I should have known it. I should have known that the reaction wouldn't take very long. I should have known it based on prior history. The news story to which I am referring is, of course, the revelation yesterday in the New York Times editorial page by Angelina Jolie that she had decided to undergo prophylactic bilateral mastectomies (removal of both breasts) because she had learned that she was a BRCA gene mutation carrier, and the particular mutation that she apparently carried portended an 85% lifetime risk of breast cancer. The reaction to which I am referring is, of course, the same sort of despicable reaction that we see all the time from one of the crankiest of quackery-promoting quacks, Mike Adams, publisher of NaturalNews.com.
This is a man known for not being—shall we say?—shy about using and abusing any celebrity cancer or health story that he comes across in the vilest way his fevered little brain can imagine to promote his favored quackery. He did it, for instance, when Patrick Swayze had pancreatic cancer. Swayze also had the temerity (and smarts) to say that he was eschewing quackery and sticking with science-based medicine, thank you very much:
If anybody had that cure out there, like so many people swear they do, you’d be two things. You’d be very rich, and you’d be very famous. Otherwise, shut up.
This, not surprisingly, infuriated Adams, who wrote up quite the tirade about it. Adams was similarly quick to pounce on the deaths of Michael Jackson of a drug overdose, the death of former Bush administration press secretary Tony Snow of colon cancer, and Tim Russert's death from heart disease. Then, of course, he worked himself into a fine lather of righteous indignation over her "maiming" when Christina Applegate announced that she had undergone bilateral mastectomies for her breast cancer, who also had a BRCA mutation. So you can only imagine what sorts of vile article Adams came up with in response to Jolie's decision to undergo bilateral mastectomy as a preventative measure, even though she didn't have cancer yet. Yes, you can tell a lot by the title, Angelina Jolie inspires women to maim themselves by celebrating medically perverted double mastectomies.
Say what you will about Mikey. He's consistent. Consistently vile. He's also dead wrong, as usual.
First, you need to take note. The purpose of this article is blatant, and it's to sell stuff. After Adams has seemingly gotten his readers all fired up over the horror of Jolie's decision to "maim" herself, the very last section of the article advertises this:
Inform yourself and you can protect your body from the insane, knife-wielding cancer surgeons. Get the New Cancer Solutions CD set and empower yourself with real answers rather than cancer industry disinformation and deadly propaganda.
It comes complete with a video (included in Adams' despicable article) that has to be seen to be believed, entitled The female anatomy of Modern Medicine. In any case, the CD includes a talk by Adams himself entitled The Consciousness of Cancer, which is billed as a "new way" of looking at cancer. No doubt it is, but also no cout it is a way that has nothing to do with science. From the title, my guess is that Adams subscribes to something similar to the German New Medicine or Andreas Moritz's "wisdom of cancer cells" quackery, in which cancer is represented as a survival mechanism. There are also talks by "luminaries" of the "integrative" oncology and alternative cancer cure world, such as Thomas Lodi, Keith I. Block, and Richard Linchitz. It all looks to be a lot about "detoxification" and woo. (One notes that the Pink Lotus Breast Center, where Jolie had her surgery, is not above capitalizingon her announcement either, with a prominent splash page with a picture of her and a link to the details of her decision."
Now that that point is out of the way (and it's arguably the most important point, which is why I skipped to the end of Adams' screed first), Let's get a real taste of what Adams thinks, if you can stand it and if you can call it "thinking":
Angelina Jolie announced yesterday that she had both of her breasts surgically removed even though she had no breast cancer. She carries the BRCA1 gene, and she has been tricked into believing that genetic code is some sort of absolute blueprint to disease expression -- which it most certainly is not. Countless millions of women carry the BRCA1 gene and never express breast cancer because they lead healthy, anti-cancer lifestyles based on smart nutrition, exercise, sensible sunlight exposure and avoidance of cancer-causing chemicals.
Jolie, like many other women who have been deluded by cancer quackery, decided the best way to prevent the risk of breast cancer was not to lead a healthy, anti-cancer lifestyle, but rather to surgically remove her breasts in what she describes as "three months of medical procedures."
...just in case, you know. Because you can never be too careful these days, with the cancer industry scaring women half to death at every opportunity. "My breasts might murder me!" seems to be the slogan of many women these days, all of whom are victims of outrageous cancer industry propaganda and fear mongering.
And later:
Oh, what a mess Jolie has made of herself. She has maimed her own body with no medical justification whatsoever, then celebrated this horrible disfiguration through some sort of twisted perception of what womanhood really is. Being an empowered woman doesn't mean cutting off your breasts and aborting live babies -- even though both of these things are often celebrated by delusional women's groups. Being an empowered woman means protecting your health, your body and your womanhood by honoring and respecting your body, not maiming it.
And, the "coup de grace":
Wonderful? To cut off parts of your body that have NO disease? With this logic, abortions are cancer prevention, too, because those babies might one day grow up and develop tumors. Better to kill them early and "prevent cancer," right?
The mind boggles.
One can't help but note that Adams is indulging in a favorite pastime of quacks every where: Denialism of genetics and wishful thinking that genetics don't rule. OK, it's true that in some cases they don't. If a gene doesn't have a high penetrance, interacts with other genes, or has an activity that is highly influenced by environment, genetics isn't always destiny, but in the case of the particular BRCA1 mutation that Jolie reports having, there is an 85% lifetime risk of developing breast cancer. Given that breast cancer is a type of cancer that is not highly lifestyle- and diet-dependent (note, that is not to say that lifestyle and diet have no effect, just that the effect tends to be relatively small), no amount of "anticancer lifestyle, "smart nutrition," and "avoidance of cancer-causing chemicals" is going to lower that 85% chance of breast cancer by very much, no matter how much Adams' wishful thinking might try to mislead other women that such interventions can.
Now, it needs to be pointed out here that a BRCA1 mutation, such as the one that Jolie had, is a very special situation, where the risk of cancer is known and very high. I'm normally not a fan of prophylactic surgery, and I tend not to do bilateral mastectomies in my practice except under certain circumstances (such as BRCA1 mutations). Few women fall into that category, and, mutation carriers aside, there is no good evidence that doing bilateral mastectomies for breast cancer improves overall survival and decreases the odds of a woman dying of breast cancer. Personally, I've been rather disturbed at how much the demand for bilateral mastectomies has been driven by patients; it hasn't really been driven by physicians. In this, I'm mostly in agreement with Monica Morrow, one of the most prominent breast surgeons there is, when she says:
“It’s important to make it clear that a BRCA mutation is a special, high-risk situation,” said Dr. Monica Morrow, chief of the breast service at Sloan-Kettering. For women at very high risk, preventive mastectomy makes sense, but few women fall into that category, she said.
