Good for her!
I can't help but point out that the sentence "I am fortunate to have a partner, Brad Pitt, who is so loving and supportive." is, well...I think the appositive maybe wasn't strictly necessary.
If I were fucking Brad Pitt I would never shut up about it.
"I am fortunate to have a partner, Brad Pitt (the actor)..." would have been too much.
"...you may remember him from such movies as Thelma and Louise..."
(I can't explain it but he really doesn't even break into the top 15 on my celebrity fuck list. Alright, there is not an actual list. But what I'm trying to say is that despite being squarely my type, outside of maybe Thelma and Louise, he doesn't really light my fire. This is all in parentheses because I feel guilty for not talking about breasts. Semper sic transit gloria moundi or something.)
"I'm fortunate to have a partner, whose upcoming movie World War Z you really must go see or his career is over..."
"...who will appear in World War Z opening this summer..."
can't explain it but he really doesn't even break into the top 15 on my celebrity fuck list.
Nor mine, but I can explain that fairly easily.
I think Heebie gets to take one free punch at me at Unfoggedy-Brad-Pitt-Con for such early topic drift.
Brad Pitt does nothing for me either. Not even that blood-smeared, half-naked, cigarette-smoking Tyler Durden still that everyone loves.
Oh I wish you could go back and edit when you've hastily put down the first thing that popped into your head and could have made a decent joke. Semper sic transit gloria 31D?
Ahem!
I think this is pretty amazing of Jolie. Christina Applegate has also been very open about her double mastectomy, but hers came after a cancer diagnosis I believe.
I feel guilty for not talking about breasts
New mouseover text for Smearcase's blog.
15: Not to deny props to Jolie, but what choice did she have?
14: I liked the first one better.
18: Wait and see? Obviously a higher risk strategy, but a choice.
18: Having the double mastectomy and not telling anybody about it?
Ok, but how is this the courageous option?
Actually, her mention of "holistic doctors" makes me wonder what alternatives she was considering.
She also had a choice not to be so public about her decision, or her reasoning. She had a choice to be as private as possible about what's essentially a private matter, instead of using her circumstances to help advance public education of the issue.
I'm confused -- heebie, are you talking about Jolie's decision to have the surgery or her decision to be extremely public about it?
Right, I think that being completely open about it is the thing here. (The holistic thing is weird and I wonder what she meant.)
I was talking about her decision to have the surgery. Being open about it is commendable, but I was being slow on the draw.
18: She could have stayed silent about it.
If I were a PR professional, I'd probably advise her to do as she's done, but I prefer to give her the benefit of the doubt and imagine that she wants to do some good.
I think it would be awesome if she got implants that could she adjust in size as the role demanded it. Like the ones that stripper in DC got to write off her taxes as a business expense.
Actually, I bet in the future all actors will have customizable hardware.
If you were a PR professional, you'd find a way to spin that as you ratifying a consensus.
27: So "what other choice did she have" refers to having the surgery and having it at this moment? There are other perfectly rational choices.
32: Sure, there are other medical choices, but it's not like one is more worthy of praise than another.
Got it. It sounded like you were saying just the opposite, which seemed rather unlike you.
Geez, the crap women have to deal with is fairly amazing.
Even the former "not going to war" just means knowing that the women in the war zone are getting raped. Plus, now that you get to go to war, you get to get sexually assaulted.
Christina Applegate's case is interesting. She was getting early mammography due to carrying the BRCA1 variation, but her doctors told her that the scans were actually impossible to read since as a young person she had dense breast tissue. They switched her (as a rich person) to MRIs, and her cancer ended up being detected at the earliest possible stage. Her charity work now centers around MRI screening for young women at high genetic risk for breast cancer. Mammograms don't actually work for them.
