Preventative medicine or preventive care consists of measures taken to prevent diseases, rather than curing them or treating their symptoms. Preventative surgery seems to me an even more extreme way of protecting oneself against a potentially fatal disease when one is not yet showing and symptoms of that disease.
There was wide media coverage last week of the actress Angelina Jolie’s decision to undergo a double mastectomy after discovering that the BRCA1 gene gave her an 87 per cent risk of developing breast cancer. Similarly, today’s newspapers reported that a businessman has become the first man to have his prostate removed after discovering he was carrying a faulty gene that raises the risk of cancer.The 53-year-old was told he had the rogue BRCA2 gene after taking part in a clinical trial at the Institute of Cancer Research in London. In both these cases the breasts and the prostate were perfectly healthy but the increased likelihood of contracting a disease means, for these patients at least, that surgery of this kind gives peace of mind and is worth all the pain.
I don’t feel too comfortable with this fear-based type of medicine. The massive media coverage of Angelina Jolie’s double mastectomy has almost all lauded her as a brave woman. That she went public with the story may be considered brave but I think her choice could also be described as fear-filled, paranoid and even ill-advised. The obvious choice surely is the extra screening which is routinely offered for high-risk women under the age of 50. Or have we really no faith in this service? Joan Smith wrote in The Independent on Sunday about her unease with the publicity. It felt uncomfortable because it is unrealistic to draw parallels between a Hollywood film star and other women. Ms Jolie’s experience I am sure would be vastly different to a women who opted for this surgery on the NHS here. Also, as Joan Smith points out, “there has been a big increase in the number of prophylactic double mastectomies in the US in recent years, and doctors recommend them in rare cases like hers where the risk of the disease is very high. But there has also been a rise in cases where a woman who has cancer in a single breast nevertheless opts to have both removed. This seems to be part of a trend towards more aggressive breast cancer treatments, even though its impact on survival rates is unclear.” At one time, hysterectomies used to be over-prescribed, are we going to go the same way with breasts, prostate, ovaries etc?
The fact is that the success of these treatments is impossible to quantify. Ms Jolie never had the disease in the first place and may never have succumbed to it. Can surgically removing a part of the body which one day might, just might become diseased be called medicine? One commentator called it “medicine on a par with witch-doctors in some bush hut, although they would not resort to such medical savagery.” Is it medicine or money-making mutilation in the name of medicine?