For women’s health advocates, the trend toward double mastectomies in women who do not have mutations is frustrating. Studies in the 1970s and 1980s proved that for many patients, lumpectomy was as safe as mastectomy, and the findings were seen as a victory for women.
Even so, there is increasing demand for mastectomy. Dr. Morrow says that she has often tried to talk patients out of it without success. Some imagine their risk of new or recurring cancer to be far higher than it really is. Others think that their breasts will match up better if both are removed and reconstructed.
And it's true. Jolie is a special case. We don't see too many BRCA1 carriers. In Jolie's case, bilateral mastectomy was entirely appropriate and medically indicated. That's not always the case for a lot of bilateral mastectomies that are being done these days. Not surprisingly, part of what drove Jolie's decision was the death of her mother at a young age (56). In any case, I'm not alone in being a bit worried that this announcement will provoke a run of patients demanding what Angelina Jolie had, regardless of whether it's appropriate or not. Expressing concern about that, as some breast surgeons have in the wake of Jolie's announcement, however, is not what Adams is about. He is about portraying modern medicine as "maiming" women and implying that it is surgeons who are promoting bilateral mastectomy when in fact the vast majority of us are not. Indeed, the drive over the last 30 years has been towards increasingly less invasive surgery for breast cancer (a trend driven, I would point out, not just by breast cancer advocates but by science and surgeons themselves, at the cost of revenue, given that larger surgeries like mastectomies are certainly better reimbursed than smaller surgeries).
There are also other issues brought up by Jolie's decision. For instance, the way she went about it is not entirely science-based. If you peruse the blog post describing the process, you'll find that she underwent a "nipple delay" procedure, in which the tissue underlying the nipple is cut in order to rule out cancer right behind the nipple and to "improve the blood flow." The idea is that the nipple delay procedure cuts the normal blood supply to the nipple and "forces" it to rely on the surrounding skin for its blood supply, thus making the chance of nipple necrosis (in which the nipple turns black and falls off due to low blood flow) much less likely. It's a procedure for which the evidence, in my estimation, is fairly shaky at best and is usually reserved only for patients who have had previous breast surgery around the nipple. After the surgery, Jolie apparently used a whole bunch of supplements at the instruction of the Pink Lotus Breast Center (which is apparently very much into "holistic medicine"), including vitamin C and a homeopathic remedy, Arnica Forte, which, it is claimed, improves wound healing. In her editorial describing her journey, Jolie herself writes:
I acknowledge that there are many wonderful holistic doctors working on alternatives to surgery. My own regimen will be posted in due course on the Web site of the Pink Lotus Breast Center. I hope that this will be helpful to other women.
Another issue to discuss might have to wait, as this post is getting long, and I need to wrap it up. (I might revisit this issue again next week on my not-so-super-secret other blog that has my real name on it, not unlike The Name of The Doctor.) Specifically, that's the issue of BRCA1 testing itself. Myriad Genetics holds the patent on all BRCA testing, which means that it holds a monopoly on the process. No other gene test for BRCA1 is legal right now because Myriad holds the patent on the genes BRCA1 and BRCA2. There's also the issue of Jolie's extreme wealth, which provides her options average women don't have, given that insurance companies will sometimes not pay for BRCA testing and preventative surgery. These might well be the topic for another post. In the meantime, contrary to Adams' spew otherwise, Jolie made a reasonable, medically justifiable decision based on her family history. The only question I have remaining is whether she will remove her ovaries too (no mention was made of it in her op-ed).
That, and how Mike Adams can live with himself, but that's a question I'll probably never have the answer to.
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"Dr" Robert O Young has been at it too.
Yesterday he wrote:
"Angelina Jolie's decision to have an elective mastectomy was not only sad but unnecessary! Breast tissue is fatty tissue and a depository for metabolic and dietary acids that are NOT properly eliminated through the four channels of elimination - urination, defecation, respiration and perspiration and is thus deposited in the connective and fatty tissues causing a cancerous condition. The gene theory for the cause of breast cancer is flawed."
He continued with his usual pH nonsense. This appeared on his Facebook page and Twitter (his posts are automatically tweeted four times). He then went on to post some of his breast cancer patient testimonials.
http://josephinejones.wordpress.com/2013/05/15/dr-robert-o-young-shamel…
It is my understanding that BRCA testing is classified as preventative care under the ACA and must be provided without copayment or deductible, beginning, I believe, next year.
Any time Robert O. Young writes anything about breast cancer, I have two words for him: Kim Tinkham.
http://scienceblogs.com/insolence/2008/01/09/a-horrifying-breast-cancer…
http://scienceblogs.com/insolence/2009/03/26/a-horrifying-breast-cancer…
http://scienceblogs.com/insolence/2010/06/22/a-horrifying-breast-cancer…
http://scienceblogs.com/insolence/2010/12/06/a-horrifying-breast-cancer…
http://scienceblogs.com/insolence/2010/12/06/a-horrifying-breast-cancer…
That's all you need to know about Robert O. Young and breast cancer.
I hope you're correct. It should be, when the indications are there.
Each to their own on this decision. My view point though is this, she cut off her breasts to save her children from her possible death from breast cancer? I wonder if she stopped smoking (if she hasn't already) or asked Pitt to stop smoking. Is she going to cut out her ovaries now? What about every other part of her body that can have cancer in it? It's her own decision of course and she can do what she wants with her body.
@Orac
Thanks so much for writing this post. I figured the quacks would have a go with the story, but I was more interested in the science; that's why I come here! Anyway, it's reassuring to read that where the BCRA1 mutation is at play, double mastectomy is warranted. I was curious how the risks of that vs. the risks of post-tumor treatment stacked up. These are the nuances that are missing in popular reporting.
@ Reb
"What about every other part of her body that can have cancer in it?"
Don't be bloody stupid. The 85% risk refers to breast & ovarian cancer, not the whole body.
