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Monday 23 October 2017

Terry Prone: Angelina Jolie offers no easy answers, that's why her advice is vital

Jolie said she wanted to raise awareness of the importance of early screening and detection
Jolie said she wanted to raise awareness of the importance of early screening and detection

Who, in their right minds, is going to take health education from a woman whose teen years were drug-elevated, who is covered in tattoos and who once carried a vial of her lover's blood on a chain around her neck?

Short answer? Millions, when that woman is Angelina Jolie (below).

The minute her Diary of a Surgery column popped up on the New York Times website - it was in the middle of the night, Irish time - it was inevitable that it would create an international frenzy.

By midday radio news bulletins across Ireland, Britain and the Continent all carried the story of the film star and director who had followed up last year's double mastectomy with a less disfiguring but just as radical elective surgery - the removal of her ovaries and fallopian tubes.

danger

By her action, Jolie has undoubtedly saved thousands of lives with which hers will never directly intersect. That's the great thing about being a global brand. It allows you to stop people in their tracks, alert them to a danger, help them to step away from the Grim Reaper.

It even moves the statistics from half-heard figures into reality. Jolie's column relaunched figures from the files of the National Cancer Registry, to which we had not paid that much attention up to this week.

Those figures tell us that Ireland has one of the highest rates of ovarian cancer in the world, with nearly 600 new cases presenting every year, north and south. Ovarian cancer is a killer, with a survival rate much lower than survival from breast cancer. It's also a silent killer, often misdiagnosed, since the early symptoms include abdominal bloating, frequently attributed, in women, to a number of other possible causes.

Angelina Jolie has earned an important place in the history of cancer management. Cancer, called "the Emperor of All Maladies" more than two millennia ago by Hippocrates, has gone through phases.

For centuries surgery, the more radical the better, was the only option. The operations were brutal and the outcomes poor. How and why cancer struck, however, remained a mystery.

In the 20th century, for the first time, cause and effect, at least for some cancers, became clearer. Although - thanks to the monied efforts of Big Tobacco - the fact that lung and many other cancers are directly or indirectly caused by smoking took a long time to become a medical fact.

For a while, the general belief was that environmental factors or lifestyle choices caused cancer. When lay people suggested that certain cancers ran in families, everybody rolled their eyes to heaven and talked of old wives' tales. Then came the genetic breakthroughs that proved them right.

When Jolie had her double mastectomy and breast reconstruction, what had seemed an abstruse genetic mystery got personal. Now, with her second surgery, women whose mother or grandmother or aunt died of breast or ovarian cancer are going for tests to find out if they carry the code that might predispose them to either or both, and increasing numbers are having prophylactic surgery.

One of the most significant sections of Angelina Jolie's column was where she said that, after these two major operations, she still felt feminine and grounded.

genetic

There was nothing self-serving about that sentence. This woman is a global star who combines sex with athleticism, whose very shape speaks of her femininity. The sentence spoke directly to women who might be moved to check their genetic status to find if they were pre-disposed to the cancer that had killed their mothers or other female relatives.

And it told them, in simple personal terms, that the surgery is tough, ends your chances of having a baby and plunges you into early menopause. It was honest: she admitted that she's still cancer-prone.

But it assured women that, even if genetics has loaded the dice against them, they can, through their own courage, even the odds considerably in their favour.

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