A recent decision by a well-known celebrity to have her ovaries removed created quite a stir. Because she carries the BRCA gene, she faced a nearly 40 percent risk of future cancer, a risk so high she felt it was dangerous not to act. Aside from the intense interest surrounding her celebrity status, what made this story so intriguing, if not controversial?
As a family physician committed to preventive medicine, I do not think taking wise actions to reduce the risk of future disease should be controversial. An increasing amount of time in medicine is devoted to this process, whether by controlling high blood pressure to reduce the risk of a heart attack, or having a colonoscopy to reduce the likelihood of colon cancer.
But the removal of body parts as disposable pieces, not because they are presently diseased but one day could be, brings the battle against the uncertainty of the future to a much higher pitch. As we consider the increasing power of biotechnology to control our health, I want to consider two questions:
- How much do we manipulate the present body to reduce future risk?
- When does a reasonable effort to reduce risk transform into a delusion that we can remove it altogether?
Reducing Risk or Removing Fear?
When there is high risk of future disease, as in the case of the BRCA gene for ovarian and breast cancer, there is a reasonable argument for prophylactic surgery, drastic as it may be. But most prophylactic mastectomies are not done on this high-risk population. It is most often done for those with usual risk who have been diagnosed with unilateral breast cancer. Though the risk of dying from breast cancer is not reduced by this procedure, fear of recurrence, the intense sense of vulnerability felt by all diagnosed with cancer, and the desire to reclaim peace of mind leads many to overstate the danger and pursue unnecessary surgeries. (See, for example, “Contralateral Prophylactic Mastectomy for Breast Cancer: Addressing Peace of Mind.”)
A young friend of mine has Lynch syndrome, another inherited genetic variant that increases the risk of several cancers over her lifetime. Highest is an 80 percent risk of colon cancer, but there is also a significantly increased risk of stomach cancer, liver cancer, endometrial cancer, and ovarian cancer. How many body parts should she remove? Some have advised her to have her colon, uterus, and ovaries removed before it’s too late, though she is only in her 20s and unmarried with no children. If our bodies are little more than two-legged bundles of potential disease, and removing risk is the goal of life, then that is exactly what she should do.
But can the known present be unfairly robbed by excessive fear of the unknown future? Perhaps the burden of a life-long colostomy from a young age and the loss of hope for giving birth to her own children are necessary; but only if we reduce the present to a colorless precaution, living in the shadow of calculated risk of a feared future. Or can current methods of surveillance for early changes allow her to keep these precious body parts, at least until their loss is less destructive of her present? Yes, it is possible, but only if she is willing to live with risk; with trust in God, this is what she has chosen, even acknowledging that a greater awareness of her body’s vulnerability has deepened her faith.
Folly and Failure of a Risk-Free Life
Our current efforts at health control have progressively distorted the power of preventive medicine even in my short life span. What began as reasonable efforts to reduce future risk has increasingly become “futures management” where we manage our “health futures” just like we attempt to manage our money to insure our fiscal future. The changing language only betrays our hopes, as we move from “reducing” blood pressure for risk reduction to “removing” body parts for risk elimination.
But pursuing a risk-free life is a fool’s errand, and, more importantly, anathema to a life of faith. In danger of biblical amnesia, we must never forget the essential connection between risk and trust. The man with the single talent lost what he had because he could not trust the Master, so he could not risk (Matt. 25:24-25). Excessive worry suffocates our ability to be fruitful, just as the seeds sown among the thorns were choked before they could thrive (Mark 4:18-19). If we wish to save our lives, to keep them safe and secure, we really have no other option but to lose them—to surrender our future into the hands of God. Indeed, we cannot look to any technology to insure our material or spiritual future, as only One truly knows it. Any other dependency is idolatry.
Without doubt, technology will advance, choices will continue to multiply, and opportunities for health control will increase. If my young friend desires pregnancy one day, she will have the power to remove the risk of transmitting this genetic variant to her children. With in-vitro fertilization (IVF) and pre-implantation genetic diagnosis (PGD), she can choose to discard the embryos that carry the gene, and only implant a “healthy” one. How strange to think that the person who can now contemplate this newfound control over the next generation would not exist if her mother had known the same power and used it.
As we contemplate the possibilities to change our present body to reduce our risk, or remove future life to remove any risk, could there be any good news about living with a body at risk? It is news of a magnitude better than we could have asked or imagined—God became like us. Jesus Christ, taking on the risk of a life of flesh and blood, shared in our humanity so that “through death he might destroy the one who has the power of death, that is, the devil, and deliver all those who through fear of death were subject to lifelong slavery” (Heb. 2:14-15). In this freedom we find our hope—that the body we have been given is not to escape, nor a hindrance to our souls, but the very means through which we will find and fulfill our God-given destiny.