My Medical Choice
nytimes.com
nytimes.com
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.
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.
What would people eat then? Smoothies, cream of wheat?
"Nine weeks later, the final surgery is completed with the reconstruction of the breasts with an implant. There have been many advances in this procedure in the last few years, and the results can be beautiful."
Can proactive mastectomies double as cosmetic surgery? That would be an interesting wrinkle in the cost/benefit analysis.
I wonder if that also wasn't one of the reasons proactive teeth removal (replaced with dentures) was once so popular.
It will probably be called an "elective procedure" and especially if there is anything cosmetic about it.
My mom had a melanoma removed from her eyelid and the costs were staggering. She had some cosmetic reconstructive surgery done to allow her face to continue to look normal. That's all: normal.
They had to fight for weeks to get a good percentage of it covered—or any percentage of the cosmetic portion.
I don't know entirely what the case is for a preventative mastectomy, maybe if your cancer risk is high enough your insurance will see it as a overall benefit to them, but it can't be easy or cheap to deal with at all.
I'd need to find more sources but for one this is Aetna's policy, which it seems like Jolie would fit under due to family history and the results of her genetic testing.
Took me a few seconds to process and understand who the author is.
It was until "Brad Pitt" that I realised, hah! Early morning.
(cost of preventative care) < (cost of after-the-fact care) * 0.8The UK NHS also pays for it (http://www.nhs.uk/Conditions/Mastectomy/Pages/Why-is-it-nece...)
Sometimes it does, sometimes it doesn't. Lots of preventative medicine doesn't save either lives or money - mammograms below age 50 are a good example. The increased risk of infection from doing a biopsy on a non-cancerous mass (and similar complications) outweigh the rare early breast cancer cases prevented.
http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca...
http://www.bloomberg.com/news/2012-07-31/in-mammogram-debate...
I don't know the specific details of this case. Maybe she reduced her risk, or maybe she traded a 5/1000 risk of cancer for a 6/1000 risk of infection.
But this "preventative medicine saves lives and money" meme needs to die. Sometimes it's worthwhile, sometimes it's not. Numbers >> political memes.
Appropriate preventative medicine supported by research and numbers is so, so important.
The other poster said the meme needs to die, not all preventative medicine.
I know this is probably statistically true at some level (when using real statistics), but I do wonder how the statistics move for wealthy individuals at places like Mayo vs the national average. I would imagine the rate of infections at world class hospitals is lower than at a clinic in Englewood, but I wonder if it's enough to swing the statistics in electoral surgery's favor.
https://customercare.23andme.com/entries/23241132-Does-the-2...
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.
There is currently a case before the Supreme Court trying to invalidate Myriad's patents, as well as all patents on human DNA.
The issue, however, is that Myriad's value is no longer in their patents, but in the data they collected over the past 20 years.
Myriad charges ~$3k for their tests, while a full sequence of your entire genome is only ~$5k, and will tell you the same genetic data. But Myriad has been able to correlate much more of your DNA and the BRCA regions with cancer risk, and that data is not public.
23andMe is definitely not a substitute.
For anyone interested in the patents and the current Supreme Court case, check out: http://www.genomicslawreport.com/index.php/2013/05/01/some-t...
That's a great blog on genomics and the law, and there are other interesting blog posts on Myriad if you look through their archive.
or is there a completely different way of mapping specific genes?
I think that a lot of programmers are probably more cold and logical in their thinking (like me) so it was a pretty easy choice for me.
My wife is a lot more emotional and I have tried to convince her to get 23andMe but she refuses because she doesn't want to know.
The most significant of the "something really bad and unexpected" are the risk factors for Alzheimer's and Breast Cancer. I believe that there are certain markers for both those diseases which could reveal that you have a much higher lifetime risk (for some cases of breast cancer, >50%), which is obviously scary. Don't quote me on this, but I believe in both situations you are very likely to have had some family history in these diseases, so it should not be a total surprise. And if you have a family history of breast cancer, you should be getting Myriad's full BRCA test (see my other post). I would probably look into a clinical test for Alzheimers too if I thought I was at risk.
There are a few other diseases that also have big impact (>50% lifetime risk), but they are rarer, and I'm not sure if there are any where you would have had no family or personal history to clue you in on the possibility.
The vast majority of the diseases 23andMe reports on give you very little actionable data. For example, it might say I have a 2x risk of prostate cancer, from a background risk of 2% chance to a personalized 4% chance. I view that as pretty unhelpful. Furthermore, it's based on SNP-associations currently known. It's possible, I have another SNP that's associated with a .25x risk, and therefore I actually have only 1% chance overall, i.e. half the general population's risk.
23andMe can be useful for other reasons. For example, it will tell you if you are a recessive carrier of certain diseases, which is helpful if and when you decide to have children. It's also fun, has ancestry info, etc.
Also surprised the patents on BRCA didn't come up in this article, just the cost.
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...
(https://www.microryza.com/projects/can-we-prevent-the-transm...)
http://breastreconstructionnetwork.com/will-my-insurance-com...
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.
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?
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.
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]
Meanwhile, in PubMed: "Women in the highest glucose quartile were 63% more likely to develop breast cancer."
http://www.npr.org/blogs/health/2013/04/15/177035299/supreme...
much respect sent her way.
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).
Not done what? She published an account of her medical decisions in the NYT... hardly secret.
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.
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.
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.