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…Angelina Jolie is in a unique and privileged position. She can get the best care, top surgeons, family help, and everything else that comes with power and wealth. For the rest of us, tough medical decisions come with other costs. But we all deserve quality information, evidence-based medicine, and access to comprehensive and coordinated health care that is free from conflicts of interest and the profit motives of commercial enterprises that are eager take advantage of our fears while selling us superficial “solutions” to our problems.
Most women do not fit high-risk profiles because most cancers do not result from inherited gene mutations. The majority of genetic mutations are acquired over a person’s lifetime (i.e., somatic mutations). This is why the diagnostic tests are only recommended for people with specific risk profiles, and why rampant genetic testing would have little impact on the total cancer burden.
The stock for Myriad Genetics — the company that presently owns the patents on the breast cancer genes and monopolizes the market on BRCA analysis (e.g., trademarked as BRACAnalysis) — went up 3 percent the day of the op-ed to a three-year high with twice the usual trading volume. Myriad markets both to consumers directly and to physicians and other health practitioners. According to Director of the Genetic Counseling Program at the Yale Cancer Center, Ellen Matloff, Myriad has been known to advertise in ways that “mislead [physicians] to think that 10 percent or more of their patients need the [BRACAnalysis] test, when that is not the case.” The Supreme Court will determine in June whether Myriad’s patents on the BRCA genes are indeed legal.
The uncertain language (e.g., perhaps, might), coupled with the decisiveness of taking control of one’s future is a common advertising formula in a medicalized society. Genetic testing companies similarly advertise the “life-saving, disease-preventing” opportunities of genetic testing even though the benefits for most would be uncertain at best.
A “Beyond the Shock” educational video from the National Breast Cancer Foundation fails to mention complications in its online guide to understanding breast cancer. In the chapter on reconstruction, there is no discussion of multiple surgeries, pain and weakness, scar tissue, nerve damage, risks of infection and implant rupture, and other complications. The video of a faceless caricature of a woman simply states that, “Following a mastectomy, you have options to help you become comfortable with the changes in your body. They are all options, with benefits to each approach. What is best for you and your body may not be what is best for another woman.
…there was a 22 percent increase in breast reconstruction surgeries (from 79,000 to 96,000 procedures) between 2000 and 2011. Could the point be that, as one breast cancer blogger asks, women’s culturally acceptable body-loathing plays into these choices? One thing for certain is that both the advertisements and the educational materials tend to ignore the postoperative difficulties frequently accompanying these surgeries.
In addition to the use of emotional appeals, breast cancer advertisements increasingly use sex to sell a variety of pinked products. Some of the recent trends include the sexual objectification of women in the name of awareness itself. Femininity and stereotypical beauty ideals easily morph into advertisements for cosmetics and cosmetic surgeries aimed at both the diagnosed and would-be breast cancer supporters. The number of plastic surgery procedures generally increases about 5 percent each year. Ninety-one percent of all procedures are done on women, with breast augmentation topping the list since 2006. Now those in the beauty business can target women in breast cancer awareness campaigns.
The empowerment/awareness context easily commercializes almost every aspect of the disease (i.e., awareness, risk, prevention, diagnosis, treatment, survivorship, research, support — all propped up with a seemingly endless array of pink products and medical interventions.)
Genetic testing now blasts into the risk-focused cancer surveillance market with the joyful promise of proactive, empowered, life-saving decision-making — a promise they may help to deliver for people in the one percent. But with more than 1000 mutations already identified in the BRCA genes (and others yet to be discovered), most genetic profiles and treatment options are not so straightforward.
There is no crystal ball to say when cancer will develop or in whom. Most cancer stems from multiple factors and the complicated ecosystems of our bodies and the external environments that affect them. There are reasonable ways, however, to evaluate one’s cancer risk. For ovarian cancer, known risk factors include age, reproductive factors, inherited genetic mutations, and a strong family history of breast, ovarian, or colon cancer. For breast cancer, risk factors include age, reproductive factors, inherited genetic mutations, postmenopausal obesity, hormone replacement therapy, alcohol consumption, and previous history of cancer of the endometrium, ovary, or colon. Unfortunately, risk factors are more relative than absolute. Seventy percent of those diagnosed with breast cancer have none of the known risk factors (besides being a woman).