Diana Zuckerman, PhD, National Center for Health Research, Huffington Post: May 16, 2013

When I read about Angelina Jolie’s announcement this week, I cringed.

I have greatly admired her willingness to speak out on important issues over the years. Her public announcement about her mastectomies will certainly reassure some women that losing a breast to breast cancer isn’t quite as frightening as it had once seemed. But Ms. Jolie is a powerful role model to millions of women. What are the unintended consequences of the role she is modeling regarding breast cancer?

Is breast cancer so frightening that it is better for a woman to remove her breasts before she is even diagnosed? Obviously, that isn’t what Ms. Jolie is saying. She has one of the breast cancer genes (BRCA1), and that greatly increases her chances of getting breast cancer.

However, the extremely high risk that she quoted from her doctor (87 percent chance of getting breast cancer) was based on old, small studies. Newer studies have found that the risk of getting breast cancer for an average woman with BRCA1 is 65 percent. Since being overweight and smoking increase the risk and exercising and breastfeeding lower the risk, Ms. Jolie’s risk of breast cancer, even with the BRCA1 gene, could be considerably lower.

Of course, the lifetime risk of breast cancer would still be high, but it wouldn’t be nearly as high a risk during the next 10 years or even 20 years. According to experts, a 40-year-old woman with the BRCA1 gene has a 16 percent chance of getting breast cancer before she turns 50. That’s not nearly as frightening, and with regular screening and all the progress in breast cancer treatments, the survival rate from breast cancer is higher than ever. Many breast cancer patients live long and healthy lives. And, it is possible that by the time Ms. Jolie (or any other woman with BRCA1) got breast cancer in the future–if she ever did–the treatments available would be even more effective than they are today.

Thanks to mammograms, women are getting diagnosed with breast cancer at much earlier stages, making it safe to undergo a lumpectomy (which removes just the cancer) rather than a mastectomy (which removes the entire breast). And yet, American women are undergoing mastectomies at a higher rate than women in other countries–many of them medically unnecessary. Breast cancer experts believe that many women undergoing mastectomies don’t need them and are getting them out of fear, not because of the real risks.

As an actress whose appeal has focused on her beauty, surgically removing both her breasts when she didn’t have cancer was a very gutsy thing to do. But if we care about women’s health, we need to stop thinking of mastectomy as the “brave” choice and understand that the risks and benefits of mastectomy are different for every woman with cancer or the risk of cancer. In breast cancer, any reasonable treatment choice is the brave choice.

Nobody can second-guess Angelina Jolie’s choice–it’s hers alone to make. Fortunately for her, she has access to the best reconstructive surgeons in the country, and they will keep her breasts looking as natural and beautiful as possible, an advantage that most implant patients don’t have. If she has any of the common problems with her breast implants, she can afford to get those problems surgically fixed whenever she wants to. She can also afford breast MRIs every other year ($2,000 each), which the Food and Drug Administration recommends as a way to make sure that the silicone from the implants is not leaking into the lymph nodes.

Angelina Jolie is not in any way an average woman, and what felt right for Angelina Jolie might not be right for most women who are afraid of getting breast cancer, and not even for most women with the BRCA1 or BRCA2 gene.

I thank Ms. Jolie for speaking up about her decision, and I thank the many cancer experts who are doing their best this week to explain why double mastectomies are not the best choice for most women. Let’s use this teachable moment to have a frank discussion of the treatment choices for breast cancer and to encourage women to make decisions based on their own situations, not on the choice of a celebrity, however admirable she is. For each woman, it’s important to weigh her own risk of cancer–in the next few years, and not just over her lifetime–and the risks of various treatments, and to make the decision that is best for her.

Read the original article here.

Diana Zuckerman, PhD, National Center for Health Research, Fem2.0: April 11, 2013

Cross-posted from Fem2.0 with permission.

More than 300,000 teens and women in the U.S. decide to get breast implants every year.  To hear them talk about it, you’d think they were getting therapy instead of surgery.  They almost never say “I want larger breasts” (or even “I want better boobs.”)

What they say is “I don’t like my body and I want to feel better about myself.”  And plastic surgeons will tell their patients “this will really improve your self-esteem.” But their advertisements seemed designed to make us feel insecure about our bodies, not better about ourselves.

