14 ms·
My Medical Choice
- deleted 13y ago[deleted]
- yason 13y agoYou can run but you can't hide. Body is a 100% accurate signal of your condition. She's messing with it to remove reception: it's like taping your car's warning light black so that you won't have any problems.
- prodigal_erik 13y agoMore like replacing a frayed wire before it shorts out and sets the car on fire. Cancer is a cell going badly out of control, not a message from some malevolent deity.
- tempestn 13y agoWhat are you even talking about? If anything this is like performing expensive preventative maintenance on your car: the exact opposite of taping over the warning light.
- outworlder 13y agoErm, no. She can't have breast cancer if she doesn't have any breasts anymore! What she is doing is prevention. Like fixing the engine before the warning light comes up.
- bugschivers 13y agoActually, she can, breast cells are not limited to the breasts, neither are ovarian cells limited to the ovaries, hence the 5 - 10% remaining risk. Woman who have this procedure cannot expect to never have to check for ovarian or breast cancer again, it is not a 100% preventative.
- jergosh 13y agoHer going public about this has got a great potential to raise awareness and make other women more likely to consider this course of action. The sad reality is, however, most women won't be able to afford the reconstructive surgery (or to have it done to the standard Angelina Jolie has).
- irollboozers 13y agoI think more importantly it brings up the very real human implications of the debate against patenting human genes, which has most recently been centered around the BRCA gene. http://www.npr.org/blogs/health/2013/04/15/177035299/supreme-court-asks-can-human-genes-be-patented http://www.npr.org/blogs/health/2013/04/15/177035299/supreme...
- michh 13y agoPreventive medicine like this saves lives and money. But try convincing the pencil pushers. Looks like in both privatized and nationalized healthcare, they are often only willing to pay when there's a disease to diagnose. Not when there's an 80% chance you'll get it later when it's much harder and expensive to cure. Unless you have Jolie money and can simply afford to pay for it yourself.
- pixelcort 13y agoWouldn't the expected value of preventative care make it worth doing statistically? (cost of preventative care) < (cost of after-the-fact care) * 0.8
- arnsholt 13y agoSure it would. But the down-stream savings of preventative medicine don't show up in a balance sheet. There all you can see is money spent on people who don't really need it right now (or some variation on that general theme). That's a big part of the problem.
- Vivtek 13y agoWell, yes, actually they do show up in a balance sheet - that's why it's a good thing if your balance sheet is an entire population without the difficult cases jettisoned.
- rjtavares 13y agoIn Portugal I believe the state pays for preventive mastectomy in these cases. Of course, a lot of people chose not do it anyway (which I understand). The UK NHS also pays for it (http://www.nhs.uk/Conditions/Mastectomy/Pages/Why-is-it-necessary.aspx http://www.nhs.uk/Conditions/Mastectomy/Pages/Why-is-it-nece...)
- TazeTSchnitzel 13y agoNitpick: That's England's NHS, there is no UK-wide one. Although I think Wales, NI and Scotland's do similar things.
- gdonelli 13y agoAt first I thought, this wasn't relevant to HN. But then I realized that A. Jolie is hacker. She is trying to hack her life.
- pervycreeper 13y ago>http://www.imdb.com/title/tt0113243/ http://www.imdb.com/title/tt0113243/
- Evgeny 13y agoI am fortunate to have a partner, Brad Pitt Took me a few seconds to process and understand who the author is.
- jbrooksuk 13y agoFunnily enough, when I started reading the first paragraph and thought "I wonder who the author is", then I scrolled up and read "Angelina Jolie" and thought "oh" not thinking anything of it. It was until "Brad Pitt" that I realised, hah! Early morning.
- rythie 13y agoI don't get why they don't make a bigger thing of who the author is on this one.
- davidgerard 13y agoEvery link I've seen to this today that's not on HN has been all about who the author is.
- kokey 13y agoI quite like how they did that, it made the reading experience interesting.
