Listen to Angelina

Movie star Angelina Jolie’s disclosure that she had double mastectomy to elude cancer would be a landmark in mankind’s cultural history. How could a supernova celebrity decide to remove two of the most important parts of any woman’s—especially an actress’—body entirely on the basis of her trust in science, and to prevent an illness expected to occur many, many years away? The future is here, we have unlocked the innermost secrets of life and death.

The best geneticists and onco­logists in the world—she certainly could afford them—had recommended that the only way for here to escape the fate of her mother who died at 56 of cancer, was to ensure that the “faulty” gene coded BRCA1 that caused the illness and which was passed on to her was purged out of her system. This required the removal of her breasts.

Jolie could have kept her mastectomy secret, after all, with the best cosmetic breast surgeons money could buy, her breasts look unchanged with her nipples intact, and the only signs of surgery, to use her words, “are small scars, and that’s it.” Yet she told the world about her brave undertaking, at a big risk to her in an industry in which an actor or an actress’ slightest health condition would be devastating to his or her career. What a bold woman, a heroine of our times.

In her article in the New York Times, she explained why she revealed her secret: “I choose not to keep my story private because 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.”

While applauded by most commentators, anti-medical establishment activists vociferously criticized her action, and claimed that while there are “faulty” genes that allow the spread of cancer cells, these are triggered by external chemicals and can be suppressed. There is even a new science for this: epigenetics, how a gene’s “expressions” (i.e., cancer) change depending on factors other than its nucleotides’ sequence.

One writer noted: “Cancer is not a disease you just ‘get’ like being randomly struck by lightning. It’s something you must ‘manage’ or ‘prevent’ day by day, meal by meal, through a lifestyle choice that involves vitamin D supplementation, nutrition, super foods, vegetable juices and avoidance of cancer-causing chemicals and radiation.”

Indeed, a classic example is that while we all have inactive lung cancers cells, it is one or several of the 4,000 chemicals delivered by cigarette smoke that would trigger those cancer cells to multiply.

A woman may not have Angelina’s deadly BRCA1 gene, but she will most likely have breast cancer—according to many medical studies—if she smokes or inhales second hand cigarette fumes everyday because of her hus­band’s smoking.

There are also some evidence that its near-epidemic incidence has been due to the widespread use­—portrayed as an absolute requirement for women by huge multinationals and endorsed (for huge fees of course) by top celebrities — of underarm deodorants and antiperspirants, whose carcinogenic chemicals easily pass through the armpit’s pores to breast tissues.

Medical evidence is said to be still inconclusive on this. But then how many decades had passed and how many billions of dollars cigarette companies had spent for PR to mislead the public before the medical establishment concluded that cigarette smoking caused cancer?

But it is not the procedures Angelina went through that Filipinos should pay attention to. After all, the cost of her mastectomy and cosmetic breast reconstruction (one estimated it to cost $500,000)—not to say the $4,000 price just for a genetic study to detect the fatal BRAC1—is beyond Filipinos’ means, except the billionaires. Angelina’s BRAC1 gene is also rather rare, afflicting one in 500 Americans, and I would surmise rarer among Asians.

Rather, especially in a country obsessed with American celebrities, Angelina’s bold disclosure should shock us about the very real and widespread danger of breast cancer. Our super-rich elite and our government—even if its head is a poster boy for cancer-causing cigarette smoking—to undertake serious efforts to set up institutions allowing women to detect it early enough (which makes it easier to contain) and for victims’ to have inexpensive access to treatment.

There is a drug treatment for women afflicted with the early stages of breast cancer. But it costs at least P100,000, so how could the poor afford this? While we have world-class hospitals devoted to heart, lung, and kidney diseases, there is no center for breast cancer. Either because of Filipinas’ inherent shyness, or because of mam­mogram’s inconvenience, even pain for many, not too many women bother to check if they are in the incipient stages of breast cancer.

Yet breast cancer has overtaken lung cancer as the most prevalent form of cancer in the country, Philippine Society of Medical Oncology president Dr. Felycette Gay Lapus said in a press conference last year. Worse, our country has the lowest survival rate of people with breast cancer among 15 Asian countries. “We are number one for breast cancer in Asia. Three out of 100 Filipinas will get breast cancer before age 75 and one out of 100 will die before reaching 75,” she said.

I hope Angelina’s disclosures would be a shock not only to remind our women to be vigilant in detecting cancer but to change Filipinos’ worldviews.

It wasn’t too long ago—and even today among Filipinos it’s a fact—that cancer and other diseases were seen as God’s punishment for the wicked and the wicked’s descendants. In our clan there was talk that the prevalence of breast cancer among women in my father’s Kapampangan side was a curse created by an ancestor who insulted (or even killed) a Spanish friar. I would bet though that this was due to Kapam­pangans’ fondness for meat cured by salitre (saltpeter or potassium nitrate) such as tocino and longganisa. It might even be because of carcinogens the US military spread in the area, as most of our clan lived around Clark Air Base.

The main market for our cottage industry of faith healers, healing priests and nuns in fact has been cancer victims, with these charlatans taking advantage of the cancer cells’ feature that their growth often slows down, even to a halt, which is interpreted by healers as the work of God, through them of course. Most Filipinas, I think, believe, because of cancer’s seeming randomness that whether one gets it or not is a matter of faith or Divine decision.

Angelina’s case, her dissemination by her very action of medical sciences’ most advanced findings, should shatter that kind of view. And as she most eloquently ended her article: “Life comes with many challenges. The ones that should not scare us are the ones we can take on and take control of.”