WORLD U.S. N.Y. / REGION BUSINESS TECHNOLOGY SCIENCE HEALTH SPORTS OPINION ARTS STYLE TRAVEL JOBS REAL ESTATE AUTOS
Advertise on NYTimes.com
OP-ED CONTRIBUTOR
My Medical Choice
By ANGELINA JOLIE
Published: May 14, 2013 472 Comments
FACEBOOK
TWITTER
GOOGLE+
SAVE
E-MAIL
SHARE
PRINT
REPRINTS
LOS ANGELES
Enlarge This Image
Loren Capelli
Connect With Us on Twitter
For Op-Ed, follow @nytopinion and to hear from the editorial page editor, Andrew Rosenthal, follow @andyrNYT.
Readers’ Comments
Share your thoughts.
Post a Comment »
Read All Comments (444) »
MY MOTHER fought cancer for almost a decade and died at 56. She held out long enough to meet the first of her grandchildren and to hold them in her arms. But my other children will never have the chance to know her and experience how loving and gracious she was.
We often speak of “Mommy’s mommy,” and I find myself trying to explain the illness that took her away from us. They have asked if the same could happen to me. I have always told them not to worry, but the truth is I carry a “faulty” gene, BRCA1, which sharply increases my risk of developing breast cancer and ovarian cancer.
My doctors estimated that I had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer, although the risk is different in the case of each woman.
Only a fraction of breast cancers result from an inherited gene mutation. Those with a defect in BRCA1 have a 65 percent risk of getting it, on average.
Once I knew that this was my reality, I decided to be proactive and to minimize the risk as much I could. I made a decision to have a preventive double mastectomy. I started with the breasts, as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex.
On April 27, I finished the three months of medical procedures that the mastectomies involved. During that time I have been able to keep this private and to carry on with my work.
But I am writing about it now because I hope that other women can benefit from my experience. Cancer is still a word that strikes fear into people’s hearts, producing a deep sense of powerlessness. But today it is possible to find out through a blood test whether you are highly susceptible to breast and ovarian cancer, and then take action.
My own process began on Feb. 2 with a procedure known as a “nipple delay,” which rules out disease in the breast ducts behind the nipple and draws extra blood flow to the area. This causes some pain and a lot of bruising, but it increases the chance of saving the nipple.
Two weeks later I had the major surgery, where the breast tissue is removed and temporary fillers are put in place. The operation can take eight hours. You wake up with drain tubes and expanders in your breasts. It does feel like a scene out of a science-fiction film. But days after surgery you can be back to a normal life.
Nine weeks later, the final surgery is completed with the reconstruction of the breasts with an implant. There have been many advances in this procedure in the last few years, and the results can be beautiful.
I wanted to write this to tell other women that the decision to have a mastectomy was not easy. But it is one I am very happy that I made. My chances of developing breast cancer have dropped from 87 percent to under 5 percent. I can tell my children that they don’t need to fear they will lose me to breast cancer.
It is reassuring that they see nothing that makes them uncomfortable. They can see my small scars and that’s it. Everything else is just Mommy, the same as she always was. And they know that I love them and will do anything to be with them as long as I can. On a personal note, I do not feel any less of a woman. I feel empowered that I made a strong choice that in no way diminishes my femininity.
I am fortunate to have a partner, Brad Pitt, who is so loving and supportive. So to anyone who has a wife or girlfriend going through this, know that you are a very important part of the transition. Brad was at the Pink Lotus Breast Center, where I was treated, for every minute of the surgeries. We managed to find moments to laugh together. We knew this was the right thing to do for our family and that it would bring us closer. And it has.
For any woman reading this, I hope it helps you to know you have options. I want to encourage every woman, especially if you have a family history of breast or ovarian cancer, to seek out the information and medical experts who can help you through this aspect of your life, and to make your own informed choices.
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.
Breast cancer alone kills some 458,000 people each year, according to the World Health Organization, mainly in low- and middle-income countries. It has got to be a priority to ensure that more women can access gene testing and lifesaving preventive treatment, whatever their means and background, wherever they live. The cost of testing for BRCA1 and BRCA2, at more than $3,000 in the United States, remains an obstacle for many women.
I choose not to keep my story private because there are many women who do not know that they might be living under the shadow of cancer. It is my hope that they, too, will be able to get gene tested, and that if they have a high risk they, too, will know that they have strong options.
Life comes with many challenges. The ones that should not scare us are the ones we can take on and take control of.
Angelina Jolie is an actress and director.
A version of this op-ed appeared in print on May 14, 2013, on page A25 of the New York edition with the headline: My Medical Choice.