I know this because I had a college friend die a couple of weeks ago. Despite beginning mammography at 35 due to a family history and a series of "clean" mammograms, she was diagnosed with Stage IV breast cancer after a doctor manually discovered a mass in one of her breasts (not too long after receiving one of her 100% clean radiology reports). It turns out that in most states, it is SOP to tell a woman no problems were found in her scan, even if the reason nothing was found was because literally nothing could be seen. Before dying, my friend worked to pass a law in NYS mandating that women be told if their mammograms are unreadable. (She worked on the CA bill as well, but Brown vetoed that one, not wanting to cause women "undue anxiety.")
Where are the med-mal attorneys when you need them? The SOP in 36 seems ripe for a class-action.
36: So sorry about your friend, oudemia.
Peggy Orenstein's NYT magazine article from a few weeks ago was good on this subject.
(BTW, does anyone want 3 months of free access to the NYT? Lemme know.)
I acknowledge that there are many wonderful holistic doctors working on alternatives to surgery.
My guess is that among her Hollywood friends, a common response to her decision was something like, "Don't you know that if you just flush all the toxins out of your system, and pray to L. Ron Hubbard and/or the Goddess etc., you can never get cancer?" So that sentence is there to mollify them.
41: I think it's more likely that she partly buys into the woo but decided to go with science anyway. She's said things in other contexts that are woo-ish.
41 was me, and I think 42 and 41 can both be true.
Here's a vanity point that's been plaguing me lately: in my 20s, I decided not to get reconstructive surgery. The thing is that then, I was thin and fit, and it's easy to be transgressive when you imagine that you'll always be thin and fit.
Now it seems a lot more likely that I'll be apple-shaped as I age. Flat scars on an apple-shape are a much tougher pill to swallow than flat scars on a thin body. It's just vanity, and Jammies is 1000% supportive either way, but I've sort of gotten cold feet because of general body dysmorphia.
If she were a real humanitarian, she'd put the unwanted tits up on eBay and give the proceeds to charity. I imagine Angelina Jolie's tits would fetch a pretty good sum.
(I do feel guilty about joking about it, just not guilty enough for it to affect my behaviour)
39: Good on what? I agree in general that early scans for everyone wouldn't likely be helpful. But sending women at very high risk for scans that can't actually be read and then lying to them about it is something else entirely.
Early scans for everyone would almost certainly be harmful, but that is indeed something else entirely.
Early scans for everyone would almost certainly be harmful, but that is indeed something else entirely.
Yup.
I'm going to see if I can take the opposition position on the utility of conveying statistical information about risk in two adjacent threads.
44: It's not a one-time offer, is it? (Insurance sucks so much that I wouldn't be surprised.) If you decide you aren't happy without reconstruction, is there a way to have left things so reconstruction is an easier possibility later?
44.last: Trying to put myself in your shoes (and failing, no doubt), I'd opt for reconstruction. Part of it is cowardice about feeding dysmorphia (it's not like aging doesn't provide plenty of ammo on that front anyway). Another part is just my sense that it completes the 'fuck you' to BRCA in some way. Not that either is necessarily a good reason, especially if the pain management during reconstruction is incompetent.
Also Thorn's point is a good one. There's probably a way to leave the door open for reconstruction is you initially opt against.
50: We discussed this at least once before, but I think it's much easier to reconstruct immediately rather than later.
50: Some parts are reversible, some aren't. The major one which is not reversible is whether or not to have the nipple-sparing procedure, which Jolie describes.
(I'm not actually sure I'll even have the option of having the nipple-sparing procedure - depends on your body and whether your surgeon offers it. If I can't get it, the choice is actually much easier - if looking normal is off the table, might as well be transgressive. If that makes sense.)
Trying to put myself in your shoes (and failing, no doubt), I'd opt for reconstruction. Part of it is cowardice about feeding dysmorphia (it's not like aging doesn't provide plenty of ammo on that front anyway). Another part is just my sense that it completes the 'fuck you' to BRCA in some way.
These two reasons seem like they're anti-reconstruction. Am I mis-reading you?
