It's always a mixed bag whenever celebrities take up pet causes. On one hand, they can bring exposure to important issues. On the other, far too many of them push misguided solutions for issues they know little about, and as a result, only end up spreading ignorance to the masses. (Case in point: See Jenny McCarthy and her deadly wrong activism against vaccines that is now killing children.)
Angelina Jolie's latest pet cause of highlighting surgery to remove organs as a preventive move against the possibility of cancer (first her breasts, now her ovaries and fallopian tubes) teeters precariously in the middle of this divide. On March 24th she posted an essay detailing her decision to undergo this latest surgery. Though some cancer experts are applauding her vocalism on the topic, it has us worried.
Even though she states this was a personal decision based on an elevated genetic risk she had for certain types of cancer, removing one's body parts as a preemptive strike is an area where the science is murky and the potential benefits rather gray.
First of all, the causes of cancer are complex, and the genome is but one part of the equation. These “genetic risks” are typically small, and are often misrepresented as bigger than they actually are. For example, a 60% increased risk in ovarian cancer sounds scary, right? But let's say ovarian cancer strikes 1 in 1,000 women. This 60% risk means that instead of your odds being 1 in a 1,000, your risk jumps to . . . are you ready? 1.6 in a thousand. Not quite as scary now, is it? Factor in the fact that these studies which genome sequencing companies use to define risk are not absolute (other studies may show no increased risk for the same gene or show a lower overall risk, and all genome studies involve correlation, which does not prove causation) and the picture gets murkier still.
There's also the fact that the fight against cancer is about preserving life. Most cancers strike late in life, and there are scores of experts who believe we're diagnosing and treating cancers that would never become fatal. (The body is always producing cancerous cells; most die off or never grow to become life-threatening.) So it's not as cut and dried saying that every case of cancer prevented is a life saved. Many would die of other natural causes long before their cancer would kill them. And since cancer risk can also be mitigated through lifestyle choices such as diet and exercise, this further clouds the picture for such an invasive procedure.
There's also absolutely no data on the effectiveness of such pre-emptive moves. For example, we don't know if breast removal surgery will actually lower your odds of dying from cancer, or if it will simply displace this elevated risk to elsewhere. Will the same genetic vulnerability simply express itself in another part of the body? Can a cancer still grow in the area the organs used to be? (Every cell in your body carries your genome, so just because you remove the breasts this doesn't necessarily stop a rogue cell from becoming cancerous in the same way.) Though scientists assume the answer to such questions is no, we know too little about it to be sure. Even among specific types of cancer, one person's breast cancer is not the same as another person's breast cancer – one of the reasons so much research is going towards individualized treatment. The bottom line is that cancer is a complex thing, and while the idea of “remove the organ, remove the cancer risk” may be alluring, until we have more data there's no way to be certain this is true. Medical history is full of preventive measures that later turned out to be misguided.
Finally, surgery itself is not without risk, especially given the antibiotic resistant strains of MRSA that have plagued hospitals in recent years. Anytime you go under the knife you put yourself at risk for developing a fatal infection. These risks may cancel out much of the benefit one hopes to achieve.
So don't go jumping on the body part removal bandwagon just yet. You may simply be buying a false peace of mind. Though some experts might disagree with this assessment, to us it seems more like a boon to-the surgery industry than an actual solution in the fight against cancer. Proceed with caution, and talk it over with more than one doctor before you take such a step yourself.
Teaser: Angelina Jolie has surgically removed her breasts as well as her ovaries and fallopian tubes to reduce her risk of cancer after personal genome sequencing turned up a genetic risk. Should you consider the same?