- meatsock 13y agoshe's credited in the byline
- rdl 13y agoI assume a lot of women would want to wait until after they were done having children (particularly since ovaries would also be removed). It might be a harder choice between "mastectomy/oophorectomy and sterility" and "increased risk of cancer" for a 22 year old. Also surprised the patents on BRCA didn't come up in this article, just the cost.
- ssprang 13y agoOn the other hand, given a genetic risk factor so potentially life threatening that it warrants having body parts preemptively removed, you might think twice before reproducing.
- Osiris 13y agoThat would certainly be a great way to prevent genetic disorders for future generations, just disallow anyone with a pre-disposition from reproducing and/or being born. That seems like an odd way to look at reproduction. Would you rather like 50 years and die of cancer or not have lived at all? It's one thing to make a decision when there's medical evidence during the pregnancy that can be tested but when you're only talking about a statistical risk that something may or may not occur...
- ssprang 13y agoI was implying a personal decision to avoid becoming pregnant in the first place. I guess if you want to knowingly risk passing genes that cause terrible disease and suffering to all your descendants… yay freedom!? There are other options if having kids is important to you.
- dannowatts 13y agoi think it's brave and commendable of ms. jolie to open up about something so personal and difficult, using her fame and notoriety to help others who come into similar situations. much respect sent her way.
- spullara 13y agoThis is generally covered by insurance in the US, including the reconstructive surgery. http://breastreconstructionnetwork.com/will-my-insurance-company-pay-for-a-mastectomy-to-reduce-my-risk-of-breast-cancer/ http://breastreconstructionnetwork.com/will-my-insurance-com...
- hispanic 13y agoGenerally, maybe. My friend had this surgery recently and she had to fight (her insurance company) for it.
- Swisscoder 13y agoutterly pointless... By that logic some say we were born to the grave.
- LatvjuAvs 13y agoWhen one fear makes us step over another fear. Well, we must fear what fear dictates us to fear and act accordingly. Her choice, her fear, her resolution and way of lessening the fear. What we have left if there is no fear.
- rms 13y agoNote that the BRCA test costs $3k when purchased through a physician, but 23andme violates the patents and tests for BRCA for $99. http://23andme.com http://23andme.com
- forrestthewoods 13y agoQ: "Does the 23andMe service include analysis of the BRCA gene?" A: "... The BRCA mutations covered by this report are only three of hundreds in the BRCA1 and BRCA2 genes that can cause cancer." https://customercare.23andme.com/entries/23241132-Does-the-23andMe-service-include-analysis-of-the-BRCA-gene- https://customercare.23andme.com/entries/23241132-Does-the-2...
- rms 13y agoBut those are three of the most significant of the possible BRCA mutations, no?
- siganakis 13y agoNo. Micro-array analysis (as opposed to the Exome sequencing they are starting to offer, which may be useful for BRCA diagnosis) focusses on frequently occurring single nucleotide polymorphisms (substitution of one base for another). The majority of these are benign. By looking at lots of commonly occurring variants it is hoped that they can map regions of the genome that may harbour other mutations that may actually have an effect. Baynes et al., 2007 [1] showed that none of the commonly occurring SNP's in BRCA (> 1-5% of the population) have a significant risk in cancer. http://www.ncbi.nlm.nih.gov/pubmed/17428325 http://www.ncbi.nlm.nih.gov/pubmed/17428325
- rms 13y agoI stand corrected. It looks like 23andme is testing for just a few high-penetrance but uncommon mutations that are mostly only of interest to Ashkenazi Jews.
- exit 13y agois this on the front page of hn because jolie starred in hackers?
- daliusd 13y agoNo. http://ycombinator.com/newsguidelines.html http://ycombinator.com/newsguidelines.html What to Submit On-Topic: Anything that good hackers would find interesting. That includes more than hacking and startups. If you had to reduce it to a sentence, the answer might be: anything that gratifies one's intellectual curiosity.