Unfortunately, breast implants don’t deliver on that promise of feeling more self-confident. 

On the contrary, the breast implant companies’ own studies prove it.  There are 2 major breast implant companies in the U.S., Allergan and Mentor.  Both tried to prove to the FDA that breast implants helped women’s self-esteem and both failed miserably.  Allergan used 12 different quality of life measures to compare augmentation patients before surgery and 2 years later.  Nine of the 12 (75%) were worse after the women got their breast implants, including self-esteem. 

The results were similar for women getting Mentor breast implants.  The women got worse in their self-reported physical health and mental health, with most showing no difference in their self-concept or how they felt about their body.

Why do they feel worse?  For some women, it is the disappointment that even after plastic surgery they are still not beautiful enough.  And for some women, the complications from breast augmentation — numb nipples, hard or painful breasts, and for some women chronic fatigue or other problems – make them feel physically messed up and guilty because they “made a stupid decision and now I’m paying for it.”

Myth and Reality

Where does the myth of breast augmentation as therapy come from?   Wouldn’t you think that any cosmetic surgery would make women feel better about themselves?

If you ask women (or men) who had plastic surgery how it influenced them, many will say that they feel better about themselves.  But, memory can play tricks on us.  For example, some of us have mostly wonderful memories of our childhood and others have mostly sad memories, but those memories aren’t always accurate.  The best way to find out what the impact of breast augmentation – or any cosmetic surgery – is to interview the people before the surgery and again after they have completely recovered from surgery and gotten used to the “new me.”

Study after study shows that men and women who get plastic surgery usually feel better about the body part that was “fixed” but they don’t feel better about themselves and they don’t feel better about their relationships or their lives.  How we feel about ourselves is a central part of who we are.  It doesn’t change easily. For example, a “good hair day” or a great outfit can help us feel more attractive, at least for a while, and can help us have a good day, but it doesn’t make us feel more worthwhile as people or happier in our lives in general.

Psychologists explain that this is the difference between a “state of mind” (feeling good because I’m having a good hair day) and a personality trait (how I feel about myself because of my high or low self-esteem).

Plastic surgeons like to believe that they make magic by making people feel better about themselves.  And the “beauty industry” helps convince us that if we just buy the right product (whether it is a cosmetic, an outfit, or a surgery) will make all the difference.  For example, “makeovers” – whether in magazines or on TV – work by making the women feel awful about themselves at first and then “curing” their shortcomings.

Teenagers are the most vulnerable

Teenagers are especially likely to feel bad about how they look.  But every year throughout the teen years, boys and girls tend to feel better about how they look.  By the time they are 18, they feel much better than they did at 13 or 14, for instance.  If they get plastic surgery as teens, they think that’s the reason they feel better, but the truth is that even teens who don’t get plastic surgery and don’t necessarily look better than they used to, still feel more comfortable with how they look as they get a few years older.

One more thing to keep in mind: women who get plastic surgery once tend to want more plastic surgeries.  In other words, after fixing one perceived flaw, they find other flaws that bother them and that they want to fix.  That’s another sign that breast augmentation and plastic surgery are not the way to improve self-esteem.

Therapy vs. Plastic Surgery

Why are so many women so unhappy with how they look, and especially with their bodies?  The standards seem to be getting more unattainable.  Let’s face it: thin bodies with very large breasts don’t happen in nature very often.

I’ve talked to actresses about this and I call it the trickle down insecurity effect.  Beautiful women are more likely to become actresses or models than plain Janes, but as they struggle to make it in Hollywood or the beauty industry, they are told they are not quite beautiful enough.  They try extreme diets, personal trainers, professional make-up artists, the best hairdressers, and the most gorgeous outfits.  When even that isn’t enough, they get plastic surgery.  Then regular girls and women see them and feel inadequate as they think “Why can’t I look like that?”

Of course, even movie stars don’t always look as good as they do in magazines or movies.  In real life, there is no photoshopping, airbrushing, or flattering lighting to fix the imperfections.

But the bottom line is: if you want very large breasts, breast implants can help.  If you want to feel better about yourself, breast augmentation isn’t the answer.  Therapy might be.  And, it can also help to stop comparing yourself to women whose images aren’t real, but have instead been manufactured into unattainable ideals of beauty.