I feel like forgoing reconstruction is "right" for me, so my guess is that I'll stick with that, but it's much more confronting (and frankly, scary), now that I'm clearer about aging, than it used to be. I mean, aging isn't pretty, so might as well throw that pipe dream away anyway. But still.
46: Yeah, sorry, I was unclear. I meant that women get this overall message that mammograms are the answer to everything about breast cancer, which is lousy advice in the ways that Orenstein describes and in the false sense of security they gave your friend.
Well, you were already thinking about using prostheses at least sometimes, so that can help with some of the dysmorphia to the extent that it's a problem for you. (And prostheses are more adjustable to work with visually complementing the rest of your proportions than surgical reconstruction would be, which seems like a plus.)
Getting old really does suck. I'm on one of my "Do more pushups" kicks, and for some reason this time the bottleneck is my abdominal muscles -- they get too sore to continue before my arms give out, and one rest day between workouts isn't really enough. What the hell is that? I've never noticed abdominal weakness as a problem before for anything.
55: I sort of see how they could be read that way, but to me they argue for reconstruction. It's difficult to realistically imagine being in that position for me, but trying anyway: Minimizing the physical change due to having to take this defensive action seems to me the most likely to leave me feeling like beat it, which goes to the 'fuck you BRCA!' bit. I don't really get how not having reconstruction would be less likely to feed dysmorphia, but diff'rent strokes, I guess.
In the end of the day I can see how a person might choose either path. It's about as personal a decision as one can encounter.
And prostheses are more adjustable to work with visually complementing the rest of your proportions than surgical reconstruction would be, which seems like a plus.
That's an excellent point, actually, which I hadn't considered.
The idea of being breastless an exercising is such a fantastic plus that it outweighs a lot of cons.
If I had to get a testicle removed because of cancer or careless golfing, I'd get one of those fake ones put in.
56: Obviously you have to create a Family Day tradition of each kid having to make you a new set of prostheses out of modeling clay or packing peanuts or whatever else is age-appropriate, and then you'll have plenty of options. More seriously, I can see both sides and you seem to me like you could rock the no-reconstruction body, but I know that physical differences can also have a mental impact that you don't necessarily expect. But it still must be really hard to feel enough certainty about what Future You will want/feel/think.
It's funny -- I'm moderate-sized breastwise, neither flatchested nor extravagantly the reverse -- but I've never noticed them as a problem at all exercising. I mean, I wear sports bras because who wants to get their regular bras all sweaty, but it's never occurred to me that my breasts were at all a problem for exercising. No point, really, it's just funny how different people's experiences are.
I don't really get how not having reconstruction would be less likely to feed dysmorphia, but diff'rent strokes, I guess.
I thought that by "don't feed dysmorphia", you meant "fight back! take on the dysmorphia head on and embrace unattractive bodies!" rather than "placate the dysmorphia and don't exacerbate it".
64: Got it. I guess I'm a coward on that front.
(For the record, I'm always very glad that people here are willing to discuss the minutia of the surgery and my decision. Much appreciated.)
but I've never noticed them as a problem at all exercising. I mean, I wear sports bras because who wants to get their regular bras all sweaty,
Even running or playing sports?
I don't find them a hassle if I'm doing something low-impact.
68: I don't play any sports, but running, no problem. Like, I ran five miles with Newt on Sunday, and the fact that I had breasts never crossed my mind as a source of discomfort.
70: I would have described myself as "medium," but I lock that shit down before running, because ugh. (But, you know, once locked down it's fine.)
I have terrible problems running. I also lock that shit down, and then I get chafing problems from the sports bras. So I end up taping before bra-ing before running and goddamnit, let's just lop the whole things off.
If you get a reconstruction, they'll be kind of locked down already, since the implant goes under the pectoral muscle. It's like having an internal sports bra.
The gf went through a mastectomy and reconstruction last fall. I'm sure she'd be fine with discussing it if you want, heebs, so email me if you want me to put you in touch.
