By Jeffrey Kluger; Alice Park, TIME
There’s a chilly arithmetic to the way we all get sick. At the end of any year, a fixed and knowable number of us will have developed heart disease, and another number won’t have. There will be a different entry in the ledger for cancer, another for lung disease, another for Parkinson’s or dementia or HIV. The people who study those mortal metrics–the actuaries, the epidemiologists–don’t give too much thought to the individuals behind the numbers, and the truth is, they can’t. It’s no good sentimentalizing math–not if you want to get anything useful out of it.
But sometimes it’s impossible not to: sometimes the person who is sick has a very recognizable face. So it was in 1985, when Rock Hudson, Hollywood heartthrob of an earlier era, died of complications from AIDS and a country that thought it could fence off a disease suddenly realized we were in this together. So it was in 1995, when Christopher Reeve, a man best known for playing a character utterly immune to injury, was thrown from a horse and suddenly could do nothing at all without help–and with that, the spinal-injury community had a point man a lot more powerful than Superman.
And so it was again when Angelina Jolie, the most beautiful woman in the world by a lot of people’s lights, stepped forward and announced in an op-ed in the New York Times that she had undergone a double mastectomy, an operation she decided to have after learning that she carried a genetic mutation that in her case increased the odds of developing breast cancer to a terrible 87% and ovarian cancer to 50%. She decided to get tested because her mother died of ovarian cancer at age 56. Jolie herself has no current signs of either disease.
She explained her treatment decision with a simple clarity: “Once I knew that this was my reality, I decided to be proactive and minimize the risk as much as I could.” She explained it with an eye toward the 12% of all women who will one day develop breast cancer and the 100% who worry about it: “I hope that other women can benefit from my experience. Cancer is still a word that strikes fear in people’s hearts.” And she explained it in a way that went straight to what many were thinking, when a woman whose very name signals beauty and whose profession depends on it makes such a dramatic choice. “On a personal note,” she wrote, “I do not feel any less of a woman. I feel empowered that I made a strong choice that in no way diminishes my femininity.” Jolie, like many other women who have undergone mastectomy, has had successful reconstructive surgery. But as with those other women too–especially the ones who were not yet sick–it took a lot of courage to get to that point in the first place. “It’s such an emotional and personal decision,” says Sarah Hawley, associate professor of general medicine at the University of Michigan, “particularly because it’s the woman’s choice.”
Jolie, according to most experts who have weighed in publicly, made a smart choice for her case. “It’s one of the truly unique situations where most medical professionals would say if a woman chose to have both breasts removed, it’s a pretty reasonable thing to do,” says Dr. Eric Winer of the Dana-Farber Cancer Institute. Exceedingly reasonable, judging by the numbers. Jolie’s doctor estimates that her cancer risk fell from its 87% high to just 5%.
But the seeming straightforwardness of Jolie’s case masks a much murkier reality, one that involves science, policy and probabilities, not to mention Americans’–indeed everyone’s–tendency to observe what the famous do and then conclude that we should do the same. When Katie Couric underwent a televised colonoscopy in 2000, demand for the procedure jumped–a phenomenon that was promptly dubbed “the Couric Effect.” In that case, many lives were likely saved by the raised awareness. This trendsetting power is exponentially greater in the case of Jolie, a megawatt star. She gave birth to a girl in 2008 and named her Vivienne, and in 2009 that name cracked the top 1,000 in popularity for newborn girls for the first time in the U.S. since 1930. It is now trading at a high of No. 322. Something similar happened with the names of her children Maddox and Shiloh. It’s one thing when you model your fashions after Jolie’s; it’s another thing to model your kids.