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Actress, singer, and producer Rita Wilson just went public with the news that she had a mastectomy following diagnosis of invasive lobular carcinoma of the breast. She's the latest in a growing list of celebs to talk frankly about breast cancer and her own situation, and she could be part of a new wave of thinking when it comes to what we talk about when we talk about cancer. No more "awareness" campaigns, no more vague pink products, but actual nitty gritty, serious, concrete conversations about breast cancer and the available treatment options.
One of the most high profile cases in recent memory was of course that of Angelina Jolie, who wrote two years ago about her decision to have a double mastectomy after genetic testing indicated a very high risk of cancer. She was very open about the emotional struggle over the decision, and the fact that there are numerous issues to consider with genetic testing — her piece wasn't a prescriptive suggestion that people with BRCA mutations run out and get mastectomies.
But, she said, "...there are many women who do not know that they might be living under the shadow of cancer. It is my hope that they, too, will be able to get gene tested, and that if they have a high risk they, too, will know that they have strong options." Genetic testing can still be expensive and time consuming depending on a patient's insurance plan, but Jolie highlighted the fact that it, along with counseling, is available to people who want to explore options for managing their health proactively. And that it should be more financially accessible.
Her piece was striking because it didn't shy around the issue of breast cancer in pink, clouded metaphors. She wrote in brutal honesty about her experiences and even posted a detailed discussion of every step of her medical treatment, demystifying the process for those interested in pursuing testing and treatment, but nervous about what to expect.
Wilson's discussion about her situation stressed the importance of a second opinion, noting that her invasive cancer wasn't caught by her first pathologist, but two additional physicians determined that it actually was malignant. Like Jolie, her goal was not just to talk about breast cancer as a vague entity and a "cause" that requires donations and public handwringing, but as a concrete thing that happens to real people — 12 percent of cis women in the U.S. develop breast cancer and trans men are at risk as well, as are, of course, cis men, trans women, and people of a variety of other genders — and as something that needs to be faced directly.
Earlier this year, Jolie brought cancer to the forefront once again with an op-ed in the New York Times discussing her decision to get an oophorectomy and providing more information about cancer care and options. As in her prior case, and with Wilson's, she stressed that patients need to talk to doctors about their individual needs, and that cancer prevention and treatment is not one size fits all.
Given the pushback to her prior piece about her mastectomy, in which a number of people seemed to believe they owned Ms. Jolie's breasts, her courage in coming forward with even more details about her health was evidence of her striking commitment to changing the face of cancer discussions.
Putting a face on an issue, especially a prominent and highly regarded one, is important. So is demystifying a topic and providing information about what to expect and treatment options — so much "breast cancer awareness" that spews across the world every October seems to be focused on the simplistic news that "breast cancer exists" or "maybe you should get some vague, undefined screening."
Patients writing about what their screening was actually like provide an opportunity to understand and talk about breast cancer on a more personal level. Jolie's conversation about breast cancer risk factors, for example, encouraged people with questions about their genetic heritage to talk to their doctors about whether they needed testing, and what kinds of options might be available to mitigate increased risks.
Kelly Osbourne is another celebrity who's chosen to speak out prominently about her experiences with cancer — her mother Sharon was similarly open about her cancer, and Kelly is concerned that she could have a precancerous condition. She commented in support of Jolie and indicated that she was considering further testing and preventative care, saying that "I have been the child of a cancer survivor, so being on that end as well is really, really hard to deal with, so I'm so lucky to have the brave mother I have that has taught me so much."
Kathy Bates, Wanda Sykes, Giuliana Rancic, Christina Applegate, Olivia Newton-John, Richard Roundtree, Judy Blume, and many more have been open about their mastectomies and the decision process that led to the decision to get the surgery. In Roundtree's case, his frankness was especially important, because it highlighted breast cancer risks in men, and the fact that men also need to be evaluated though a relatively small percentage of them actually develop the condition — a man's lifetime risk of breast cancer is roughly 1 in 1,000.
All of these very public discussions provided frank, diverse, and helpful perspectives on breast cancer prevention, diagnosis, and treatment options. They also refocused the conversation to a concrete point, allowing members of the public to connect with breast cancer patients and evaluate parallels in their own lives and generating important conversations — like support for more widespread availability of genetic testing to evaluate risks for patients concerned about cancers in the family.
These are important conversations to have, but they often feel elided in the highly simplistic "awareness" rhetoric that can be so frustrating to witness every October. The rise of celebrities talking about breast cancer could be a sign of a turnaround, though, taking an issue that still seems to lie in the shadows as though it's a shameful subject that should only be spoken about in metaphors and bringing it into the public. We need to have a conversation about associations between breasts and sexuality, bodily autonomy, the medical system, and more. Prominent people opening up are helping to enable that conversation.