Otis Brawley, ACS official and big opponent of unnecessary testing, comments: women should not get this genetic test without risk factors, and preventive double mastectomy can be a good choice, but only based on "very strong clinical and/or pathologic indications," with second opinions recommended.
since the implant goes under the pectoral muscle
Which itself sounds incredibly unpleasant.
I'd be interested in chatting with your girlfriend, J. I'll shoot you an email when I think of what questions to ask.
74 seems a bit extreme. Why wouldn't a positive mutation itself be sufficient reason for surgery?
76: I'm not clear from the discussion, but possibly because when a mutation is rare, screening the whole population will create many more false than true positives.
Right, I agree that genetic testing doesn't need to be universal. I thought it was then saying furthermore, when testing is warranted and turns up positive for BRCA, you still maybe shouldn't have the surgery.
Joan Walsh has a piece in Salon today about how although she knows she's a greater hereditary risk, she has opted to have neither the genetic test nor the surgery, but yearly mammograms and twice-yearly surgical consults. (Despite initial medical opinion that she should have a double mastectomy.)
The USPSTF recommendations and evidence that he's presumably drawing from (being a member of that task force). Not clear still, but it seems there's good evidence that prophylactic bilateral mastectomy and oophorectomy reduce cancer incidence by a huge degree, but a lack of evidence that they reduce mortality, and the risks and side effects of surgery are significant. I can't find the full ACS statement that he quotes that addresses the pros and cons of the procedure itself; the USPSTF is at core about whether the genetic test is recommended.
IIRC, BRCA1 mutations only becomes a high risk factor if you also have a family history of breast and ovarian cancer. The same mutations, in different contexts, are far less of a danger.
the implant goes under the pectoral muscle
This does not sound like it's good for the pectoral muscle, speaking as someone else who's on the `Fortyish, forty pushups' kick.
I was in a dragon boat once that lost to a boat of radical mastectomy holders and a different boat of people who were missing at least one original limb. (Although, now that I think of it, my boat was Team RSI as well as Team Indoorsy Nerd.)
What I thought was political about Jolie's essay was that she was discussing her breasts in terms of her health and her pleasure and her family -- not how she looked for fans.
I assume Team Amputee rowed circles around you.
I can sort of understand why Jolie herself isn't directly mentioning the gestating SCOTUS BRCA decision now (though she does allude to the prohibitive cost, which is 10x the cost of a 23andMe screen that gets you many many more SNPS), but I'm surprised at how little the other reports mention it. Anyone know how it's likely to shake out? I was wondering if the Monsanto Case has any relevance.
>http://www.npr.org/blogs/health/2013/04/15/177035299/supreme-court-asks-can-human-genes-be-patented
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Definitely in the running for most misleading headline of the year.
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84: Yeah, same here. If she didn't say anything, she risks it being gossip fodder in the future, but she also risks it somehow irrationally impacting her career which, unfortunately, has been partially powered by the successful objectification of her breasts. So it's kind of nice that she doesn't get bogged down in that history of being an actress whose famous for beautiful breasts---you could totally imagine the Elle magazine version of this spending many paragraphs ruminating on that.
It's funny, I had no opinion on her either way and had never really seen her in much or cared when I did, but even though it's full of flaws I viscerally loved loved loved SALT and will watch it over and over again. So I had this weirdly selfish thought of "gosh, I hope this doesn't impact her health so much that she doesn't make the sequel after all."
My situation is weird - I would not have qualified for genetic testing. This is because I got the mutation from my dad, and neither he nor I have any sisters, so there just is not any data.
The only women on my dad's side are his mother, his aunt, and his three cousins. All of them had breast or ovarian cancer before menopause, but none of them besides my grandmother (who died from breast cancer in her early 40s) would be taken into consideration by a genetic counselor.
My dad had himself tested, on a hunch, under a pseudonym, back in 2000, and paid for me to be tested, also under a fake name, in 2001. Just because it was completely unclear whether or not insurance companies would be able to bar you from coverage if you had the mutation.