- DanBC 13y agoThere's some interesting stuff about describing risk. Patients don't understand risk, but scarily doctors often don't either.
- mysterywhiteboy 13y agoIt is on the front page because enough readers of hacker news considered it interesting and [hacker]newsworthy, and therefore up-voted it.
- stevoski 13y agoDo any of my fellow HN readers know enough to say that Angelina Jolie processed the available information of her extremely high risk of breast cancer correctly? Is the mathematics logical? Something I wondered is, that given that 1 in 3 American women will have cancer sometime during their life, (and 1 in 5 will die from cancer), how much has she improved things by reducing from 87% to 5% the chance of having one specific cancer?
- tinco 13y agoWell, you can't really say anything about cancer without the "before the age of XX" part. Like, if she had an 87% chance of being diagnosed with breast cancer before the age of 57 like her mother, then she has improved her lifetime by a lot. (even if you take the 33% percent number, she went from 87% to ~33%, tell me that's not significant). Also keep in mind that breast cancer is in a rather critical area, the slightest of spread affects the most vital of organs, this has a large effect on the survivability. With the current speed of technology, I think anything that delays cancer is something that gives you an increased chance of surviving cancer.
- 300bps 13y agoWikipedia has a good summary of the risks: http://en.wikipedia.org/wiki/BRCA_mutation http://en.wikipedia.org/wiki/BRCA_mutation A 25-year-old woman with no mutation in her BRCA genes has an 84% probability to reach at least the age of 70.[16] Of those not surviving, 11% die from either breast or ovarian cancer, and 89% from other causes. Compared to that, a woman with a high-risk BRCA1 mutation, if she had breast cancer screening but no prophylactic medical or surgical intervention, would have only 59% chance to reach age 70, twenty-five percentage points lower than normal. Of those women not surviving, 26% would die of breast cancer, 46% ovarian cancer, and 28% other causes.[16] Women with high-risk BRCA2 mutations, with screening but with no prophylactic medical or surgical intervention, would have only 75% chance to reach age 70, nine percentage points lower than normal. Of those not surviving, 21% would die of breast cancer, 25% ovarian cancer and 54% other causes.[16] The likelihood of surviving to at least age 70 can be improved by several medical interventions, notably prophylactic mastectomy and oophorectomy.[16]
- irollboozers 13y agoElizabeth Iorns, the CEO of Science Exchange (YC S11), is currently conducting independent research to find a potential cure specifically for the BRCA mutation. (https://www.microryza.com/projects/can-we-prevent-the-transmission-of-brca-mutations https://www.microryza.com/projects/can-we-prevent-the-transm...)
- Swizec 13y agoI find it fascinating that just over a hundred years ago proactive teeth removal was a standard practice. Women would get all their teeth removed to save money for the prospective husband. And left untreated for too long, rotten teeth will definitely kill you through infection. These days, women are getting proactive mastectomies, not so much because of the costs involved in treatment, but because cancer is a much scarier disease than teeth rot. At least to us. To us proactively removing your teeth is a bad joke. In 100 to 150 years, will people think about a proactive mastectomy as a bad joke? I sure hope so.
- lostlogin 13y agoMy grandparents both had all their teeth out in their 20s as a proactive health move. This was in Edinburgh. They are in their 80s now, so I guess this was 60 years ago.
- mcbain 13y agoI was chatting to my mid-80's grandmother only recently when she casually mentioned that she had all her (still relatively healthy) teeth removed before her wedding, essentially as a benefit to her husband-to-be as the above post suggests. My grandmother made it sound like it was a standard thing to do here in Australia in the 1930s/40s - whereas I'm still shaking my head.
- lostlogin 13y agoWhat is the nationality of your grandparents? Was this a Scottish/UK thing? While the practices seems crazy and very painful, I suspect that over a life time it is quite cost effective. I wonder if anyone with a dental background hangs around here who knows a bit about this arcane seeming practice
- rdl 13y agoOr maybe in 20 years we'll be used to removing parts and replacing them with vat-grown improved variations. I'd be totally down for getting a superhuman liver.
