Prophylactic Mastectomy: Angelina Jolie Opens a Door on a World of Challenging Decisions

Angelina Jolie’s brave announcement in the New York Times last week that she has undergone a prophylactic mastectomy and reconstruction because of her high hereditary risk of breast and ovarian cancer has resonated loudly with other women who come from families with high cancer rates. Being a carrier of a deleterious mutation in a BRCA1 or BRCA2 gene means that a woman faces a 56-87% risk of developing breast cancer and a 20-60% risk of developing ovarian cancer, both rates far above those faced by women in the general population. Many of the breast cancers occur at unusually early ages, so breast screening in women at high risk is recommended to begin at age 25 and women in screening programs are also advised to consider prophylactic mastectomy and prophylactic oophorectomy when they complete their childbearing.

 As the Cancer Genetics and Prevention Clinic Director of Psychology Research and Clinical Services and the author of Prophylactic Mastectomy: Insights from Women who Chose to Reduce Their Risk (Praeger, 2012), I have heard many women’s stories about how they came to the same decision Angelina made and how they have coped with the physical and psychological challenges which surgery created. The vast majority of women feel as Angelina said she did, grateful for the chance to avoid cancer and to be able to reassure her children that they would not lose her to that disease. Having lost a parent to cancer at a young age and having small children are two of the most common motivations for women to choose prophylactic mastectomy. What Angelina could not cover in her letter were the many dilemmas, challenges, decisions, problems and adaptations which a woman opting for prophylactic mastectomy faces along the way to her successful surgery and recovery. The 21 women I interviewed for the book talked openly about difficulties finding sympathetic doctors, countering well-meaning relatives who opposed the surgery, confronting innermost feelings about their breasts, figuring out how to explain this surgery to small children (one woman told her young children her surgery was like when their stuffed animals needed new stuffing!), and adjusting to a changed sexual experience and body image. The road to “saving my own life” or “feeling safe within my body” is often a bumpy one, leading to a good place, but sometimes requiring support from family, friends, and professionals along the way. Hats off to Angelina, for pointing the GPS down that road! She has made it much easier for other women to follow.

Andrea Farkas Patenaude, PhD, Director of Psychology Research and Clinical Services, Dana-Farber Cancer Institute, Author, Prophylactic Mastectomy: Insights from Women Who Chose to Reduce Their Risk (Praeger, 2012) 

International Criminal Court's Historic First Conviction Puts Spotlight on Child Soldiers

On March 14, the ICC found Congolese warlord Thomas Lubanga guilty for the war crime of using children under the age of 15 as active participants in hostilities in the Democratic Republic of the Congo between September 2002 and August 2003. This is the ICC's first conviction in its 10 year history. In his forthcoming book, Child Soldiers: A Reference Handbook, Dr. David M. Rosen tackles the complex legal and social questions surrounding this controversial global issue.


For more than 40 years, humanitarian and human rights groups have sought to ban the recruitment and use of child soldiers. Their efforts have produced mixed results. On one hand, they have had a profound effect on the development of international law prohibiting the recruitment of children, but on the other hand, such laws seem to have had only limited efficacy in reducing the actual number of child soldiers participating in conflicts throughout the world. This huge gap between the aspirations of law and the practical reality of child recruitment is one of the greatest problems in ending the recruitment of child soldiers.


International efforts to end the use of child soldiers first bore fruit in 1977. That year, for the first time in history, there were changes made to the so-called “laws of war” that placed restrictions on recruiting children into armed forces and groups. Since that first victory, the issue of child soldiers has developed and expanded in scope. What began in 1977 as a relatively narrow concern with protecting children under 15 years old from serving as armed combatants has evolved into an international effort to sever a broad range of connections between the military and any person under the age of eighteen. The entire concept of the “child soldier” has evolved to encompass a greater number of children engaged in a wider variety of activities than first imaged. This raises some powerful questions. Are there actually more child soldiers in the world today than in the past? Certainly, child soldiers have been integrally involved in the military for a very long time. Andrew Jackson, 7th President of the United States, joined the armed forces of the American Revolution at age 13, and he was far from alone in doing so. How have changing definitions of child soldiers affected our perception of the actual number of child soldiers in the world? Are all children who are involved in the military coerced or abused? Is it always the case that children would be better off away from military involvement? And finally, when children are involved in military activity, should they be held responsible for their actions in the same way as adult soldiers?

- David M. Rosen is a professor of anthropology and law at Fairleigh Dickinson University




Explore these new ABC-CLIO resources to learn more about the complex issues surrounding the use of child soldiers around the world:


Child Soldiers

Slavery in the Modern World

Issues: Understanding Controversy and Society

Censorship: The Web Goes Dark

With minimal effort even casual Web users can locate information that many governments, including at times the U.S. government, would prefer to restrict: hardcore pornography, plans for making explosives or illegal drugs, home addresses of government officials and celebrities, unauthorized copies of copyrighted songs and movies, encouragement of racist violence and terrorism, and almost any imaginable type of objectionable content. Children researching homework assignments online may stumble upon Holocaust-denial and pro-genocide Web sites, unaware that what they are reading is not fact but paranoid delusion; criminals can find co-conspirators and all the information needed to plan their crimes.


At times the presence of this harmful content leads to demands for censorship, although harmful content is only a tiny portion of total online content—and many would disagree on whether particular content is harmful. Censorship carries a negative connotation; in the United States the power of the federal government to censor is severely restricted by the First Amendment to the U.S. Constitution, while the Fourteenth Amendment extends these restrictions to the state as well.


Even in pre-Internet times censorship was difficult. First, it was unpopular: the First Amendment is close to the core of the values lumped together under the heading "civil liberties"; censorship, in other words, is perceived as un-American. Second, the magnitude of the task was daunting even when information was published on paper. The Internet has done nothing to diminish the first problem, while expanding the second—the volume of information—by several orders of magnitude. In addition, the Internet provides new censorship challenges: encryption technology makes it easy to conceal content from government snoops; the lack of face-to-face contact provides children with access to the same information as adults; and the borderless nature of the Internet makes it easy for providers of content censored in one country to move that content to a server in another, more permissive country—while remaining accessible to web users in the first, censoring country.


This international character also makes it difficult for the government to control another type of information: content that infringes on the intellectual property of others. While the Digital Millennium Copyright Act provides measures to remove infringing content or shut down sites that promote illegal downloads, it applies only in the United States. US authorities and copyright holders can do little about Web sites that are based in foreign countries. In 2011, two bills were introduced in Congress to address this problem. The Stop Online Piracy Act (SOPA) and the Preventing Real Online Threats to Economic Creativity and Theft of Intellectual Property Act (PROTECT IP Act or PIPA) in the Senate attempt to stop copyright infringement via foreign Web sites by cutting off funds and access from the United States. While applauded by many rightsholders, such as film and music industry associations, the bills have been denounced by civil liberties groups and Internet technology companies as an avenue of government censorship that threatens the Internet itself. The controversy grabbed national headlines in January 2012 as many popular Web sites staged a protest on January 18, with such sites as Wikipedia, Reddit, and BoingBoing going completely dark while others including Craigslist and Google featured prominent messages against the bills urging the public to contact Congress.


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(Partial excerpt) Cornwell, Nancy C. "Censorship: Overview." Issues: Understanding Controversy and Society. ABC-CLIO, 2012. Web. 18 Jan. 2012.