乳房與生命，安吉莉娜效應 From the New York Times

之前NPR提到過所謂的IKEA effect，英文最多的新字來自於XXX效應，好萊塢知名女星(兼導演)安吉莉娜裘莉Angelina Jolie，日前投書紐約時報The New York Times，揭露了自己為了預防乳癌與卵巢癌，數月前已經決定採取的預防性治療手術，也就是將雙乳的組織切除double mastectomy。名人自宮本來就會轟動全球，更何況是性感尤物決定切除性感象徵的雙乳？這個手術讓安吉莉娜一舉占據全球版面，連時代雜誌都將以她為封面，所謂的「安吉莉娜效應」這個名詞，大家可不能不知道。

名人的一舉一動都具有非常大的磁吸效應。安吉莉娜的個人經驗，除了鼓舞了許多罹乳癌的女性，也讓預防性切除治療與昂貴的血液測試篩檢曝光，成為眾人討論的熱門話題。類似的雙乳切除手術，從篩檢測試(至少十萬台幣)、手術治療、乳房重建手術，全部的療程加起來，可能得花費百萬，這樣的費用絕非一般人所能負擔(健保當然不給付)，但是透過名人拋磚引玉，或許至少會讓乳癌這個問題受到更多正面重視，也為許多罹癌女性打氣，讓她們有理由勇敢活下去，這件事情的正面效應是值得肯定的。

另外一件值得注意的事情就是，裘莉選擇投書紐約時報The New York Times絕對不是輕率做出的決定。之前我在課堂上大力推薦大家閱讀經濟學人雜誌The Economist與The New York Times正是因為這兩個平面媒體的表現有口皆碑，不但媒體專業強且具公信力，這麼嚴肅的議題，如果落入狗仔手裡，被八卦小報tabloid大書特書一番，馬上就模糊焦點了。

所以這件事情其實有很多層面，第一是訊息的正面性，名女星以身作則，要求大家正視致命性的癌症(打破名人也會罹患癌症的迷思)，再者，介紹救命的篩檢(雖貴但是提供有選擇的人一線希望，或許能讓檢驗費用日後變得更平價，因為不是每個人都需要這種篩檢)最後，對於致力於公益的名人而言，透過正派媒體揭露類似訊息，不會模糊焦點，且文章由本人親口說出，不是採訪，所以沒有二手傳播的問題，當然更無八卦空間，這當然是最高明的做法。

最後我要說的是，好文章不見得要賣弄單字用語。有時候用詞淺顯更能引發共鳴。大家看這一篇投書就會明白。我猜想這篇文章，可能由裘莉主筆，再請公關與相關人員做最後潤飾，此文言簡意賅且主題單一明確single-minded，寫起來絲絲入扣，證明裘莉不只是會演戲導戲，也具有文采與公關的能力。不過話又說回來，好萊塢有才的藝人其實非常多，這篇文章就算沒有經過高人修飾指點，我也相信要裘莉寫出這樣的文章，應不是一件難事。

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From the New York Times

My Medical Choice

By ANGELINA JOLIE

Published: May 14, 2013 

MY MOTHER fought cancer for almost a decade and died at 56. She held out long enough to meet the first of her grandchildren and to hold them in her arms. But my other children will never have the chance to know her and experience how loving and gracious親切和藹的 she was.

We often speak of “Mommy’s mommy,” and I find myself trying to explain the illness that took her away from us. They have asked if the same could happen to me. I have always told them not to worry, but the truth is I carry a “faulty” gene一個有缺陷的基因, BRCA1, which sharply increases激增 my risk of developing breast cancer乳癌 and ovarian cancer卵巢癌.

My doctors estimated估計 that I had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer, although the risk is different in the case of each woman.

Only a fraction of一少部分 breast cancers result from an inherited gene mutation遺傳性的基因突變. Those with a defect in BRCA1 have a 65 percent risk of getting it, on average.

Once I knew that this was my reality我需要面對的現實, I decided to be proactive提前採取動作 and to minimize the risk將風險減至最低 as much I could. I made a decision to have a preventive double mastectomy預防性的雙乳切除術. I started with the breasts, as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex.

On April 27, I finished the three months of medical procedures that the mastectomies involved. During that time I have been able to keep this private低調不公開 and to carry on繼續 with my work.

But I am writing about it now because I hope that other women can benefit from因為…而受益 my experience. Cancer is still a word that strikes fear into 引發恐懼people’s hearts, producing a deep sense of powerlessness深沉的無力感. But today it is possible to find out through a blood test抽血檢查 whether you are highly susceptible to容易受到…影響(這邊指的是容易罹患癌症) breast and ovarian cancer, and then take action採取行動.

My own process began on Feb. 2 with a procedure known as a “nipple delay保留乳頭但切除乳房組織的手術,” which rules out disease in the breast ducts 輸乳管behind the nipple and draws extra blood flow to the area. This causes some pain and a lot of bruising瘀青, but it increases the chance of saving the nipple.

Two weeks later I had the major surgery, where the breast tissue乳房組織 is removed and temporary fillers暫時性的填入物 are put in place. The operation can take eight hours. You wake up with drain tubes引流管 and expanders擴張器 in your breasts. It does feel like a scene out of a science-fiction film科幻影片中的一幕. But days after surgery you can be back to a normal life恢復正常生活作息.

Nine weeks later, the final surgery is completed with the reconstruction of the breasts with an implant乳房重建手術. There have been many advances進步/進展(當名詞) in this procedure in the last few years, and the results can be beautiful.

I wanted to write this to tell other women that the decision to have a mastectomy was not easy. But it is one I am very happy that I made. My chances of developing breast cancer have dropped from 87 percent to under 5 percent. I can tell my children that they don’t need to fear they will lose me to breast cancer敗給乳癌.

It is reassuring that they see nothing that makes them uncomfortable. They can see my small scars and that’s it. Everything else is just Mommy, the same as she always was. And they know that I love them and will do anything to be with them as long as I can. On a personal note我自己的感覺, I do not feel any less of a woman我不覺得自己因此不是個女人了. I feel empowered有自信與活力 that I made a strong choice that in no way diminishes my femininity一點都不會減少我的女性特質.

I am fortunate to have a partner, Brad Pitt, who is so loving and supportive. So to anyone who has a wife or girlfriend going through this, know that you are a very important part of the transition過渡時期. Brad was at the Pink Lotus Breast Center, where I was treated, for every minute of the surgeries. We managed to find moments to laugh together. We knew this was the right thing to do for our family and that it would bring us closer. And it has.

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 acknowledge that there are many wonderful holistic doctors提供傳統西式醫療與替代療法的醫師 working on alternatives to surgery. My own regimen療法/養生法 will be posted in due course在適當的時候 on the Web site of the Pink Lotus Breast Center. I hope that this will be helpful to other women.

Breast cancer alone kills some 458,000 people each year, according to the World Health Organization, mainly in low- and middle-income countries. It has got to be a priority to ensure that more women can access gene testing基因測試 and lifesaving preventive treatment救命的預防性治療, whatever their means財力 and background背景, wherever they live. The cost of testing for BRCA1 and BRCA2, at more than $3,000 in the United States, remains an obstacle困難 for many women.

I choose not to keep my story private because there are many women who do not know that they might be living under the shadow of活在…的陰影 cancer. It is my hope that they, too, will be able to get gene tested, and that if they have a high risk they, too, will know that they have strong options.

Life comes with many challenges. The ones that should not scare us are the ones we can take on面對 and take control of駕馭.

Angelina Jolie is an actress and director.