that her femininity is all there still. She says that the decision to have her breasts removed was not easy, but when she identifies the factors that went into her decision, her appearance is not among them, except for an indirect reference -- that she opted for reconstructive surgery. Instead the negatives she identifies relate to the surgery itself. When she mentions her scars, it is only to celebrate that they do not scare her children. In fact, her children had only one fear, and that was that their mommy would die of cancer just as their "mommy's mommy" had. She says that she is fortunate to have a loving and supportive life partner like Brad Pitt, who was there for every minute of every surgery, who helped her to laugh and who is part of the "we" that made the decision. Now, winning male attention may be one of Angelina's less-celebrated talents, but it is one that she is using for good when she speaks directly "to anyone whose wife or girlfriend is going through this," urging them that they need to be aware that they are an important part of the "transition."
The implication is clear, I think: Angelina would not approve of a man who does not support the woman in his life through the decision to remove her breasts, prophylactically or otherwise.
While Angelina Jolie's announcement will not cure cancer, it may help prevent at least some cases of hereditary breast cancer. As she points out, although hereditary breast cancer accounts only for a fraction of breast cancers, the presence of the inherited gene mutations that are often referred to as the "breast cancer gene" can raise a woman's lifetime risk of breast cancer to 87 percent -- which was what her own doctors estimated as her lifetime risk. For women who have a family history of breast cancer, Angelina Jolie's announcement could spur them to get tested and make the choice to reduce their risk from something close to a near certainty to something close to near impossibility (in Angelina Jolie's case, the risk was reduced to under 5 percent). This is especially significant for women who are aware that they may be at risk but for one reason or another are unable to work up the courage to talk to their doctors about testing. And as more women get tested, knowledge about breast cancer increases: The specimens and data collected in the course of testing can lead to the identification of new means of prevention, detection and treatment of breast cancer.
In her announcement, Angelina points out that the cost of testing may be prohibitive. However, Facing Our Risk Of Cancer Empowered (FORCE), a national nonprofit organization founded to addressing the needs of families affected by hereditary breast (and ovarian) cancers, is committed to its mission of providing women with resources to determine their risk and is a wellspring of information regarding clinical studies and gene-testing "registries" that provide testing at no cost. FORCE's website also contains a detailed explanation of financial and insurance considerations.
Angelina Jolie's announcement marks a giant leap from where we were when FORCE was founded in 1999. And an even more giant leap from where we were a mere two years earlier. The year was 1997, and an episode from the third season of David E. Kelley's iconic hospital drama Chicago Hope featured a pretty young mom who was determined have her breasts removed because she tested positive for the breast cancer gene ("Positive ID"). Her female doctor was aghast. Her male surgeon was outraged, going so far as to protest that "When it comes to cutting off a woman's breasts, she might as well cut off her head."
And then there was the husband. He looked nothing like Brad Pitt, not even close. Our first glimpse of him showed us a man deeply wounded by the terrible thing about to befall... him. Upon being shown photos of what his wife's results might look like, he snarled at the surgeon and stormed out of his office, pausing only to demand to be told how he was to be expected to look at his "mutilated" wife every morning.
I get the feeling that Angelina would most definitely not approve.
The good news is that everyone came around eventually, and the brave wife was wheeled into surgery. But as I re-watched the episode today in light of Angelina's news, I found myself snarling at the mid-'90s crybaby husband emoting there on my computer screen: "Hey! Dude! If it's good enough for Brad, why aint it good enough for you?!"
And that's when I realized: Mission accomplished, Angelina. Thank you, on behalf of all the girls.
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