Moreover, mastectomy "cutting off your breasts". It's removal of the breast tissue, which is the bit than would develop cancer . The skin & nipples remain & implants can be used to retain a feminine figure.
@Reb - what part of having the BRCA-1 gene don't you understand?
That's interesting, it was pretty much the tweeted reaction of one of our French politician, Christine Boutin, a woman deputy from our Christian-democrat party. According to her, a woman having her breasts removed is just deluded into wanting to be like a man.
Even right-wing newspapers called this deputy on her nasty, ignorant behavior.
And I just learned she is also a 9/11 truther, like dear Mike. At least she is not blogging about "natural" products...
@ Reb
If either of them does stop smoking, it would be a good decision, from a "healthy lifestyle" point-of-view.
If I understood correctly the nastiness of this BRCA1 mutation, this could be a good decision too.
But if so, so what?
Are you sure you are not confusing women with dairy factories?
My mom had her organs removed after my sister was born, for a different medical reason.
I won't say it was no big deal, because it certainly was a difficult decision with difficult repercussions.
But that didn't stop my mom from being a human being, a woman (don't ask) and a loving and caring mom.
Thank you, Lawrence (#7). Reb (#5) is confused about BRCA1. I am about to have a prophylactic bilateral mastectomy and a complete hysterectomy after testing positive for BRCA1 (my mother, my mother's mother, and my mother's mother's mother all died young from cancer and presumably all carried the BRCA1 mutation). My understanding is that Jolie is, in fact, planning to have her ovaries removed. The abdominal surgery can be even more important for BRCA carriers than the mastectomy, because while "surveillance" of the breasts is possible (mammograms, MRI), screening for ovarian cancer is extremely difficult and ovarian cancer is very deadly.
If there's an 85% chance that someone will break into your house and kill you, it's probably a good idea to install a security system. Installing that system would not be an overreaction. So while removing breasts on a woman who does not have the BRCA mutation is not advisable (as Orac says), the BRCA thing is a whole different story.
Stanford created a BRCA "Decision Tool" that shows risks associated with the mutation and how the risks can be reduced. http://brcatool.stanford.edu/brca.html
Orac, Adams lives very well with himself: he believes that he is helping readers. As he helps himself to their money by frightening them into buying his films or products.
Similarly, we should expect the same from Null who has also gone on about preventative masectomy ( e.g. Ms Applegate and others). Only a few days ago ( via PRN tapes) he announced that women need not ever fear breast cancer because they can take preventive measures ( paraphrase) - "You take this supplement here which helps 20% and that other one there that helps 30% and those others... pretty soon you get to 100% protection". OBVIOUSLY becoming a vegan would turn the odds, he perseverates whilst quoting in vitro studies about vitamins or his own scurvy imagination as he mentions products he offers. So I expect to hear him caterwaul about Ms Jolie's decision.
I suspect another motivation for their disdain for women who decide on surgery- as well as their usage of words like "maim" and"messed up":
perhaps they value women primarily for their appearance thus surgery to prevent cancer or SBM cancer therapies would be sacrilege to them. Seeing women primarily as sex objects and engines of procreation is as old as disrespect for women's decisions about what to do with their bodies. I notice that Adams mentions abortion as well.
I should mention that the misogyny and sexism I often detect at sites like his and Null's is usually disguised under layers of Gaia-worship. These guys may be idiots when it comes to science but they are savvy enough to not want to simultaneously insult women and try to sell them products.
It's more a patronising, "Let me tell you what's good for you". We should also note that they portray SBM as the REAL sexists who manipulate women and have no respect for their choices. Right, and you're the one to tell them this and how to live.
Read their rants carefully, perhaps you'll see it too.
Again, "Oh, what a tangled web we weave......"
@Reb - How do you know she hasn't already had an oophorectomy?
Maybe, I dunno whether I'm reaching here, she realised that, as one of the world's most famous actresses, her obviously different appearance required a preemptive announcement to stop cruel paparazzi rumours. Ovaries, or the lack of, cannot be detected by that kind of pap, hence Ms Jolie has no need to describe her gonadal status.
Like I said though, maybe I'm just using that stupid 'logic' thingy. If my mother had spent ten years dying of cancer in front of me, and I had six kids to care for, I'd cut off anything to spare them that ordeal.
As for quitting the fags, why not call/email and ask her? You're obviously close enough to her if you're engaging in critiques of her health decisions.
In a similar vein, Mike f+cking Adams-
Actually, Mikey, female empowerment means that only WE choose what happens to our bodies and our lives. I know it chaps your arse raw to think of our silly, fwuffy ladybrains being used to think about anything but babies, kittens, or cushions.
I can see you wholeheartedly embrace the idea of a patriarchy, where sensible, logical men like yourself get to make the rules about what women can/can't do with our own bodies. I can also tell that you're frothing with indignation at the thought of a woman who not only has a professional role that involves speaking out, and for, girls and women worldwide, but who also has the temerity to tell her sisters to turn to science-based medicine instead of following your line of twisted magical thinking. But guess what Mikey? TOUGH.
You can sit at your desk, flecking your monitor with spittle as you rant and howl, crapping out missives about the evil wimmenz who don't want to let warped little sh¡tweasels like you dictate their life choices, but it's to no avail. I know it's deeply unfair that such a manly man as yourself has zero authority over that frail, delicate, mushminded 51% of the world's population. Why, I can almost hear you stamping and flailing from here, but life's not fair Mikey.
Don't worry though, I'm sure your mommy still thinks you're special.
PS all my thanks to the last few posters who nipped in while I painstakingly thumbtapped my rant on this pad. Heliantus, Denice et al., who calmly laid down some facts. My calm supplies are immediately overridden in the face of health-related misogyny. That's what put me where I am today.
The * (well, +) in my comment was to note that Mikey is happy enough to decry paternalism in healthcare when actual doctors are guilty of it. Are quacks exempt, I wonder?
Even more disgusting than Mikey's woo was the reaction from some of his commenters, who in typical full conspiracy-theory mode, claimed she never underwent the surgery to begin with and is faking it.
One commenter said he wouldn't believe her story until he sees photos of the scars.
And why would she lie? Of course she's a shill for Big Surgery, or the cancer industry, and is merely trying to use her position of infuence to drive women to have similar surgery to "line the pockets of surgeons," of course.
