Why Cancer Screening Is For Everyone: A Health Economist on Angelina Jolie Pitt’s ‘NY Times’ Op-Ed

On Tuesday, Angelina Jolie Pitt wrote an op-ed, “Diary of a Surgery,” in The New York Times, explaining why she had “a laparoscopic bilateral salpingo-oophorectomy” — or in layman’s terms, the removal of her ovaries and fallopian tubes. The piece is an informative and important piece of advocacy regarding women’s health and women’s options in the fight against cancer. (For the gossips among us, it is also skillfully timed, debuting the same day as Jolie Pitt’s film Unbroken became available on DVD and streaming.)

In a way, her op-ed functions as a sequel to her previous 2013 Times op-ed, “My Medical Choice,” where she went into detail about testing positive for the BRCA1 gene. The combination of that positive test, which means that she runs a high risk of having cancers (87% chance of breast cancer, 56% of ovarian cancer), along with her family history (her mother died at 56 from ovarian cancer), led to her choice of a double mastectomy at the time. It was shocking to hear about this choice from one of the world’s leading sex symbols, but it’s a choice that women have been facing since the genetic link was discovered: in 2008, television writer Jessica Queller released a memoir called Pretty Is What Changes: Impossible Choices, the Breast Cancer Gene, and How I Defied my Destiny, about how her positive BRCA gene test changed her life.

As I read Jolie Pitt’s latest op-ed, I wondered about whether or not her choice was one that’s possible for the average American patient running the gamut of private insurance. Is her quality of health care different from the rest of us? While money is clearly not a problem for Jolie Pitt, it’s “not the issue,” according to James Burgess, Professor of Health Policy and Management at the Boston University School of Public Health, where he is the director of the health economics program.

“If somebody had a mother go through what her mother went through, and Jolie Pitt’s positive genetic testing for the BRCA gene, pretty much anybody in that situation would be getting the blood test that the actress was getting. What’s going on is pretty specialized,” Burgess told me over the phone. “It’s about educating the public about the available testing. We want the people who need testing the most to get testing.”

“Remember, if the Affordable Care Act goes through the Supreme Court, we will get to a more equal system of health care, or a more equitable system,” Burgess said, suggesting that that the ACA will make screening for disease more accessible for the public. “In general, [with] the U.S. health care system, once we get on the case, and on the horse, we spend a lot of resources on a case.”

Burgess said that Jolie Pitt’s advocacy makes these issues “more vivid to people,” because of her celebrity. “But again, to draw large conclusions from it is something that we academics don’t love doing,” he noted. Jolie Pitt is taking “relatively austere” approaches, he said, whereas other people “may take their chances until they saw something.”

While Jolie Pitt may be on the leading edge of women’s health, it was a pleasant surprise to talk to Burgess and to realize that preventative health care, particularly in the United States, can, should, and will be for everybody. Women who are in similar positions can and do have access to the testing and resources that can lead to tough choices about how to combat the risk of breast and ovarian cancer.

“It is not possible to remove all risk, and the fact is I remain prone to cancer,” Jolie Pitt concluded, in a moment of moving honesty. She is clear-eyed about what she wants the future to hold: “I know my children will never have to say, ‘Mom died of ovarian cancer.'” Clearly, she is doing the work to be informed and prepared, and by sharing her journey in public, she’s informing women about their health options regarding a deadly disease.