Diana Zuckerman, PhD, National Center for Health Research, Fem2.0: February 22, 2013

Cross-posted from Fem2.0 with permission.

Do you like your body?   If there was a simple way to change it, with no risks, would you do it?

If making that change meant you would put your health at risk and have multiple surgeries for the rest of your life, would you hesitate?

Most women say they don’t like their bodies, and research shows that dissatisfaction usually starts during the middle school years and may never go away.  For many of us, it eases up a little in young adulthood as we come to appreciate our attributes and accept any “flaws,” but insecurities rev up again as aging takes its toll.  It seems ironic that we long to regain the body that seemed so imperfect when we were younger.

In the U.S., there are thousands of products and procedures that feed on women’s insecurities.  Most are ineffective – the pills and products that promise to melt fat away without diet or exercise, or to make cellulite or wrinkles disappear.  But only a few are actually dangerous to our health.  Breast implants are one of those.

The FDA just approved a new kind of breast implant, which many plastic surgeons promise will be safer and better than other kinds of breast implants.  It is made of thick silicone gel (nicknamed “gummy bear implants” for its consistency), which is supposed to prevent it from breaking, leaking, or wrecking havoc with your body.

What’s the proof that this product is safer, or even safe at all?  Apparently, that’s a secret.

When breast implants were first sold in the U.S. in the 1960s, no testing was required to make sure they were safe.  For the next 30 years, more than a million women in the U.S. got breast implants, not realizing that studies on women had never been done to prove they were safe or to determine how many months or years they would last.

In 1990, I was working as an investigator in the U.S. House of Representatives when a Senate staffer called me.  She told me that her mom had gotten breast implants after a mastectomy, which had resulted in terrible problems including silicone leaking out of her nipples.  Her mom was cured of cancer but the implants had put her through hell.  I was sure that the FDA had very strict rules about safety testing, but I promised I’d look into it.

I found out that I was wrong: the FDA had never required clinical trials for breast implants.  We held a Congressional hearing, I continued my investigation, and soon my office – and the media – was full of horror stories about women whose health had been ruined by breast implants.

Thanks to Congressional and media pressure, the FDA changed their policies.  They eventually required breast implant companies to conduct studies on hundreds of women with breast implants, to find out how safe their products were.  Public meetings were held so that women could testify about their experiences, scientists could openly discuss the research, and the media could report what was said.  Some companies failed to do the newly required research and their implants were no longer allowed to be sold in the U.S.  And, although all breast implants were found to have high complication rates, the FDA, under tremendous pressure from implant companies and plastic surgeons, decided that women were capable of making an informed choice about the risks they were willing to take.

I have no doubt that women are capable of making an informed choice.  But the FDA is still not providing the full information that women need to make an informed choice, and neither are the plastic surgeons.

In a giant step backwards, some FDA officials are reverting to their old ways.  They approved “gummy bear” implants with no public meeting and they have not made the study findings public.  Instead, in a press release that the agency quietly released on February 20, they report that the new breast implants have the same kind of complications as other types of implants – such as hard, painful, or lopsided breasts and the need for additional surgery – but don’t say how often those complications occur.  They also reported a new complication: the silicone gel in these new implants can crack.  What happens to women when that happens?  The FDA isn’t saying.

Since I did my investigation in 1990, I have been one of the FDA’s strongest critics and biggest fans.  I have often been horrified by some of the decisions FDA makes to approve unsafe or inadequately tested medical products, but I also know that when the FDA does its job well, it can save millions of lives.

When I did the Congressional hearing on breast implants, I was 7 months pregnant.  My son is now a college senior.  In those 22 years, the FDA regained and is now again at risk of weakening its public health focus, as Congressional pressure on the FDA to protect patients has been replaced by Congressional pressure to get products to market as quickly as possible and thus “create jobs.”  Whether it is breast implants, riskier birth control pills, TB drugs that do more harm than good, or sleeping pills with questionable benefits, the FDA is allowing drugs to be sold that do a lot of harm.  And when the FDA fails to hold medical products to a high standard, it is women – the consumers of most medical products – who are harmed the most.

Read the original article here.