The Limits of Prevention

When Angelina Jolie first announced to the world two years ago that she had had a double mastectomy because gene tests showed a high probability of her contracting breast cancer, it was as if the advent of preventive medicine’s next leap had been announced. There couldn’t have been a more effective ambassador to the idea that incurable ailments can be nipped even before they became a bud. She broke the news in an article in New York Times, writing that doctors had given her an 87 per cent chance of contracting breast cancer because a of rare inherited gene mutation. Her family had a history of women with cancer. They also said she had a 50 per cent chance of getting ovarian cancer.

On Tuesday she again wrote an op-ed article in The New York Times revealing that now her ovaries and fallopian tubes had also been removed. She explained the process and the psychological and physical effects of the organ removals. It will send her into menopause and she will not be able to have children. The trigger had been an apprehension by her doctor that some parameters of a blood test showed a possibility of cancer. She took further tests for cancer and even though the results were negative, chose to go ahead with the removal of her ovaries.

When she did the double mastectomy, it had been an inspiring moment for many across the world because here was a beautiful public icon deciding that long-term health was more important than breasts. Medical science too had made yet another statement about surpassing limits set by nature. Her present announcement of a second round of organ removals is however somewhat disconcerting for a number of reasons.

There is the startling truth that such eviscerations are not necessarily a one-time operation. And that momentous decisions need to be based on probabilities. Breast removal seems like an easy decision to take when there is an 87 per cent chance of breast cancer, but if the risk of ovarian cancer is 50 per cent, then how does one make an objective call? And, while the absence of breasts might be something a woman could still live with, never being able to conceive and having to live with a lifelong regimen of hormone treatment without ovaries is a different set of choices. How does one negotiate such dilemmas?

It will have to be a personal decision, but that only makes it more challenging. Doctors will present the numbers but unless they are really high, no one can make a recommendation to the patient. There is also the big question of knowing when to stop. If genes predispose the human body to the likelihood of developing different ailments, how many organs shall we replace? And even then, because we still don’t know everything about either disease or the human body, wouldn’t it all be pointless if something utterly unexpected were to claim us instead? These questions might become irrelevant in a few decades when there will be artificial organs for everything except the brain, but we, who are of this time, are that unlucky generation of people who can imagine immortality but are no closer to it.

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