SAVE
E-MAIL
SHARE
472 Comments
Share your thoughts.
ALLREADER PICKSNYT PICKS
Write a Comment
JudyLos AngelesNYT Pick
As I am nearing 40 with the BRCA gene, I have been trying to decide when not if. I have not had the courage to face the mastectomy concept, I am just trying to decide on the hysterectomy. Thank you so much for the article. Angelina Jolie is the world's icon of a beautiful woman, so when she has the courage to do something like that and share it with the world, then, the simple press and exposure helps the rest of the BRCA carriers to be viewed as less "extreme" when we do face the decision to do life altering and possibly life changing surgeries.
When people hear about me doing something, they may be more like, "Oh yeah, I have heard about people doing that before" as opposed to, "That's crazy talk." I can't say thank you enough.
May 14, 2013 at 7:14 a.m.REPLYRECOMMEND149
susiesan francisco, CANYT Pick
One of the most powerful Op-Ed pieces that I have read. It really brings home to me just how important it is to be tested for the BRCA1 gene.
My Mother had breast cancer and I was diagnosed with Stage III breast cancer ten years ago. There are many people who look at you with pity because you lose your breast/breasts to this terrible disease. But I discovered that life goes on and with a good partner love goes on as well.
Going public is the best gift that you can give another woman in this situation. I have always admired you. You are a strong woman and a wonderful role model for your beautiful children.
Happy belated Mother's Day.
May 14, 2013 at 7:15 a.m.REPLYRECOMMEND117
Kellie (Bam Bam)Pleasanton, CANYT Pick
Breast cancer has been a taboo subject for far too long. I've been so vocal since my diagnosis, while many others I knew fighting the same battle remained silent (because of either shame or embarrassment).
At 38 years old, with no family history, my cancer diagnosis came out of left field. I was already at Stage II by the time I found this life threatening lump. Why didn't I know that breast cancer could strike even those who don't have a history in their families? And why didn't I know that some women get this disease before the age of 40? Because I was ignorant. Why aren't more of us unabashed about educating society about this disease?
There are preventive measures we can take. We need to be proactive about our bodies and understand that if we have any genetic mutations, we can be more diligent about getting our tests performed. Education is key. No one should have to grieve for a loved one lost before their lifetime is lived. Technology and medical advancements is a gift we have access to and charities and donations are gifts we can give to those who do not have the luxuries of paying for imaging and scans. We can help each other by standing up and talking about it - and being outspoken - and not hiding in a corner because society tells us to be ashamed.
Kudos to this courageous woman for bringing the BRCA1 genetic testing subject to light. Many lives will be saved because of this.
May 14, 2013 at 7:25 a.m.REPLYRECOMMEND39
david 7680southwestNYT Pick
Bravo to you Ms. Jolie - and to all of the anonymous, courageous women who have gone through this procedure. I have a dear friend who also underwent proactive mastectomy for the same reason. She is doing very well and no longer has nightmares - and her children are very grateful. Thanks for sharing this with us.
May 14, 2013 at 7:26 a.m.REPLYRECOMMEND53
egreshkoTaipeiNYT Pick
Wonderful article. Fantastic outcome. Thanks to Ms. Jolie for sharing a very private experience.
I just hope there comes a day when everyone can afford the level of care I'm sure she had. The elephant in the room is always the cost.
May 14, 2013 at 7:30 a.m.REPLYRECOMMEND180
DianaSeattleNYT Pick
I made the decision at age 37 after our family was complete (1 adopted daughter and 2 biological) to have my ovaries removed when I discovered I needed a partial hysterectomy. In 1987 this was an unusual request by a patient.....Genetic testing for cancer markers was not on the medical radar. My mother died of ovarian cancer at age 46 and I wanted to be proactive with the hope of preventing the same fate for me and my family. I was blessed with a forward thinking OB-GYN who trusted me and believed in familial history. At age 66 I have no regrets. We've come a long way, baby. Not an easy decision for you Ms Jolie, but one you will not regret.
May 14, 2013 at 7:37 a.m.REPLYRECOMMEND51
Dr. GinaMontanaNYT Pick
Thank you Ms. Jolie, for sharing your personal health decisions in this way. Earlier this week I encountered a patient with a very suspicious family history and one first degree relative with the BRCA 1 mutation. Despite the fact that I very gently introduced the topic of getting tested, she refused and became very anxious. She said she didn't want to know. She went on to let me explain that we could greatly reduce her risk of getting cancer, but still declined to be tested. Now that you have gone public with with your story, just days after our visit, I am sure it will help inspire her to the sort of courage that you have displayed. I really appreciate you using your considerable talents and resources for the greater good. You are an inspiration. Blessings for an easy recovery and all good things.