Also, my brothers seem completely unaware that this could affect their daughters, even though that's been pointed out to them. They both seem to treat it as some weird thing that I'm doing in order to be...I'm not sure exactly. I imagine them rolling their eyes, though.
Their daughters have got to be very young still. It is possible, though far from certain, that holistic doctors (or regular ones) will have found a different solution.
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My colleague posted a picture of a gift from some students. It's the silhouette of a woman crossing a finish line, and in bold exuberant font, it says "ENDURE!"
I think ENDURE! may be my new favorite word of inspiration.
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91: Oh, sure. I'm not worried about my own daughters. Or myself, for that matter. I just think it's weird that they're quite so dismissive.
92 reminds me of the G.W. Bush quote reminding students to preserve.
"This is preservation month," Bush said. "I appreciate preservation. It's what you do when you run for president. You've got to preserve."
92: Narrowly beating out your other favorite --
SUFFER!
If you have the most dangerous mutation (a BRCA1 mutation), prophylactic mastectomy alone increases the chance that you will survive until age 70 by about 10% (from 53% to 64%). Simultaneous prophylactic oophorectomy improves survival by another 15% (to 77%). The average US female has an 84% chance of surviving to age 70.
My opinion on Myriad is biased by my employment, but I would throw their patent out on its metaphorical ass. You can patent a method for diagnosing the gene, but you can not patent any use of the information about the existence of the gene. I'll admit I haven't read all the arguments and amici, but the baseball bat analogy is bullshit and should be banned- they aren't taking the gene and making anything out of it (or to the extent they are, like making an artificial cDNA, they can patent those constructs but can't preclude people from getting the information by going around those patents.)
That it's only a 10% increase must be just because most breast cancer isn't fatal. The ovarian cancer is slightly scarier to me because it's much harder to detect in time.
Also by getting the surgery preventatively, you're saving yourself from possibly chemo/radiation/generally unpleasant treatments needed to survive it when you get it.
Oops, misread the table. PM only increases survival rates by 5% over screening alone.
Alternately put, prophylactic mastectomy increases life expectancy by about 1-2 years. Prophylactic oophorectomy increases life expectancy by about 6-7 years on top of that.
Survival rates take into account both breast and ovarian cancer.
Sorry. Oophorectomy is a funny word.
An oophorectomy oophor the rest of us.
We just need to teach people to perform ovarian self examinations too.
I'm going to kick ovarian cancer's metaphorical ass (it's all metaphorical asses around here today.) I've got some seriously specific early lead compounds.
If my chance of survival was 100%, and my chance of chemo/radiation/eventual mastectomy was 80%, wouldn't I still want the surgery, prophylactically, ahead of time?
105
That depends on your appetite for risk. I just thought it was interesting that the mastectomy itself didn't seem to do much. I honestly don't know what I'd go through for an additional 5% chance of surviving to a given age (or an additional 1-2 years of life)
I'm saying the opposite - forget the risk of death. Isn't skipping chemo and radiation a good enough reason to get the preventative surgery?
109: Well, surgery has risks of its own. If it were me it wouldn't be a slam-dunk, at least.
108: Thanks. It looks like that's not actual patient data but a computer model, though.
110
Correct. Based on relative risk ratios from experimental data I believe, but it is a computer model.
I don't know much about breast cancer specifically, but there's been a lot of cancer in my family lately. Three instances I can think of in my family, and T.'s father recently had a relapse. I haven't had a general medical exam in years just because I'm a young healthy guy, but I really, really do plan to start doing so again soon, and this is one of the biggest reasons why it's on my mind.
30
Actually, I bet in the future all actors will have customizable hardware.
I think making them all CGI is more likely. Then all actors will just do voice work, and the industry will go through the same thing it went through when silent film actors tried to act in talkies, but in reverse.
But the surgery could easily be a wash, because it would come with the cancer treatment anyway. (Depending, of course. But it's unlikely that you wouldn't treat a BRCA person very aggressively when they actually developed a lump.)