Adams never mentions she embraced a "holistic" approach. In fact until Orac's post I hadn't seen anything about it in the coverage I read, albeit superficial, yesterday.
Adams' also asks why male doctors don't "chop off their testicles" to prevent testicular cancer, or why we don't all cut off our legs because we might break them in an accident one day.
Hyperbole much?
News Update: according to reports, Jolie is also going to have her ovaries removed.
As an aside:
in the history of women's fashion, in eras when roles changed images did also. And stick-in-the-muds got upset then as now.
In the 1970s, many women started wearing trousers and suits to work and c. 1920, shorter skirts, cropped hair and a flatter silhouette ruled the day.
A fashionable family member ( now deceased) remembered how the world reacted to the innovations of Mlle Chanel. She also related to me how they achieved that 'boyish' appearance ' by wrapping themselves flat.
This information can be very useful if you want to cut a dashing figure in tailored clothes.
Well, now I know that I am a fully-indoctrinated Shill and Minion, because my first thought when I heard about Jolie's decision was "I hope Orac writes about it" and "I bet the cancer quacks are going to go berserk." I'm not exactly pleased to be right, but apparently I have learned my Skeptic lessons well.
Mikey's knee-jerk misogyny is of course vile, but no one expects any better from him. I do cherish a small hope that some of his (politically) progressive audience might notice the offensive mansplaining about "being an empowered woman" and start tuning him out.
Edith, I was also looking for Orac to blog about this subject.
As a slight digression, I was wondering about the Myriad patent situation. When it becomes routine to offer whole genome sequencing of patient samples, will health providers be able to report on the status of the patient's BRCA1 or BRCA2 sequence (if Myriad's patents are upheld)? Or will they have to redact that information, assuming they can turn over the sequence to the patient? or will they just kind of cough, and nod that their head toward some sequence and say, "you might want to get that checked out?"
Its unfortunate that there has been little discussion about the high cost of the test due to Myriads patents. They shut down the other groups who had also been looking for these sequences and the use their patents to prevent anyone else from producing an inexpensive test.
http://www.groklaw.net/article.php?story=20130415065049200
Here's a reaction from a self-employed woman who also has the BRCA mutation but cannot afford surgery
http://www.xojane.com/issues/cant-afford-preventative-mastectomy-uninsu…
I wonder if elective mastectomy is covered in countries that have a national health care scheme.
"Well, now I know that I am a fully-indoctrinated Shill and Minion, because my first thought when I heard about Jolie’s decision was “I hope Orac writes about it” and “I bet the cancer quacks are going to go berserk.” I’m not exactly pleased to be right, but apparently I have learned my Skeptic lessons well."
Me, too. I should have known this was going to a topic here very quickly but I was planning on emailing our host because I know this is one of his areas of expertise and my patients will be asking me questions.
Ms. Jolie's decision was evidence-based, medically sound decision and she deserves great respect. Her choice of preempting the inevitable tabloid speculation was nothing if not courageous and valuable to millions of women and their families. Valuable because it highlights the specific risk posed by BRCA1 and 2 and also opens up and informs the discussion of breast cancer between women and their physicians.
Comments from people like Mike Adams who know nothing about Ms. Jolie herself and even less about the genetics of cancer are damaging and I am very happy, Dave, that you've addressed this so quickly and so well.
Jay
@Liz,
Elective mastectomy is offered on the NHS if the risk of breast cancer is high.
Autismum beat me to it.
@MSII - So she's faked the whole think for shill payments? Wow. She's giving up all of her Hollywood income for Draconi$ Dollar$?
I love them, but you can't feed six kids on gifts from Minion Mart, and branded shillwear from the Reptile Recreation Outlet Store.
I bet the kids would look adorable in those onesies that make the wearer look like one of Lord Draconis' hatchlings.
@Edith - gotta love the mansplainers. Their Megatastic Man Minds are clearly superior, and better equipped to determine how women live. What do we know about our bodies, our lived experiences? I mean, after all w... OH LOOK! A ICKLE PUPPY IN A ROMPER SUIT!
Whoops! Where was I? Oh yeah, dontcha know that without men like Mikey to guide us, we'd be off getting abortions for funsies, and caving to the (apparent, as per Mike) new Hollywood craze of radical bilateral mastectomy.
I have nothing but admiration for someone who is a woman in an intensely looks and body-focused industry, where women* are especially subject to harsh judgment under very narrow aesthetic standards, to make a solely health-based decision that could potentially end an incredibly lucrative career. She wants to spare her precious children from the agony of watching their mother slowly die.
elburto-Dad's mam** died of breast cancer in a time when large masses were excised, then they were sent home to die in absolute misery. My dad was only 14 when she died, and he'd been her primary caretaker (his dad and older brother worked, and his other brother was younger ) for three years. He described her as "Rotting from the inside out". He still cannot even be in the same room as cotton wool, he's phobic of it, because it reminds him of her. He's still deeply scarred by it
Ms Jolie is doing her best to spare her children that same ordeal, and that is laudable.
*I actually cried when I found out that Kathleen Turner had feigned a substance abuse problem for decades, rather than admitting to having arthritis, knowing that the truth would end her career. Ableism, ageism and misogyny in action there.
** It may seem disrespectful (I do not mean it that way) to say that's she's my dad's mother and not my grandmother. I never knew her, and knew his stepmother as my Nanna.
Will be soon in Canada, as well as the genetic testing & consulting. We're also looking into providing other types of prophylaxis, such as tamoxifen.
I am working in a lab that simulates healthcare programs for healthcare agencies, and this is the big project going on right now.
We want to offer genetic testing to women (and men) at risk for different mutations (we'll be including BRCA1, BRCA2, PALB2, CHEK2, and maybe sequencing of full genomes). We're looking into pre-tests which would allow us to target the people who are most at risk so as to avoid testing the whole population.
There are algorithms, such as IBIS and BOADICEA that can evaluate your lifetime risk using certain information such as family history age at diagnosis of family members, age at menarche, ect. Those would be used on women with a family history to determine if genetic testing should be done. If someone tests positive, then prophylaxis will be offered.
Depends.
I come from a french-canadian population.
Due to the founder effect, there are about 10% of us who are BRCA1 carriers, about the same amount who are BRCA2 carriers.
