Of course you’ve heard that actor/director Angelina Jolie went public this week with an op-ed piece in The New York Times about her decision to undergo a double mastectomy in the wake of finding out that she is positive for the BRCA1 genetic mutation, which dramatically increases her risk of developing breast and ovarian cancer.
The news has generated a staggering amount of media attention, with bloggers and medical experts and pundits of all stripes weighing in on Jolie’s decision. The overwhelming reaction to the news seems to be one of support and admiration for a highly public figure who’s been forthright enough to go public with a very personal story in the hopes of raising awareness about BRCA and women’s options in the face of it, and confident enough to assert that her surgery (which included breast reconstruction) will not in any way detract from her success in the film industry, her role as a parent to six children, or—let’s face it—her status as a contemporary icon of female sexuality and beauty.
There has been been, rightly, a sizable amount of grumbling about inequalities in health care coverage: The genetic test for BRCA alone costs in the range of $4,000, which puts it far beyond affordable for the average citizen, especially those without health insurance to cover the test. Prophylactic mastectomy and reconstruction cost many times that, arguably making these procedures the purview of the 1 percent. The discussion has also brought to light that a private company, Myriad Genetics, holds the patents to the BRCA1 and BRCA2 genetic mutations and can therefore exclusively dictate the testing options (and price) for women who potentially have the gene, as well as research into it. (A case before the U.S. Supreme Court is challenging these patents, with a decision expected in June.)
What I haven’t seen, however, in my admittedly inexhaustive review of the reactions to Jolie’s disclosure, is much in the way of discussion about another surgery the actor/director alludes to: oophorectomy, or the (preventive) surgical removal of her ovaries. Jolie notes that she has a 50 percent chance of developing ovarian cancer. “I started with my breasts,” she says, “as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex.”
It would seem that Jolie is planning to have her ovaries removed at some point, in a procedure that, while less medically complicated than her breast surgery, is—in my opinion at least—equally, if not more, significant.
And my question is this: In the event that Angelina Jolie has her ovaries (and likely her uterus) removed, will we care as much as we do about her breasts?
Oophorectomy, while not as readily “visible” as mastectomy, is a radical procedure, thrusting women into immediate surgical menopause. In addition to the obvious negation of fertility, the sudden and dramatic change in hormone levels can have several side effects, including changes to sex drive and function, metabolism, mood, bone density and muscle mass, and cognitive function. The surgery and its potential effects are a big deal—but we wouldn’t know that by the amount of ink and bandwidth devoted to it in relation to Jolie.
Maybe that’s because Jolie’s oophorectomy is only a hazy future event, while her breast surgery is here and now. Maybe it’s because her risk of breast cancer is higher than ovarian cancer.
But I’m not so sure. I think that our focus on Jolie’s breasts as opposed to her ovaries speaks volumes about the ways in which we continue to overvalue the external when it comes to women’s bodies. Put simply, the world is so interested in Angelina Jolie’s breasts because they’re pretty to look at and pleasing to men. (Full disclosure: They are also pleasing to me and, I’m sure to many other women, gay or straight.) Angie Jolie is cutting off her boobs? How brave! Don’t worry, though—she’ll still be as sexy as ever due the miracles of reconstructive surgery! She’ll even get to keep her nipples!
But ovaries? No one sees those. You can’t touch those. You can’t “enhance” (much less restore) them surgically, or click on a button to increase their size the way gamers do with Lara Croft in Tomb Raider (Jolie portrayed the busty Croft her in the 2001 feature film; rumor has it that several Internet “patches” have been designed to remove the character’s clothing in the game). Tucked away inside her body, or removed surgically, Angelina Jolie’s ovaries are about as appealing as her gallbladder.
But ovaries are a crucial part to women’s reproductive, sexual and overall health. With no reliable test to detect it, ovarian cancer is often discovered too late and can be deadly. If and when Angelina Jolie undergoes prophylactic oophorectomy, she may feel no different (or even better) afterwards, and I hope that’s the case. On the other hand, the surgery poses the risk of several significant side effects.
If and when she decides to have the surgery, and if and when she writes about it, let’s hope we care as much as Angelina Jolie’s ovaries we do about her breasts. Because they’re no less an important part of her.