Georgina Guedes

What Angelina's choice means for SA women

2013-05-16 11:46

Georgina Guedes

I cried when I read Angelina Jolie's article in the New York Times about why she chose to have a double mastectomy. The abridged version is that her mother died of breast cancer, and Jolie was found to have the same anomaly in the relevant gene, so she elected to remove her breasts as a preventative measure.

The part that made me weep was the justification of her thinking, which was simply that she wanted to see her children grow up, and wanted to reassure them that the same thing that happened to her mother was unlikely to happen to her.

As a mother, I feel the same pangs of horror at the idea that something might prevent me from being there for my kids or from having the joy of watching them experience their lives. If there was anything that I could do to lessen the risk of my own death, I would do it.

Jolie's frankness about a private and emotionally gruelling procedure has been hailed as brave and generous, but then, of course, the internet got hold of it. Some very uncharitable comments were made, that tell us more about the people making them than about Jolie - but one recurring theme I thought was worth investigating further.

Many women commented that while Jolie may be promoting a choice that women can make, the same choice isn't necessarily available to women without her extravagant wealth and access to the best medical expertise in the world.

I am fortunate to have among my acquaintances a breast surgeon, so I called her up to get the full picture on what the true nature of the choice is for South African women faced with the same concerns. Dr Sarah Rayne, specialist surgeon at the Netcare Breast Clinic and the Helen Joseph Hospital had this to say:

- Less than 10% of cases of breast cancer are caused by an anomaly in the BRCA gene. The test is only performed on women who have someone in their immediate family with breast cancer so that their BRCA gene can be compared with their family member's. Searching for an unknown anomaly is like searching for a word on a page in a book in a library - virtually impossible unless you know what you are looking for. So basically, don't all dash out and ask for the BRCA test.

- The test is available for free to state patients from the Genetic Counselling Department at the University of the Witwatersrand, and counselling and testing is offered at Helen Joseph, Chris Hani Baragwanath Hospital and the Charlotte Maxeke Hospital in Johannesburg, and at similar units in Cape Town.

- Even if you test positive for the anomaly, you still won't immediately be advised to have a double mastectomy. For patients with a 50% to 80% likelihood of developing cancer, a multidisciplinary team will generally advise close, regular checkups or medication to reduce the risk of cancer. Remember that Angelina Jolie's risk of developing cancer was 87%, which is why she opted for aggressive preventative measures after much thought and with the involvement of an academic team.

- Opting for a bilateral mastectomy is not a decision to be taken lightly, and should involve a great deal of thought and the input of a multidisciplinary team of experts for any woman. 

- If this route is chosen, a bilateral mastectomy and immediate reconstruction reduces the risks of developing breast cancer by 95% to 97%.

- In South Africa, most - but not all - medical aids will cover preventative mastectomies if the process has been followed.

- However, remember that 85% of South African women are not covered by a medical aid - but the choice is still available to them. At the Helen Joseph Hospital, women can be tested for the genetic anomaly for a state hospital fee or for free depending on their circumstances, and in high-risk cases, preventative mastectomies are funded by the state - although in some cases, a reconstruction will not be.

Dr Rayne stresses that the most important thing to take away from all of this is that women shouldn't overestimate their risk of breast cancer. "Women are not walking around with targets on their backs," she says. "They don't need to feel that they need to dash out and have the test done."

But on a positive note, in contrast to what many people believe, South African women from all economic groups do have a similar luxury of choice to Angelina Jolie. "The decision is made on the merits of the patient, not on the basis of affordability," says Dr Rayne.

- Georgina Guedes is a freelance writer. You can follow @georginaguedes on Twitter.

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