If it were just a straight comparison, with no weird probabilities factored in, I would definitely pick surgery now over chemo later. Everyone agrees that chemo sucks.
And emotionally, that's what it feels like I'm deciding between. It feels like guaranteed cancer treatment, but highly unlikely cancer death. (More accurately, I never really contemplated not getting the surgery, because none of this over-treatment stuff was up for discussion twelve years ago when the topic was broached.)
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Wildly reaching a way to justify posting this Speaking of "Titties, away!" I don't know if the still of this video shows the same for everyone as it does for me, but trust me that it is quite arresting. Many possible captions that even I won't stoop to writing flash through my mind.
Now back to your regularly scheduled inane banter.
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92: I dreamed I was way out front* endured in my Maidenform bra.
*The internet is letting me down. I'm pretty sure there was a MAD magazine parody of the Maidenform ads showing a women runner crossing the tape with the "way out front" caption.
I viscerally loved loved loved SALT and will watch it over and over again
This is the most shocking thing I've ever read here.
I viscerally loved loved loved SALT and will watch it over and over again
This is the most shocking thing I've ever read here.
Seriously. The ORIGINAL were an interminable slog--the follow-up round in '79 were just boring.
119: I know, I know, it shocks most people who know me. I can't explain it, I just really loved watching it.
I came back to say that apparently I am totally wrong and BRCA1 is a huge problem for some African American women and Hispanic women. http://health.usnews.com/usnews/health/healthday/071226/brca1-mutation-prevalent-among-hispanic-younger-black-women.htm
90
Also, my brothers seem completely unaware that this could affect their daughters, even though that's been pointed out to them. ...
How about affecting them? From Wikipedia :
Men with a BRCA mutation have a dramatically elevated relative risk of developing breast cancer, but because the overall incidence of breast cancer in men is so low, the absolute risk is equal to or lower than the risk for women without a BRCA mutation.[7]:Ch8 Approximately 1% to 2% of men with a BRCA1 mutation will develop breast cancer by age 70 ...
My neighbor's father just died of breast cancer. He was maybe 55 and it was his second.
Given that 87% figure, I'd advise my daughter to get the surgery sooner rather than later, while the superbugs aren't all totally invincible and widespread and before chemo is needed.
OT: props to you, guy in my office garage who just got a Benz SLS AMG with customized plate "J SWAG." Props to you.
I guess it could have been a chick.
Last night I dreamt that I was at a sports event where lots of people were wearing shirts that said SWAG, which was supposed to stand for "honuS WAGner".
At my undergrad school, SWAG stood for Studies in Women And Gender. I believe they've since changed it.
126: It obviously stands for Jimmy Swaggart.
128: At Chicago we had "Jew-Stud," which quite unfortunately was changed to "J-stud."
My grandma had a prosthetic after her mastectomy. She used to offer to lend it to her modestly endowed descendants.
I've reached the age now where they start pushing for annual mammograms. So far, I'm not convinced. I'm curious, though, what the thinking is among the commentariettes.
131.2: My entirely unscientific take has been that unless there's a family history of breast cancer, annualized testing can wait until age 50*. I had a baseline mammogram done when I was 40 or 41 -- this seems like a good idea. Later mammograms are compared to the baseline. Maybe you could have a baseline done at 45 or 48; maybe you should have it done at 50. I don't know how recent the baseline should be before you start the annuals.
* This is based on that recent-ish study showing that annual tests beginning at 40 don't improve outcomes more than annual tests beginning at 50.
Note that my doctor dismisses that recent study and abides by the after-40 rule. While I did have the baseline done, I've ignored her instructions to have an annual exam, and she hasn't kicked up a fuss. Also note that since I'm adopted, I have no family history either way, so this is sloppy of me to an extent.
It occurs to me that it might make a difference whether your baseline is done pre- or post-menopause.
I have a creepy symptom of long standing that has gotten me mammograms & galactogram & ultrasound since my mid-30s. I don't know if I feel high-risk or low-risk, at this point.