May 14, 2013 at 7:37 a.m.REPLYRECOMMEND69
David KerrBournemouth UKNYT Pick
I am responding as a husband and doctor. My wife has had a bilateral mastectomy , her ovaries removed as well as two course of chemotherapy, radiotherapy and a year of Herceptin following two episodes of cancer. You have done a huge amount to prevent many other women suffering the ravages of treatment and I congratulate you. Now we need to work together to promote survivorship both physical and psychological and there are many ways to do this. Thank you for sharing your experience.
May 14, 2013 at 8:03 a.m.REPLYRECOMMEND103
PederOslo, NorwayNYT Pick
I think this is a crazy thing to do.
I respect Angelina Jolie in so many ways, not least for the humanitarian work she is doing. However I grossly disagree with her decision to have a double mastectomy.
I do not think there is a direct link between gene fault and cancer, rather an indirect one. We have genes that can go awry from exposure to man-made toxins, and then cancer develops. So a better strategy would be to go the alternative way (it is rather ridicolus that the natural way is now called the alternative way) and avoid those toxins: eat organic food, breath fresh air without exhaust and other pollutants, drink clean water, live in a wooden healthy home without exposure to chemicals from furniture (impregnated with fire-retardants), get your sleep etc etc.
Cancer rates today are sky-high above what was the case 150 years ago, and the types of cancers today are different from the those 150, 100 and 50 years ago. So something man-made got us here.
However, if there is such a thing as a direct link between gene and cancer, I still think one should live health, the way nature intended, without such surgery. Those natural breasts are also part of you bodys defense system.
It makes me wonder that no other comments that I have read share my point of view. And I am not a christian/right or left extremist or seller of natural treatments. I am a computer programmer, having some experience with chronic disease and natural living. I lost my mother to lung cancer when I was 7.
May 14, 2013 at 8:04 a.m.REPLYRECOMMEND50
LilySarasotaNYT Pick
When I asked for prophylatic bilateral mastectomy followed by reconstruction in the 1990's my doctors urged me to seek psychiatric counseling. Later, when I developed breast cancer, i was prepared to insist that both breast be taken, but to my surprise my doctors were amenable to the procedure.
Lately, new thinking about the treatment of some minimally invasive cancer has led the medical profession to rethink prophylactic breast removal. Well, I, for one, can tell you it was the best decision I ever made. No longer did I face a certain fate of breast cancer that had plagued my mother, her sister, their aunts and grand-aunts.
By the way, the breast cancer in my family is most certainly genetic, but it is not either of the BRCAs. Although our DNA did not match the BRCA 1 or 2 mutation, the doctors at Georgetown were carefully to point out a likely genetic link -- just one that had not yet been identified. In the hands of less thoughtful doctors, we might have been told there was no genetic basis. Family trees do not lie, and not all genetic mutations have been given a name. If a prophylactic bilateral makes sense for you, don't be dissuaded by advice that is dismissive. Peace of mind is a wonderful thing.
My new breasts are not as lovely as the real ones were, but few people know they aren't original parts. There was no nipple salvage a decade ago. It is heartening to hear of new strides in cosmetic reconstruction.
May 14, 2013 at 8:15 a.m.REPLYRECOMMEND47
NeliaNew YorkNYT Pick
Thank you for making this public!
Having a double mastectomy is really not so bad--I've had it myself. Much worse having to go through chemo and dealing with all the after side & after effects of the chemo!
Thank you Angelina.
May 14, 2013 at 8:32 a.m.REPLYRECOMMEND21
MattyCaliforniaNYT Pick
I am a 3 yr. breast cancer survivor who went through chemo, a double mastectomy, more chemo,radiation and recostruction when I was 41, with a 3 year old toddler. I tested negative for the BRCA gene and was diagnosed when I was already a stage III...I can relate to wanting to have this procedure as a prevention, but my only comment is that you have to be very well informed of your options and once you decide the path you want, trust your doctors! This is major surgery and it takes a long time to feel "normal" again. I am grateful to be alive. I wish Ms. Jolie health, happiness and love.
May 14, 2013 at 8:37 a.m.REPLYRECOMMEND14
BBEuropeNYT Pick
An incredible story, thank you for sharing such a personal situation.
However, it also highlights the problems with American health care. I truly hope that, in the near future, Americans will have the opportunity to get real 'health care' - not just catastrophic health insurance, which has nothing to do about prevention - which is what Ms. Jolie's story is really about.
