Angelina Jolie’s choice, our challenge

Today the New York Times published a very personal and, for many people, unexpected op-ed by actress, director, and humanitarian Angelina Jolie. Ms. Jolie, a carrier of the gene BRAC1 with a mutation that significantly increases breast cancer risk, recounts her decision and experience undergoing a preventive double mastectomy — the surgical removal of both of her breasts. There should be no shame in undergoing such a procedure. Still, Ms. Jolie feels compelled to note: “On a personal note, I do not feel any less of a woman.” This is a real concern for many women.

The more we talk about women’s health and the unique health experiences women face, the better. The same goes for men. Our bodies are often imbued with such greater expectations than their basic purpose, to allow us to live our lives. We make judgments about each other based on shape and size, and spend countless, wasted hours making these judgments about ourselves.

I applaud Ms. Jolie for her contribution to this important conversation. It also raises important issues for women’s health beyond the New York Times readership. Ms. Jolie writes,

For any woman reading this, I hope it helps you to know you have options. I want to encourage every woman, especially if you have a family history of breast or ovarian cancer, to seek out the information and medical experts who can help you through this aspect of your life, and to make your own informed choices.

I wish this were more true than it is. For many women around the world, there are not many options. Ms. Jolie is well aware of this, and I believe she will be one among many fighting to change the status quo. In the meantime, there are sobering facts to face at home in Uganda.

• Breast cancer is the third most common cause of cancer among women in Uganda, behind cervical cancer and Kaposi’s sarcoma (the latter of which are largely preventable).
• There are two mammography units in Uganda.
• The vast majority of Ugandan women present at late stages in the cancer’s progression, at which point there is little chance of survival.
• The estimated budget of the Uganda Cancer Institute is approximately Ushs 5.5 billion, just over US$2 millon (Sector Budget Framework Paper). The State House budget is 36 times that, over Ushs 200 billion.
• The cost of testing for BRAC1 and BRAC2, as Ms. Jolie notes, is US$3,000 in the United States, and completely inaccessible for almost all women in Uganda.

In comparative terms, Uganda has relatively low rates of breast cancer. But it’s hard to know how accurate these figures are due to poor surveillance and diagnosis in much of the developing world.