Angelina Jolie on Tuesday published a New York Times editorial about her decision to undergo a laparoscopic bilateral salpingo-oophorectomy, a procedure to remove her ovaries and fallopian tubes. It’s the second editorial Jolie has written about her medical choices after testing positive for a mutation in the BRCA1 gene that gave her an estimated 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer.
Jolie wrote in 2013 about her decision to go forward with a preventative double mastectomy, calling the decision “my medical choice.” And it’s clear that the choice to remove her ovaries and fallopian tubes as a preventative measure was just as considered:
I had been planning [the procedure] for some time. It is a less complex surgery than the mastectomy, but its effects are more severe. It puts a woman into forced menopause. So I was readying myself physically and emotionally, discussing options with doctors, researching alternative medicine, and mapping my hormones for estrogen or progesterone replacement.
But after receiving unexpected lab results from a routine blood test, Jolie consulted her doctors:
That same day I went to see the surgeon, who had treated my mother. I last saw her the day my mother passed away, and she teared up when she saw me: “You look just like her.” I broke down. But we smiled at each other and agreed we were there to deal with any problem, so “let’s get on with it.”
In my case, the Eastern and Western doctors I met agreed that surgery to remove my tubes and ovaries was the best option, because on top of the BRCA gene, three women in my family have died from cancer. [...] Last week, I had the procedure: a laparoscopic bilateral salpingo-oophorectomy. There was a small benign tumor on one ovary, but no signs of cancer in any of the tissues.
Jolie acknowledges in the piece that her decision to have surgeries to remove her breasts, ovaries and fallopian tubes may not be the right choice for others in her situation (and testing positive for BRCA 1/2 mutations does not automatically mean surgery is the right option), but “choice” can be elusive for the millions of women who don’t have adequate healthcare or any healthcare at all.
There’s much to admire in Jolie’s account of being informed and proactive about her health. She's clearly done her homework, consulting multiple doctors and learning about all of the options available to her. But for millions of women, her account likely feels like pure fantasy. You shouldn’t have to be a rich celebrity to have access to great medical care.
But millions of women in the United States are still going without care, and the fate of the Affordable Care Act will soon be determined by a Supreme Court. If the law survives the high court, Republicans have shown no signs of slowing efforts to dismantle the law that has extended coverage to more than 16 million Americans.
Among its other provisions, the Affordable Care Act requires insurance plans to cover genetic testing and counseling costs when testing is recommended by your doctor. (Compliance, however, remains uneven.) Without insurance, genetic testing can cost around $3,000, and each of the surgeries Jolie underwent would be unfathomable to most families without adequate health coverage.
And as Jolie points out, she will have to closely monitor her health regardless of the surgeries. And for the many women who have had cancer, life after the disease still means lots of visits to the doctor and possible health complications. Years of treatment can be required. Recurrences happen. The rest of your life happens.
Jolie, over at the Times, ends her editorial on an uplifting note, encouraging other women to "take control" of their health:
It is not easy to make these decisions. But it is possible to take control and tackle head-on any health issue. You can seek advice, learn about the options and make choices that are right for you. Knowledge is power.
Her sentiment is a welcome one. Unfortunately, the choice is hardly that simple for many women.