May 14, 2013 at 9:01 a.m.REPLYRECOMMEND22
MariaGermanyNYT Pick
Now, if the cost of testing for BRCA1 and BRCA2 decreased, as Mrs. Jolie demands, what would that help the women from low- and middle-income countries (as the author states, the locations where the main share of women who die from breast cancer live)? They would still not be able to pay for such a surgery, not to mention the reconstruction costs.
My grandmother and mother had breast cancer but still I prefer not to be tested and rather go to regular inspections than to have a preventive surgery or live in fear.
May 14, 2013 at 9:07 a.m.REPLYRECOMMEND13
scotttxNYT Pick
I am one of four first cousins who have the BRACA 2 gene mutation. we all made the decision to have double mastectomy when we turned 30. unlike most women we were tested and were monitored from our early 20's at both md Andersson and MSK. We are the lucky few who were able to afford the surgery and rencostruction. but, all women with an aggressive history should have the right to be tested and make the choice to have prophylactic mastectomy. I thank Ms. Jolie for telling her story.
May 14, 2013 at 9:16 a.m.REPLYRECOMMEND8
JCNJNYT Pick
Two things came to mind while reading this article. The first one is that people need to recognize that those who seem to have everything -- brains, beauty, success -- still battle the same things and live in fallible bodies just as the rest of us do. Those bodies may be far better looking than ours, but inside they are the same.
The second is that we need a health care system in this country where a woman in the inner city working two jobs in a nursing home, a fast food restaurant or a woman in the rural south working just too few hours at Wal-Mart to qualify for health insurance, can also have access to information about her own risk and to preventive treatment as well.
A brave column by a brave and admirable woman.
May 14, 2013 at 9:17 a.m.REPLYRECOMMEND76
LondongirlLondonNYT Pick
The NHS provides BRCA tests free of charge and subsequent surgery - including preventative double mastectomy - if required. These procedures are free at the point of service throughout the UK, no matter what an individual's income or personal circumstances.
I mention this because it is one of the triumphs of publicly funded health service.
Great article.
May 14, 2013 at 9:29 a.m.REPLYRECOMMEND78
mgm726Dallas, TXNYT Pick
For me it is not cancer but obesity and the eminent risk of diabetes. Your op ed shared on Twitter by Kristen Bell got me out of bed early this morning to work out. For me it will have to be a daily routine. Any less and I will give up for the billionth time. I know what I want and what I am capable of. Like you have done the research and know the frightening risks. Unlike you I lack support at home. I will have to use inner strength and the holy spirit to center me, motivate me and push me to succeed in loosing 150 lbs. But I am starting with today and making it my present and future to live a long healthy life for my self, my daughter, and my family. Thank you, Angelina. You are the angel of my day!! Namaste
May 14, 2013 at 9:41 a.m.REPLYRECOMMEND13
SUZANNE WHITEPROVENCE, FRANCENYT Pick
I did it too. I have the gene. My sister died of breast cancer at 41 in 1976. I found a lump in 1978. My kids were small. I was a single mom. I could not risk dying. I had both breasts removed and reconstructed. That was 35 years ago. Thanks to my very radical decision (in those days) to remove all the breast tissue from my body, I am still here. You did the right thing, Angelina Jolie. True. We are not all alike, But if we have that gene, we are by far more likely to develop breast cancer and even to die from it. 3 out of 4 women in my immediate family have had breast cancer. One had her breasts removed. The others decided to wait. Fingers crossed.
May 14, 2013 at 9:44 a.m.REPLYRECOMMEND7
Jim FrancoNew York, N.Y.NYT Pick
Ms. Jolie works in an industry and lives in a town not especially known for selfless acts. This act of disclosing a personal medical decision helps
other women and perhaps demonstrates to other celebrities in Hollywood the power
of selflessness.
May 14, 2013 at 9:51 a.m.REPLYRECOMMEND13
Chris McMorrowWaltham, Mass.NYT Pick
That you managed to keep this secret and come out, so to speak, on the NYT, speaks volumes about the seriousness with which you approached this decision. I applaud you for your tough decision, and the reasons why you made it, focusing on your future as mom.
I have no idea how I would have approached this, had I been given the choice. But I think what you wrote speaks volumes for the women and their partners who find themselves making a decision like yours. Because of the nature of breasts, the surgery is very special and I've heard that many men cannot cope with this.
You were fortunate to have the means, and the man in your life, to go through this painful procedure with grace and dignity. While I would wish that all women in the US have the knowledge and resources to follow your path, I know that's impossible.
I know some posters here are carping about the inequality of healthcare in this country. While that may be true, it doesn't detract from your story. Simply because you faced few struggles, other than the emotional ones, in carrying out a preventive health act, doesn't make it any less meaningful.
