Quotes, photos, videos, literary scrapbook...
At age 40, a woman’s risk of developing breast cancer by the time she turns 50 is 16 percent.
In total, 5 to 10 percent of breast cancer cases, and 10 to 15 percent of ovarian cancer cases, involve mutations on the BRCA genes. Most do not. The interactions between genes and other aspects of the molecular environment are not clear enough to explain why most cases do not involve inherited mutations or why not everyone who inherits mutations in the BRCA genes develops cancer. Though family history of breast or ovarian cancer in a primary relative (such as a mother or sister) may increase a persons’ risk, even these families do not necessarily carry mutations on the BRCA genes. For those with strong family histories that have mutations of unknown significance (and there are many), decision-making about risk-reduction strategies is even more complicated and precarious.
Since the Angelina Jolie story broke, there’s been a flurry of discussion about risks, medical interventions, access to medical care, body image, genetics and gene patents, reconstructive surgeries, and of course, health literacy and the role of celebrities in disseminating health information. These are useful conversations that I hope will continue. In the meantime, we should remember an important caveat about Angelina Jolie’s situation.
Namely, that it doesn’t apply to most women. Only about 1 in 600 women have variants on the breast cancer genes that are known to increase cancer risk. Women of Ashkenazi Jewish descent are more likely to have BRCA mutations, but overall less than one percent of the U.S. population of women has them — highly significant if you’re in that one percent, but not so for the vast majority who do not have strong family histories of inherited cancer.
The key to engaging empathy is what has been called “the identifiable victim effect.” As the economist Thomas Schelling, writing forty-five years ago, mordantly observed, “Let a six-year-old girl with brown hair need thousands of dollars for an operation that will prolong her life until Christmas, and the post office will be swamped with nickels and dimes to save her. But let it be reported that without a sales tax the hospital facilities of Massachusetts will deteriorate and cause a barely perceptible increase in preventable deaths—not many will drop a tear or reach for their checkbooks.
In the past three decades, there were some sixty mass shootings, causing about five hundred deaths; that is, about one-tenth of one per cent of the homicides in America. But mass murders get splashed onto television screens, newspaper headlines, and the Web; the biggest ones settle into our collective memory—Columbine, Virginia Tech, Aurora, Sandy Hook. The 99.9 per cent of other homicides are, unless the victim is someone you’ve heard of, mere background noise.
Why do people respond to these misfortunes and not to others? The psychologist Paul Slovic points out that, when Holloway disappeared, the story of her plight took up far more television time than the concurrent genocide in Darfur. Each day, more than ten times the number of people who died in Hurricane Katrina die because of preventable diseases, and more than thirteen times as many perish from malnutrition.
In a thoughtful new book on bullying, “Sticks and Stones” (Random House), Emily Bazelon writes, “The scariest aspect of bullying is the utter lack of empathy”—a diagnosis that she applies not only to the bullies but also to those who do nothing to help the victims. Few of those involved in bullying, she cautions, will turn into full-blown psychopaths. Rather, the empathy gap is situational: bullies have come to see their victims as worthless; they have chosen to shut down their empathetic responses. But most will outgrow—and perhaps regret—their terrible behavior. “The key is to remember that almost everyone has the capacity for empathy and decency—and to tend that seed as best as we possibly can,” she maintains.
A roof planted with sedum, however, is no greener, from the standpoint of sustainability, than is ordinary tar or asphalt.