Angelina Jolie, Tough Choices, and the Rest of Us

By now, you probably know of actress Angelina Jolie’s choice to undergo preventive double mastectomy, and her must-read op-ed in Monday’s New York Times.

In her specific case, the decision was a tough, but logical one given that the benefits of the procedure dramatically reduced future risk of breast cancer. It’s never an easy decision to undergo surgery. It must have been even more difficult for someone like Jolie, whose income is partly tied to her looks.

Double mastectomy isn’t the answer for everyone. Jolie was at very high risk because she is among the small percentage of women who carry the BRCA 1 and BRCA 2 gene mutation.

As Jolie points out, genetic testing is expensive, currently not covered by all insurance plans, and therefore only viable for a small segment of the population. “The cost of testing for BRCA1 and BRCA2, at more than $3,000 in the United States, remains an obstacle for many women.” There are other forms of breast cancer – which may be more difficult to detect and treat.

What are the choices for those women who do not have the resources for such gene testing? Disparities along racial, education, and socioeconomic lines in both incidence and screening are well documented. Women who have other risk factors, who are without access to the top oncologists, plastic surgeons, and other care providers need to know their choices.