Once a year, I get worked up about the medicalization of women. This is not coincidentally timed with my annual visit to the doctor to undergo a series of medical tests based on my genetic condition–the possession of two X chromosomes. This is, apparently, a high-risk condition and as a result I need to have my reproductive organs checked annually and as I age I need to be aware of other dangers such as osteoporosis. Not all test need to be done annually. The US Dept of Health and Human Services recommends Pap tests every 3-5 years but I have yet to find a doctor that doesn’t just automatically test me for cervical cancer and screen me for breast cancer (though I have thus far avoided an actual mammogram) despite the fact that I have no additional risk factors beyond the fact that I am female. My husband, on the other hand, has never had his reproductive organs checked. Even though the average age for developing breast cancer in women is 51 and prostate cancer in men is 67. I have been screened by a doctor annually since the age of 16.
Thanks to Angelina Jolie, I get to be upset about this subject–the medicalization of women– for a second time this year. Angelina Jolie made the difficult to decision to have both her breasts removed preemptively after discovering that she carries the BRCA1 gene that, along with other factors, makes her risk of breast cancer an estimated 87% (and 50% for ovarian cancer). Ms. Jolie watched her mother’s struggle with and eventual death from ovarian cancer, so she has personal experience with the devastation the disease can wreck on an individual and a family. After the double mastectomy, her risk for cancer is 5%. I can understand how the surgeries seemed a small price to pay to avoid her mother’s fate.
I am not judging her personal decision. I understand that cancer is scary, especially for those that have witnessed it first hand. But I find it alarming that she is promoting what can only be considered an extreme course of action. In her NY Times op-ed she writes:
…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.
This blood test detects the genes BRAC1 and BRAC2 and is patented by Myriad Genetics. It is the earliest form of early detection. It can indicate a risk before there is any physical indication of cancer but only 5% of individuals who develop breast cancer and 10-15% of cases of ovarian cancer carry this gene.
The warnings are everywhere. The push for early detection has been around since the 1930s but this NYT article highlights the little recognized downside. The author, Peggy Orenstein, detected a cancerous tumor early and underwent treatment. This article is her reflection on her decision in light of new evidence that for every one woman who’s life is prolonged due to screening 10 women are given a diagnosis and unnecessarily treated. These treatments are themselves often dangerous–lets not forget that mammagrams are made possible with radiation. A quarter of new breast cancer cases are known as “stage zero” cancers. For those DCIS, the stage zero diagnosis, the chance of developing an invasive cancer is only 5% over 10 years. But tens of thousands of women seek proactive treatment.
This does not mean none of the women with these diagnoses will die from cancer. That is the scary thing. There is a feeling that you should try to control your risk through vigilant screening and action. I am sure that we have all seen a character on tv with a breast cancer scare. I remember vividly the first episode of 90210 I ever saw. Brenda had a breast cancer scare and not coincidentally 10 year old me did too. We live with a sense that as women our breasts, cervix, and ovaries leave us vulnerable and in extra need of protection. But as Peggy Orenstein points out:
…all that well-meaning awareness has ultimately made women less conscious of the facts: obscuring the limits of screening, conflating risk with disease, compromising our decisions about health care, celebrating “cancer survivors” who may have never required treating. And ultimately, it has come at the expense of those whose lives are most at risk.
The fact is that women live longer than men in almost every country, despite gender discrimination and all the inherent risks of being a woman. So why am I made to feel more at risk? Why are there so many campaigns to alert women to the dangers seemingly unique to them? I can’t even imagine a similar circumstance, with another disease, where an 85% risk would lead to three massive surgeries. Every male in my family has had a heart attack between the ages of 50-55. Not a single one of them has elected to have preemptive stints. In fact, my dad’s idea of early detection is joining the rescue squad when he turned 50 so that they would know where he lived when his time came.