For those that are interested, though it should be mandatory for Reb, here is video of a public lecture by Mary-Claire King about the genetics of cancer:
http://www.gs.washington.edu/wednesdays/2007/speakers/king.html
And according to this morning's Seattle Times article a colleague of hers is not happy about the test patent by a private company on publicly funded research:
I wasn't going to talk about this... but in the interest of reality:
one of our frequent tennis players suffered from 2 bouts of breast cancer about 20-odd years ago, long before I knew her. She thought she was "done with it" but a few years ago, she was diagnosed with ovarian cancer. And the same mutation that Ms Jolie has.
We only see her occasionally now but had heard good reports from someone who is close to her so we were happy when she dropped in at a party around New Year's: expecting only good news, my friend and I talked privately with her.
BUT after a couple of drinks she gave us details of her current situation and prognosis. She had been given the "all clear" but then, a while later, was told she had a recurrence - the size of a ... uh.. tennis ball, which was removed. She has had other complications involving surgical procedures and she needs other treatments as well. It has been a grueling, painful ordeal for her and she is cognisant of the future.
She may have chosen us because I am usually rather *sang froid* and my friend once had to identify a family member's body blown up in a terrorist bombing. So she might have thought that it wouldn't be as unnerving or painful to *us* as to some of the other people: she wanted to tell somebody about her fate.
She was wrong - although both of us hid our reactions well until after she had left- we were entirely unnerved by what she related. I also recall a certain wistful resignation in her voice and expression which I can't seem to forget.
Her tale was horrifying and frightening. I imagine that anyone who has a sizable risk of developing this illness would want to take any preventive measures available to them.
"Maiming" yourself? What do you think CANCER does, Mike?
RE Liz' quoted comment:
To someone without insurance, the price can be mind-boggling. The actual price to someone with insurance, on the other hand, is often a small fraction.
I have this both from quite a few news sources and some personal experience: recent surgeries (ranging from total knee arthroplasty to in-office removal of melanoma in situ) have mostly been quoted at four or five times the amount actually billed to insurance.
Which is profoundly offensive, IMHO. I can certainly afford this kind of thing, even without insurance, better than the woman Liz quotes (although I'm a poor candidate for mastectomy due to a chromosomal variation.) Some States have legislation to limit the practice of jacking up charges to the uninsured to this extent. If your State doesn't, you might want to do something about it.
elburto,
To be fair, the "she faked it" claim came from several readers who posted comments, not from Mikey himself. Once posits that she did it for publicity to boost her career, one speculated she wanted implants so this was a good excuse, and others feel she is faking the whole thing and is a shill trying to increase traffic in operating rooms as other women will copy her and ask for the same operation.
Adams's readers are pathetic. Many comments said something along the lines of "she should have just taken the risk, because there are things like Gerson therapy that could have cured her if she did get cancer." Other morons insist she could prevent cancer in the first place merely by eating organic, dealing with emotional issues in her past, or accepting god.
And apparently Alex Jones has also weighed in on the conspiracy theory (maybe it was a false flag?) but I don't have any Gravol in the house and he truly makes me nauseous.
elburto: You're not alone in that history. My (late) mother's mother died of breast cancer when my mother was 13. As the oldest child, she was not only the caregiver for her mother but for her little brothers as well.
Yeah, it left emotional marks that she carried to her grave and to some extent passed on to her sons.
@ LizDitz
I live in the Netherlands and testing and preventive & corrective surgery are fully covered under our health system.
@ Denice
...
That sounds awfully familiar to me.
My best friend went through that ordeal, and died, about 2 years ago. If she had had any way to prevent this, she would have chosen to do it. Especially when she had witnessed her own mother dying from it at about the same age as she did (in her mid-thirties).
She still managed to finish her thesis (in molecular oncology of all things !!!) and defend it, while undergoing chemo herself. She was a totally amazing woman in many aspects.
And for those who still think her cancer could have been prevented by any "natural" means : my friend didn't drink, didn't smoke, was a vegetarian, avoided sweets and practiced yoga regularly. She was a victim of crappy genetics, and the only thing that might have helped her is appropriate testing and prophylaxis.
Adams’ also asks why male doctors don’t “chop off their testicles” to prevent testicular cancer
If you knew they had a 85% chance of spawning cancer you'd be a fool not to chop them (if I may call a spayed a spayed).
Think of the cool devices you could include in their prosthetic replacements.
I know of two women who had elective mastectomies, because they have BRCA gene mutations.
The first woman's mother died of breast cancer and she herself had already had one mastectomy and a breast reconstruction with an implant. Just before her scheduled elective surgery, I read an article in New York magazine about double elective mastectomies and I provided her with the article. She, like the woman in the article learned after the surgery, that a small cancer was found in the removed breast tissue:
http://nymag.com/nymetro/health/features/999/index4.html
(Her 38-year-old daughter was diagnosed with breast cancer, underwent extensive radiation and chemotherapy after excision, then had double elective mastectomies and reconstruction).
My friend was diagnosed with breast cancer about 25 years ago, had a lumpectomy, radiation and chemotherapy. She also underwent surgery to remove her uterus and ovaries, putting herself into menopause at age 40. Her mother died from breast surgery and her sister who survived breast cancer died of ovarian cancer.
Twenty years after her first cancer was diagnosed, another cancer was found on her other breast and she underwent another lumpectomy, radiation and chemotherapy.
Two years ago, she underwent two elective mastectomies and reconstructive surgeries, (12 hour procedures, six weeks apart), using fatty tissue transplants from her buttocks:
http://www.webmd.com/breast-cancer/tissue-flap-surgery-for-breast-recon…
The "good news" is that her daughter and her two nieces underwent genetic testing and they do not have BRCA gene mutations. More "good news", no cancer was found in the surgically removed breast tissue.
I think Mikey and the poster/ping at # 24 are idiots.
I think Mikey and the poster/ping at # 24 are idiots.
All the evidence suggests that Mike Adams has had large parts of his brain removed as a precautionary measure against cancer.
Great, high and holy Frigg!*
Who has come down from heaven and presented us with a gift- 64 minutes of uninterrupted woo that would harm women! Praise her!
@ PRN, the Gary Null Show, today's edition, taped, features:
the chief idiot's reflections on "gutter science" (i.e. genetic testing), the real ways to prevent breast cancer: supplements, turmeric, organic fruits and vegetables AND avoidance of "bra wearing... perfumes, skin care, cosmetics" **. Diagnosis of breast cancer leads to MI.