- startupstella 13y agoI think this is a great example of how a celebrity can use star power to impact the lives of other women. I only wish she had not done this in secret...if there are tabloid reports of pregnancy and weight loss, why not on such an important issue that can have an impact? I also wish (for the first time ever) that she had introduced herself earlier in the article. Just like many readers, I didn't realize this was Angelina Jolie until very late in the article (which doesn't minimize her story, it just puts it in a different context).
- palimpsests 13y ago| I only wish she had not done this in secret. Not done what? She published an account of her medical decisions in the NYT... hardly secret.
- js2 13y agoSee also https://news.ycombinator.com/item?id=5607618 https://news.ycombinator.com/item?id=5607618 (discussion of "Our Feel-Good War on Breast Cancer"). That article does not address women with a BRCA mutation however.
- Eva_Peron 13y agoBest of luck to Crash Override. You're the best!!
- mrexroad 13y agoahem, acid burn.
- EvilLook 13y agoAnd what do women without insurance, money, and BRCA mutations do?
- davidrudder 13y agoMy mother lost both breasts, her gallbladder and her fallopian tubes to 4 separate cancers. When they discovered the BRCA gene mutations, she was tested and turned out positive. My sister tested positive and had proactive masectomies and hysterectomies. I was tested as well, but came up negative for the BRCA mutations (phew). I'm male, but if I was positive it would have meant changes for my daughter. One advantage of the human genome project was that it lead to discoveries like the BRCA mutations. Now, the women in my life could decide ahead of time to prevent these cancers.
- Mz 13y agoI have mixed feelings about seeing this. On the one hand, I do understand why she would make such a choice and I am cool with her using her fame to try to promote awareness and discussion. On the other, I am not happy with the way so much of modern medicine mutilates people instead of making them genuinely healthy and her example helps encourage people to feel that is okay.
- juskrey 13y agoGoogle: "Angelina Jolie complies diet, which combines a high percentage of carbohydrates and proteins with a low percentage of fat intake." Meanwhile, in PubMed: "Women in the highest glucose quartile were 63% more likely to develop breast cancer."
- lostlogin 13y agoThe quality of the surgery is important too. If a plastic surgeon does it they tend to be less aggressive in scraping every last bit of tissue off before reconstruction. Breast surgeons tend to be more aggressive. Source: breast surgeon in the practice next door who I was discussing this with. Due to the source there may be a bit of profession bias.
- Mz 13y agoI will add that breast cancer runs very heavily in my family. My sister has had two mastectomies and four occurrences of breast cancer. My mother has had two occurrences of breast cancer, one mastsctomy, one lumpectomy. I took care of my sister after her first mastectomy. I know how severely and permanently impaired my two workaholic relatives are. Angelina Jolie may be less impaired than my relatives because she might not have had lymph nodes removed. But this is major surgery and she is really downplaying that. My sister likes to garden. She used to dig in the red Georgia clay with a pick axe. These days, she can't even vacuum. Her arms are prone to swelling. She does not have the strength she once had. Her life is far more limited than it once was. For years, my mother owned two pathetic, falling apart bras. Anything new with the eladtic still working made her arm numb and caused it to swell. She cannot tolerate anything snug, so she also wears a hugely oversized one piece bathing suit. They carry on and are not complainers. But the reality is they are both very seriously and permanently impaired. Having seen what my relatives have been through, I understand why Angelina would make such a radical choice. I have done some rather extreme things as well for health reasons. But I am disturbed by the way this is being glossed over. I hope she remains satisfied with her choice. But with her fame and beauty and social influence, I think she is being negligent and irresponsible to make light of the consequences of this surgery. It may be a perfectly reasonable thing to do, but it is not without consequence.