Star power

Dear Reader, Did you really think I was going to let Angelina Jolie's recent announcement go by without mentioning it? Of course I wasn't. This news has been everywhere. But just in case you've been living under a rock for the past couple of weeks, you can read her headline-grabbingNew York Times op-ed piece, "My Medical Choice," here. Now... where to begin? I guess what concerns me the most is that the press is praising Ms. Jolie for mutilating her body. Not in the wake of a breast cancer diagnosis, mind you--but in an effort to prevent the disease, which she may never have gotten. Yes, I understand that her mother died of cancer at the age of 56--and that she wants to be around for her own children for many years to come. But this is a woman who is recognized around the world. For better or worse, people look up to her as a role model. And in this case, I fear the consequences could be dire. True, Angelina did test positive for the BRCA1 genetic mutation. As her editorial explains, this significantly increases her odds of getting ovarian and breast cancer. But, that genetic mutation does not mean she will definitely get those cancers. And this is why I have a major problem with genetic testing as a diagnostic tool. The results can muddy the waters when you're dealing with a disease like cancer. And this swings the door to unnecessary treatment wide open. So as not to obscure the issue here, let's focus on a few facts. BRCA1 mutations with a family history may put the risk for breast cancer at 85 percent and the risk for ovarian cancer at around 50 percent. (This risk drops to 15 percent and 25 percent in the case of the BRCA2 mutation.) By having the surgery that Ms. Jolie chose--a double mastectomy, and reportedly, an oophorectomy (removal of the ovaries) in the near future--you absolutely willreduce your risk of getting either of these cancers significantly. But the cost of this form of risk management is obvious. And very weighty. Please understand that I am not picking on Angelina. Nor am I suggesting that she did something she shouldn't have done. There really is no right or wrong choice when it comes to matters like these. There's only what's right or wrong for you. I feel that every health decision you make is just that--yours to make. You have to be comfortable with it. And you have to believe in it. Because ultimately, you are the one who has to live or die with the consequences. But I do have a problem with the skewed coverage of this story. For one thing, going under the knife isn't the only treatment choice that a woman with the BRCA1 gene has. And it's not the one I would recommend, either. Instead, I would suggest very close monitoring--with breast ultrasound and/or MRIs twice per year. (You know how I feel about mammograms. It's not worth risking the radiation.) Proper diet and nutritional supplementation are also vital. (Another topic I've discussed at great length here and in my monthly newsletter, Logical Health Alternatives.) These strategies are especially important in light of another message that I don't see getting out--which is that 99 percent of women do not have this genetic mutation. And yet, many of these same women are now disproportionately afraid of their own breasts. The fact is, we tend to over-medicalize most illness, especially in the United States. And does it lead to better health outcomes? After a certain point, unfortunately, no. There's little question that Angelina's announcement will trigger an onslaught of genetic testing among women in this country. I can only hope that it does improve the health of these women's lives--and that itdoesn't just increase the number of billable surgical procedures. Because for the vast majority of women to begin modeling their own choice of breast cancer treatment after Ms. Jolie's choice would amount to a public health disaster. Believe me, I am very torn on this topic, because I enthusiastically applaud anything that increases awareness for potentially fatal diseases. I just wish the other side of the story could be heard as loudly. That's why I look forward to hearing about the holistic healing methodologies that Ms. Jolie also wrote about in her editorial. Because to focus solely on the surgerywithout the other key pieces of the story does a disservice to women everywhere. Until next time, Dr. Fred