He reads Sayer Ji's Green Med Info comments about Angelina and welcomes Dr Christiane Northrup as a guest: the latter agrees with his woo wholeheartedly and discusses epigenetics, near-death experiences and how the "forces of Dark and Light" struggle on the internet. Thanks, Dr Chris for remembering us..
Towards the end, Null discusses Dr Issels' amazing work*** with cancer patients and speaks with his woo-begone nurse enabler, Luanne .
* not that I believe in her.
** if true, yours truly is in trouble with those last 4.
*** right, he really helped Bob Marley.
He seems to be dressing on both sides, given the allegation in "Vaccine Zombie."
Herr doktor:
(if I may call a spayed a spayed)
*rimshot*
Think of the cool devices you could include in their prosthetic replacements.
I'm thinking a bicycle pump. Give the jewels a few sqeezes to inflate the tires.
I'm going to keep that in mind if I have a mastectomy in the future...
I have had one removed because of its cancer risk. Sadly, it was sent off to the lab for slicing & histology, so I did not get to bring it home in a little jar of alcohol and keep it on the mantelpiece.
Dr Hilda Bastion did an excellent balanced blog on this here http://blogs.scientificamerican.com/guest-blog/2013/05/14/courage-versu…. I have had 2 relatives who had awareness raised by screening and elected to have a mammogram and colonoscopy respectively. This meant early diagnosis spared them the consequences of phyloddes tumor and colon cancer, still the risk of false positives in screening is high. It is important to maintain balance and be an informed decision maker.
Free books to download that share about making medical decision and calculating risk in easy to understand terms can be found here http://www.ncbi.nlm.nih.gov/pubmedhealth/understanding-research-results/
On the topic of bilateral mastectomies, I just read an interesting New York Times Magazine article about how, as Orac said, many patients are undergoing the procedure because the risk of breast cancer has actually been overblown--in part thanks to the "Pink" campaigns--and women have been trained to think of their breasts as "ticking time bombs." In particular, the author noted that many women have complete mastectomies after finding benign lumps in their breasts, as they think the lumps will doubtlessly turn malignant later and destroy their entire bodies. Better to lob them thangs off before they go bad!
I think that's a silly precedent (personally). I just got an FNA thyroid biopsy and found out I have Hurthle cell adenoma and that I should be re-checked in six months. Now, there's a chance (small) that it may become malignant later. My father did not develop thyroid cancer, but his thyroid stopped functioning (period) several years ago.
Should I have the damn thing removed? Of course not. Let's wait until something ACTUALLY HAPPENS, right?
I see Adams is also suggesting that:
But the problem isn't BRAC gene expression, if anything it's the opposite. The BRAC gene produces proteins that help repair damaged DNA. I3C, found in broccoli etc., upregulates the BRAC genes but that isn't very helpful if those genes are mutated and the proteins produced don't help to repair DNA. You can eat as much broccoli as you like, but it won't make mutated BRAC genes unmutated. Yet another example of how ignorant Adams is on these subjects.
BRCA not BRAC, I have an odd mental block about this.
If I were in Jolie's shoes, I'd do the same thing. And I'm not exactly in her shoes--no family history of breast or ovarian cancer--but I am going to have my ovaries removed. My ovaries have always been a hot mess, and after 30 plus years of endometriosis, 6 surgeries for endo,and fertility treatments to get pregnant, I'm just not willing to live in fear any more. The CDC has recently decided that endometriosis is a risk factor for ovarian cancer. I had a hysterectomy 5 years ago for the endometriosis but left my ovaries in. Now that I'm turning 50 and very close to menopause, I'll just be speeding mother nature up a little bit. I just went through another cancer scare and I'm done.
Herr Doktor Bimler,
That might give an entirely new meaning to The X-Men. Especially if they were adamantium or vibranium.
I'm also thinking Utility Pouch.
Krebiozen,
I trust "none" counts there.
Dr. Gordon - just a note to say that was a very thoughtful and well written comment on the post.
Adams is the Westboro Baptist Church of quacks.
I’m also thinking Utility Pouch.
Useful for small change and memory chips.
Zach Miller: women have been trained to think of their breasts as “ticking time bombs.” In particular, the author noted that many women have complete mastectomies after finding benign lumps in their breasts, as they think the lumps will doubtlessly turn malignant later and destroy their entire bodies.
Or they just have had enough of their chest and see a good excuse. Seriously, I've never met a woman who doesn't hate her boobs. They're too small or too big, cause too much comment or commotion, and are generally the most annoying and most judged part of the female body.
#21, 49 Good on you, Dr. Gordon.
#21, 49 Good on you, Dr. Gordon.
Thirded.
Krebiozen:
While many think that it stands for BReast CAncer, it actually stands for BeRkeley, CA. Which is where Dr. Mary-Claire King was when she discovered it. Well, at least that was her story when she explained it in the video I posted. (I was in the audience)
And, yes, thank you, Dr. Gordon for those sentiments on Ms. Jolie's decision.
Orac, as a breast cancer patient, I wish surgeons weren't so quick to remove preventative mastectomy from the table of options. I think the push for these mastectomies is patient-driven because reconstruction is a pain in the ass.
I'm a 36 year-old long-distance runner (symmetry helps) with small children (surgical recovery time is hard to come by). Once we complete this reconstruction (it'll be at least another five months; my mastectomy was 11 months ago), I'll need to replace the implants (one for a breast, and one for matching) every 5-10 years. If the hospital wasn't so conveniently located, or my employer wasn't so understanding, I doubt I'd have even managed to get the expander filled. From a lifestyle perspective, it would be easier to just not have breasts. The benefits I was hoping for are far off (symmetry) and far from guaranteed (I might lose nerve function on the other side anyway). Chasing those benefits has meant more time off from work (unpaid, because I ran out of PTO a long time back), more surgery (my first expander leaked), more complications from surgery (post-op infection after the expander replacement), and major disruptions to my family (I spent five years being the athletic parent who caught flying kiddos, and I'd be back there by now if wasn't screwing around with rebuilding).
Dealing with prostheses on a permanent basis would mean some major changes that I'd be unhappy to make, but I know that I'm pretty uncomfortable walking around asymmetrical. My surgeon formally ruled out bilateral mastectomy when I tested BRCA-. I wish he'd at least been open to a more extended discussion of the possibility, and I wish the decision had been left more in my hands.
