Could They Be Saved?

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I must confess to a sense of profound discomfort. The feeling began as soon as I heard of Angelina Jolie’s decision to have both her breasts removed as a preventive mastectomy, and has increased up until this very moment. I knew I had to write about this urgent public health issue, but every possible commentary feels wrong.

None of this disquietude stems from my sex. As a man, my risk of developing breast cancer stands at about 1% of that of a typical American woman, but that in no way means the issue doesn’t affect me. To the contrary. Breast cancer first rudely intruded into my family life almost twenty years ago, when a beloved aunt lost her battle with it. The deadly disease intruded again when I was in law school, and I had to watch a close friend and classmate fail to meet her goal of walking the stage – not because she couldn’t make the grades, but rather because breast cancer refused to give her the time. Given the grief I have born over this terrible disease, I understand somewhat of the anguishing decision Jolie had to make, regardless of the curvature of my torso.

Rather, my unease spills out of the sharp ethical quandary intrinsic to the news story itself. Jolie’s decision was courageous: facing an estimated 87% chance of developing breast cancer, she elected to have both breasts removed in a procedure which drops her chances to only 5%. Her decision to publicly announce her surgery was even more courageous, as many thousands of women similarly situated may draw hope and inspiration from the actress’s example. But just because an act is courageous does not mean it is all upside.

The New York Times summarizes the dilemma: while Angelina’s choice makes sense for Angelina, it may not make sense for every woman at risk for breast cancer. “She is a special case, and you can completely understand why she did it,” says Dr. Susan Love, a breast surgeon and lecturer at the David Geffen School of Medicine at UCLA. “But what I hope that people realize is that we really don’t have good prevention for breast cancer. When you have to cut off normal body parts to prevent a disease, that’s pretty barbaric when you think about it.” The article elsewhere notes that only 5% of breast cancer patients develop the disease because of the genetic mutation which Jolie was found to have; the vast majority of women at risk for breast cancer have a much lower risk, and may not need to undertake such drastic action.

Thus, any recommendation I could possibly make is fraught with peril: if I endorse Jolie’s action I may encourage women to elect a traumatic surgery which they may not need, and if I denounce it I may discourage others from a procedure which could save their lives. No blog post, Op-Ed, or encyclopedia entry should ever take precedence over the conscientious advice of a physician in full consultation with their patient, and thus all women at risk for any kind of breast cancer should consult their doctor first and foremost.

“Thus, any recommendation I could possibly make is fraught with peril: if I endorse Jolie’s action I may encourage women to elect a traumatic surgery which they may not need, and if I denounce it I may discourage others from a procedure which could save their lives.”

Still I must speak, because there may be an alternative. Last year, a body no less august than the National Cancer Institute, the US government’s principal agency for cancer research, quietly released the following statement: “A laboratory study of cannabidiol in estrogen receptor positive and estrogen receptor negative breast cancer cells showed that it caused cancer cell death while having little effect on normal breast cells.” The cited study corresponds with other studies which have found a strong negative correlation between regular cannabis use and incidence of lung, brain and bladder cancers, among others. Not all cancers appear to react the same to cannabinoids, but the research looks extremely promising.

Would my aunt and law school friend still be alive today if they had had access to medical marijuana? I don’t know. Indeed, far too little about the anti-carcinogenic properties of cannabis are presently known, in a time in which the National Institute on Drug Abuse (NIDA) only supplies its study drugs to researchers proposing to study pot’s harms and quashes any clinical studies which propose to quantify its medical benefits. Meanwhile, far too many doctors remain blinded by the DEA’s persistent denial of any medical benefit whatsoever, conflicting with a growing mountain of evidence to the contrary – thus, far too many at-risk women cannot even get an unbiased answer from a trusted professional who swore foremost to do no harm.

So in the end, all I can say to the women of the world is this: get screened. Ask questions. Do your own research. Don’t be afraid to talk to your doctor. And above all, demand change. Until the federal roadblocks to potentially life-saving cannabis research are removed, none of us will know for sure whether Angelina Jolie’s breasts could have been saved. And ignorance, in this case, is anguish.