Good luck to you and I sincerely hope that what you have told us can help other women make informed decisions and give their partners the courage to support, not abandon, their mates.
May 14, 2013 at 9:59 a.m.REPLYRECOMMEND10
LizNYNYT Pick
The option is to believe that a woman is more than specific body parts. For years, the word "mastectomy" implied the loss of not only a woman's breasts but her femininity. For a woman who has defined feminine beauty for the past decade to have the courage to write honestly and openly about her choice to have a mastectomy is to empower all women to realize that a woman is most beautiful when she is empowered to choose. Having lost a mother to cancer, I know how vital it is for a woman to have information regarding medical options and to actively participate in decisions involving health care.
May 14, 2013 at 9:59 a.m.REPLYRECOMMEND4
Sarasota BluesSarasota, FLNYT Pick
If Oscars were awarded for thoughtful pieces written by people with the platform to make a difference, Ms. Jolie would be this year's front-runner.
Gutsy move.
May 14, 2013 at 10:01 a.m.REPLYRECOMMEND6
JfulDallas, TexasNYT Pick
Frankly, I can't imagine what it would be like to be in a position to have to learn and make the type of decisions Ms. Jolie describes. I applaud and admire her courage for doing so, and think it's wonderful she's surrounded by supportive people. I especially appreciate her efforts to create an atmosphere of open dialogue and awareness in the public square about women's health care.
Unfortunately, the reality for most women in this country, unless you're white, wealthy and have insurance, is that we will never be in a position financially to benefit from much, if any, of what Ms. Jolie has access to. Which is top level medical professionals; at top level institutions. As an activist for the poor, I'm sure Ms. Jolie is aware of the data on this too.
If anything, I would ask Ms. Jolie, as she talks with the media, that she broaden the discussion to include how to get the same type of options she and a minority of women have to this level of (preventative) health care, to those at the lower and bottom financial rungs. Support for Planned Parenthood would be a good a start. As that's where many women get some of their basic medical needs met. Like breast exams. She's also got a great opportunity to continue to demonstrate a healthy self-image that, as women, we are more than our breasts.
May 14, 2013 at 10:08 a.m.REPLYRECOMMEND4
ColleenPhiladelphiaNYT Pick
While I think it is great that Angelina Jolie shared her story, I do have a problem with you return to your normal life in a few days. Umm...nothing normal about having 4 drains hanging out of your body, not being able to lift your arms to wash your hair or put on a shirt, not being able to sleep comfortably. I was diagnosed with BC in 6/2012 at the age of 35. I had a double mastectomy in 10/2012 and final reconstruction 1/2013. Also, not every insurance carrier pays for genetic testing without a cancer diagnosis, so for some people this test is just not affordable.
May 14, 2013 at 10:18 a.m.REPLYRECOMMEND1
READ MORE COMMENTS
Get Free E-mail Alerts on These Topics
Breast Cancer Mastectomy
Genetics and Heredity
Ads by Google what's this?
Prostate Cancer Treatment
Get a 2nd Opinion at Brockton's Top
Prostate Cancer Treatment Center.
ResearchProstateCancer.com/Brockton
Log In With Facebook
Log in to see what your friends are sharing on nytimes.com. Privacy Policy | What’s This?
What’s Popular Now
My Medical Choice
Minnesota Senate Clears Way for Same-Sex Marriage
Advertise on NYTimes.com
MOST E-MAILEDRECOMMENDED FOR YOU
10 articles in the past month
All Recommendations
1.
Shunned Elsewhere, Body of Marathon Bombing Suspect Is Buried in Virginia Cemetery
2.
OP-ED CONTRIBUTOR
Pakistan’s Tyrannical Majority
3.
EDITORIAL
Shortcomings of a Psychiatric Bible
4.
Crucial Carbon Dioxide Reading Revised Downward
5.
DOT EARTH
More on a Sensitive Climate Question
6.
BY DEGREES
A Change in Temperature
7.
IHT RENDEZVOUS
Is Canada's Oil Too Dirty for Europe?
8.
HEADS UP
A ‘New Louvre’ North of Paris
9.
CRITIC’S NOTEBOOK
Defending a Scrap of Soul Against MoMA
10.
LETTER
MoMA Reconsiders
Go to Your Recommendations »
What’s This? | Don’t Show
2013 Tony Awards special section
ALSO IN ARTS »
Riding a fast sled to the Tonys
Tony Awards: 1948-2012
Ads by Google what's this?
Mini Tummy Tuck Recovery
Harvard-Trained, Board Certified,
Wellesley, MA. Call Us Today!
www.ChristopherDavidsonMD.com/Tuck INSIDE NYTIMES.COM
N.Y. / REGION »
