Lou Gehrig, Angelina Jolie, and Cancer Genetics
Authors: Harold J. Burstein
Journal: Journal of the National Comprehensive Cancer Network (2013)

In the autumn of 1938, Lou Gehrig was (and remains to this day) the best first baseman in baseball and the most accomplished player on the champion New York Yankees, a team that had won 3 consecutive World Series.For most of his career, Gehrig had batted fourth in the lineup, behind Babe Ruth.By the late 1930s, Gehrig was no longer batting behind Ruth but behind the young Joe DiMaggio.It was a talented group.Gehrig was famous for both his skill and his durability.He set the major league record with 2130 consecutive games, and his nickname, The Iron Horse, was a testimony to his strength and resilience.But within a year of that autumn, Gehrig had retired from baseball.He had sought medical evaluation for progressive weakness and, after a workup at the Mayo Clinic, was diagnosed with amyotrophic lateral sclerosis (ALS).He went public with his illness.On July 4, 1939, in a ceremony at Yankee Stadium, he announced himself the "luckiest man on the face of the earth."Less than 2 years later, he died of ALS.So magnificent were his talents as a player and as a person, so prominent was he in the national culture, and so compelling was his battle with ALS, that the disease has been known for generations since as Lou Gehrig's disease.That eponymous tribute brought global understanding and awareness to what had been a rare, silent, and anonymous illness.Cancer genetics just had its "Lou Gehrig moment," and its name is Angelina Jolie.Like Gehrig, she has given a rare medical disorder both a face and a body.On May 14, 2013, Jolie disclosed in a New York Times op-ed contribution that she harbored a hereditary BRCA1 mutation and had undergone preventive surgery. 1 Jolie is a highly visible person in our culture: Academy Award-winning actress, film director, United Nations Goodwill Ambassador for the High Commission on Refugees, familiar paparazzi target, and often named "most beautiful woman in the world."Still, that kind of public attention and fame paled in comparison to the outpouring of interest that her disclosure generated.Measuring the extraordinary media attention is difficult.I tried by compiling search results on Google for highly respected, decades-old organizations devoted to breast cancer care and those for Jolie, 1 week after her announcement.Here are the data: NCCN and breast cancer, 250,000 results; Komen and breast cancer, 5,000,000 results; Angelina Jolie and breast cancer, 84,000,000 results and trending up.And Jolie does not even have breast cancer.She has a hereditary predisposition to cancer.Undoubtedly, her disclosure has brought more attention and recognition to hereditary cancer than anyone or anything in history.Much in Jolie's essay is valuable, and the whole is worth reading and reflecting on.Start with her title, "My Medical Choice."It emphasizes that the decisions are hers-not her friends, family, or medical team's-and that it is a choice.Many people with hereditary cancer syndromes will have choices to make-prophylaxis, prevention, surveillance.A person's preferences and choices can change over time.Making choices requires information and reflection.She framed all those ideas in her editorial; she sought to help women "make your own informed choices."She also got her facts right.Her condition is rare.Her personal risks were high.She received sophisticated medical testing and treatment.She experienced pain and discomfort and got through it.Jolie's word for her surgery-preventive-is also a good choice.The medical literature tends to term such surgery prophylactic or risk-reducing.