I have some questions I hope someone can help with...
an oncologist once told me that he could see some cancer tumours grow from week to week, whereas others may only grow a fraction over ten years or more. So, does the BRCA mutation lead to tumours which are incredibly fast growing and/or more likely to spread throughout the body? Is it the case that if you have this gene mutation you'll go from stage 1 cancer to stage 4 within a couple of weeks/months?
thanks
PGP -- then meet me. ;-) I'm happy with my set. But I did know a gal who indeed felt hers were too big. You might find it just vanity, but it was ruining her excellent diving career, giving her backaches, and making her the brunt of some extremely cruel comments. (It seems that if a woman is large-chested, it is immediately assumed that she sleeps with everybody, which is really quite a strange assumption since of course she did not choose to have a bust so large that undergarments must be specially ordered.) She had breast reduction surgery as a teen and although it's a brutally painful procedure, she was very happy with the results.
Seriously, I’ve never met a woman who doesn’t hate her boobs.
You have a limited circle of female acquaintances.
Well, the thing is with BRCA mutations, that moment is usually much too late.
Also, BC & ovarian cancer, especially among young women where they are diagnosed at late stages, do not have the same remission rates as thyroid cancer.
It means that you may develop cancer at a younger age than is typical (typical is post-menopause). Breast cancer in young women tends to be more aggressive, so yes, spreads faster.
Breast cancer is also more difficult to detect in young women because their breast have more density, which makes mammograms unreliable.
What that means is that if you have a BRCA mutation, you are more likely to develop breast cancer at a young age, that the cancer will spread faster because you are younger and still producing estrogens, and that it will be detected later because mammograms have a higher chance of missing it.
"She wants to spare her precious children from the agony of watching their mother slowly die."
Elburto, please don't take offense, but this sort of statement sends chills up my spine. It's so common, and I certainly understand it, but... Couldn't she also, or even primarily, want to spare herself the agony of a slow and painful death? Is it less tragic if a woman with no children dies of breast cancer?
I live in New Zealand. Several times in the past few years, questions around government funding of some of the more expensive treatments have arisen. The common statement in the press is, "it's a tragedy when a young mother dies of breast cancer [and so the government should fund treatment X]". I know I'm a bit sensitive about this--being one of those less sympathetic women who is at risk for BC, but is childless and no longer young. I suppose that if the sympathetic cases can foster interest and commitment to assist the rest of us, then that's a good thing. But geez, why can't women be seen to be interested in living for our own sakes?
Sorry for the rant, and I certainly don't mean disrespect to your family's tragedy, Elburto. Obviously this has been rankling with me for quite a while...
@Calli Arcale: I have a friend who had breast reduction because it was causing her severe back pain and embarrassment. Before the surgery, she was about a 10G - and she was less than 5ft tall. Because she was so short, you had to look down to make eye contact, and it was REALLY hard to keep the eyes from travelling downwards because her breasts were so damn big! She had back and neck pain and also had to put up with getting groped etc. She's now a much happier 10D.
Calli: I knew a girl in high school who matured way early and had to have breast reduction surgery. So, yeah, I get that someone would want that for health reasons.
Shay: Yes, and they're also mostly in their mid-20s. Point? I'd actually prefer to be friends with women who either hate or are indifferent to their bodies.People who love their body as a teenager or a twenty-something tend to be insufferable or athletes.
No! Not athletes--what are those women thinking?
PGP, I think you're projecting. I don't hate my breasts (never have) and I'm 57.
PGP: The only thing that annoys me about my breasts is that so many clothing manufacturers make clothes that are awful for larger breasts. And that is not me hating my breasts, that's me hating clothing manufacturers!
tumbling:
She remembers losing her mother at a relatively young age. That is not easy for a young person. I know because my mother died when I was eleven.
I personally believe that Ms. Jolie wishes to spare her younger children the trauma of losing a mother at a young age.
Once upon a couple of decades ago I went to memorial service of someone who was crucial in me becoming an engineer and my early career. She found out she had breast cancer when she felt a lump while breastfeeding her younger daughter.
At that service I spoke of her influence on me while her two very young daughters played near by. She was only about forty-two years old, the same age my mother was when she died in a plane crash.
I still think about those little girls, who are now grown up.
I am sorry, tumbling, but being a mother actually changes everything.
Here is one thing: do you think the movie "Terms of Endearment" is a comedy? I don't, and neither does my spouse who also had a parent die as a child. I was the one who had the strength to do to the lobby and ask for more napkins to dab crying eyes. I told the poor young teenager that those people still sitting in the theater crying their eyes out had a high probability of losing a parent during childhood.
Here is a question for you tumbler: are your parents still alive? If not, were you a child when one died?
tumbling: I don't think anyone is suggesting its less of a tragedy when a childless woman dies of breast cancer. I certainly don't think elburto is.
But I agree with Chris, above. When you are a parent, it does change everything. And I say this as someone who is militantly childfree - and I watched my father die over a long period from illness, and die too young.
Ms Jolie identifies as much as a parent as she does as an actress. I have no doubt she meant it when she said she was doing this so her children wouldn't have to watch her die - especially after watching her mother suffer.
And there it is... I suspected that this has nothing to do with cancer and more to do with 'womanhood'. I guess I was right.
It's feminine to be in pain? To have cancer? To sit around and wait while your body decides to attack you or not? To 'respect' it by ignoring potential health risks?
Oh wait, I forgot Adams lives in fluffy pink unicorn world where women are barefoot and men are men.
*rolls eyes*
Being the empowered woman that I am, I will choose not to listen to a *man* telling me to ignore health problems that I have discussed soberly with my own doctor and who is familiar with my particulars and not just some generalised idea of what women's health should be about.
Fortunately, Jolie and many others prove that being 'Hollywood' doesn't mean you're stupid, lazy, or any other stereotype people like to come up with.
@elburto
Your rant further up is far better than mine :)
Isn't it sad that drug addiction is acceptable, but arthritis isn't? Maybe I should take back that remark about Hollywood stereotypes...
@MSII
Maybe men are actually wimps in Adams' world, who would rather be 'men' than consider proper medical advice...
