Prevention vs cure, with Angelina Jolie

While playing the house-husband the other day I heard on the kitchen radio (it was probably Heart or Magic, which I blame entirely on my wife) that Angelina Jolie is planning to follow up the preventive double masectomy she underwent last year with further surgery to reduce her chances of developing ovarian cancer. It turns out this also gave media outlets a good excuse recently to run stories illustrated by pictures of Angelina (I feel we can talk on first-name terms, given where I’m going with this post) “daringly” showing off her reconstructed breasts at the Oscars this year.

Undeterred by the fact that the stories at the top of my Google search results to find out more were from the Daily Mail, Newsbeat and Glamour magazine, I discovered that genetic testing had shown Angelina had an 87% chance of developing breast cancer, and a 50% chance of developing ovarian cancer (of which her mother – like mine – died). She decided to do something about it, which reduced her chances of developing breast cancer to 5%, as she revealed in a New York Times editorial urging others to pursue the possibility of gene testing.

Good on her. I imagine it would be terrifying to go to an appointment at which you will be told what your chances of developing various cancers are – and to make the brave decision to undergo surgery when you’re feeling perfectly well. A schoolfriend of my mother’s works in cancer screening at the Royal Marsden, regularly having to explain to young women that they are likely to develop the same illness that may have already taken their mothers from them. It’s a tough job, and she thoroughly deserved her OBE.

Acute lymphoblastic leukaemia, however, does not seem to be passed on genetically, and as far as I am aware there’s no test that will tell you whether you’re predisposed to getting the illness. My attitude has always been that as anyone can get it, there’s no reason I shouldn’t have got it; and there was nothing I could have done to prevent it, so there’s nothing in my lifestyle I feel I could/should have changed to minimise the risk.

Now, though, like Angelina, I find myself cancer-free, facing a daunting and potentially dangerous procedure in order to reduce the risks of being hit by the illness in the future. Unlike her, however, I never took that tough, proactive first step of going out deliberately to find out what my chances were. That’s not to say, of course, that it’s easier to go through months of treatment for leukaemia than it is to sign up for genetic screening as a prerequisite for knowing what chance you have of getting cancer in the future. But her move – and willingness to use her celebrity to share such an intimate moment in order to raise awareness – definitely showed bravery.

It’s strange to beat cancer by getting into remission, yet still to have to face the toughest part of the treatment. However, without the transplant, and given the fact that I have already relapsed once, there would be a high chance of the cancer coming back. I’m not sure what the probability of relapse without this transplant would be, but I can’t imagine it being much more favourable than Angelina’s previous 87% chance of getting breast cancer.

So it’s prevention rather than cure – particularly important as each time I fight the leukaemia it becomes harder to beat it, and my body’s capacity to recover from the side effects of treatment becomes less. The bone marrow transplant brings a range of risks and possible complications, of course – not to mention the major effect it will have on my and Mariacristina’s way of life for at least the next 6-12 months. But it’s good to know that despite the difficulties and things that could go wrong, the doctors deem this a less risky option than doing nothing: by undergoing the transplant I’m giving myself the best possible chance of a healthy future.

Just like Angelina!

PS I considered basing this post on Bush/Blair and pre-emptive strikes, but decided i) I’d rather keep my blog clean of political debate, and ii) I would get more hits by talking about Angelina Jolie, particularly if I managed to squeeze the word ‘breasts’ in somewhere. It’s all in promotion of a good cause, mind.