Angelina Jolie's bravery has little to say to everywoman

I'm sure Angelina Jolie meant well when she wrote about her double mastectomy in The New York Times. Her doctor followed up the article with a blog which explained Jolie's treatment in more detail, including the fact that she was back at work only four days after surgery. The doctor said she was pleased to find the actor "in good spirits" and surrounded by storyboards for the movie she's about to direct, even while six drains dangled from her chest. Jolie hopes the disclosures will help other women who don't actually have a tumour but know they have a faulty gene that predisposes them to a high risk of breast or ovarian cancer.

Ever since Jolie's article appeared last Tuesday, I've been trying to work out why the publicity around it makes me uncomfortable. It isn't just that I'm wary of drawing parallels between the lives of Hollywood stars and other women, although that's part of it. Many women have to make difficult decisions about breast cancer on their own, without a supportive partner or much in the way of resources to make the treatment less wearing. That isn't Jolie's fault and I'm sure she would like to see other women get the support she's enjoyed. But her experience is always going to be very different from a single mother being treated in an overstretched NHS hospital. Jolie's optimism may be refreshing, but I suspect some women will struggle to feel quite so positive in a culture obsessed (as this story confirms) with women's breasts.

It's also important to bear in mind that Jolie's situation is very unusual. 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. I can't help suspecting that some American women with early-stage breast cancer are undergoing more radical surgery than they actually need, just as hysterectomies were overprescribed for earlier generations.

At the same time, most readers seem to have missed the confused messages sent by Jolie's decisions. She insisted that having a double mastectomy didn't make her feel any less of a woman, but we don't know how she'll feel when the initial sensation of relief has worn off. She also opted for complicated reconstructive surgery, which suggests rather more anxiety than her article acknowledges. That isn't a criticism: it's hard to know how women would feel about losing a breast in a culture where they weren't on permanent, erotically charged display. But I'm uneasy about drawing too many conclusions from the health choices of celebrities, and I doubt whether Jolie's feel-good article tells the whole story.

Joan Smith is Political Blonde

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