Yeah, because someone like her really needs help getting noticed. Sarcasm aside, how does having breast surgery make you look more employable to people only interested in her looks and ability to jump over speeding cars in front of a camera?
Because apparently having more than one surgery is just so much cheaper and less aggravating to your body than having one surgery for implants... And it's not like she would need to have an excuse. Since when is getting implants in Hollywood problematic for one's career or reputation?
Sadly the same people who believe Adams' crap are also the same people who are most likely to follow star fad diets. So they're not all that wrong, only on the shill part.
you fucking shills.
Dr Richard Schulze also commented on what she did. He said the same thing as mike. She didn't need to do that. She is no hero. https://herbdocblog.com/article/Commentary/prophylacticbreast-removal/
Great job John. Very well argued. Not.
Did you have something up your sleeve a little more in-depth and original? Or did you just want to prove that you have no rebuttal to Orac's arguments?
I would like to point out that these genes also indicate an increased risk of prostate cancer in men, but i haven't heard anyone suggesting that men should undergo prophylactic surgery to remove their prostates.
In 1997 the National Genome Research Institute (http://www.genome.gov/10000939) downgraded the risk of cancer if one has these genes from the above quoted 87% to perhaps 56%, stating that " The data provides us with information about the average cancer risk among a group of carriers," said Margaret A. Tucker, M.D., chief of NCI's Genetic Epidemiology Branch. "We can't predict the risk for an individual carrier. The risk for breast cancer for an individual woman, for example, may be higher or lower than the 56 percent average.
The researchers calculated that only about 7 percent of the breast cancer in Jewish women is due
to these alterations in BRCA1 and BRCA2. Likewise, the vast majority of breast cancers in non-Jewish women are not due to inherited alterations in these genes."
Flip: It’s feminine to be in pain? To have cancer? To sit around and wait while your body decides to attack you or not? To ‘respect’ it by ignoring potential health risks?
Yep. And this is one of the many reasons I want nothing to do with femininity, ever.
This is a horrible review of a serious problem. Cancer docs are abject failures and liars. To come forward and say that some person has an 85% chance of developing a killer cancer because of a gene is a true indictment against the alleged scientific nature of these people. I must insist that Orac and his pals honestly assume the title of "quack" since this is the correct neutral description of their practice and attitude in our dreadful poison based system. They use poisons and charge a very high price--scamming, lying and creating disinformation is the defintion of scam artists and quacks. The term was used because of their fondness for mercury--a fondness they have not abandoned at all. They say they were wrong fro bleeding so many patients but I have never read an apology. because they are in complete ignorance and yet possess ultimate arrogance and they are never really wrong in their own eyes--no matter how many millions they murder. I have been wrecked by their poisons--antibiotics which are of no value and the public should learn to stop using them and then the "doctors" will stop RXing them--and the poison based system will only come up with ugly ideas to deal with problems they do not and are not willing to understand.
If--At any moment, I could be magically be scanned and indeed I might show a pre-disposition to testicular cancer for example--clearly diabetes as a result of the evil antibiotics--so what? My future is in my hands. I work hard on my health and the best step first and foremost-- NEVER see an MD again-- since I was almost dead in November. I have transformed my life and my body and I am actively detoxing all the poison the medical mob has put inside of me with the intent of killing me. Healing means getting the bad stuff out that was placed inside my body intentionally by the state and the doctors.
Removing healthy breast tissue and ovaries in a wild attempt at increasing one's chances of not getting a cancer is not a serious proposal. It is a really extreme approach. This is so obvious . Thus, when cancer appears in an organ--removing the organ as soon as it is detected does very little to slow the progress of cancer--if you stick with the quacks and do nothing else. Therefore pre-emptively removing body parts and ignoring real medicine is a very callous and almost suicidal position.
And this beautiful actress is to be applauded as "courageous" for taking healthy breast tissue and inserting a toxic substitute?
Here prominent tattoos are toxic and more likely to present as a threat to her health...her healthy tissue is not a threat. The genetic marker may easily be caused by a virus that the MD's cannot possibly understand since they have not studied real medicine. Recently, I noticed that schizophrenia is now understood properly as a viral infection and it also is expressed as "genetic."
Sure I feel bad for Ms. Jolie since she has been scammed by a truly monstrous force in our society and our culture. Organized, monopolistic, anti-science, illogical, ignorant modern medicine is losing its hold on the populace despite its elaborate attempts to crush its competition.
Sorry, Orac--we want to live and not join the neglected, cut, poisoned and burned. Can we live? Must you kill us all?
So, Mr. Friedman, we need to take your rant seriously because.... why?
@david n. friedman
And you would have any evidence that would support your little rant?
How about more of your rant Mr. Friedman...so we know which special treatments you are using on yourself to detoxify your body from all those "poisons" that were prescribed for you.
Got any links to articles that antibiotics cause diabetes?
Say, that's not David "Seasilver" Friedman, is it?
There's a comment from David N. Friedman on this website dealing with "mercury detoxification":
http://www.amandashealthjournal.com/my-quicksilver-mercury-speciation-t…
"I am sorry, tumbling, but being a mother actually changes everything. "
And I'm sorry, but do you know how condescending this sounds?
Maybe objectively speaking the death of a mother is more tragic that the death of a non-mother of the same age. But a non-mother still has a life and people who love her.
I cannot have children. My life is still important to me.
@David
What now? You want an apology from doctors several hundred years ago for doing something they genuinely thought to work - and abandoned it once they realised they were wrong?
The "state" forced you to take medical treatments you didn't want? Which state? Why?
Because her only value is as a well-known beauty, right?
How are tattoos toxic? I know many tattooed people and none of them are unusually sick.
... On a side note, does anyone have a medical bingo card for fallacies and tropes? These comments really do get dull after a while.
A search for his name in quotes, plus the word mercury turns up some... er, interesting comments and links.
“I am sorry, tumbling, but being a mother actually changes everything. ”
To the posters who don't like this statement, it is neither condescending nor patronizing, it is simply the truth. It does not diminish women who can't have kids, nor those who choose not to. But being a mother is life changing whether you like it or not.
Biblia, everyone acknowledges that motherhood is life changing. But in the context of this story, are you really saying that if Jolie were childless she would be quite happy to risk her life for the sake of keeping her breasts? Because that seems to be the implication. And I'm sorry that you can't see how hurtful that implication is.