Angelina Jolie had a preventive double mastectomy after learning she carried a gene that made it likely she would get breast cancer.(Photo Evan Agostini AP)
It wasn't just that a supernova movie star had her breasts surgically removed to improve her chances of not getting breast cancer. It was how Angelina Jolie a woman who is rarely without a paparazzi scrum in pursuit was able to do it in secret and then announce it on her own terms.
This never happens. Until Tuesday.
The next shock was how the news went over with people who love her people who loathe her or people who up until yesterday didn't give a fig about her.
In an exclusive interview with USA TODAY just hours after his fiancee went public mega movie star Brad Pitt said he's quite emotional about it of course. He went on to say why her coming forward was important. It doesn't have to be a scary thing. In fact it can be an empowering thing and something that makes you stronger and us stronger.
EXCLUSIVE Brad Pitt on why Jolie went public
That strength was lauded in the world of social media a place where comments can sometimes be soul destroying. A surge of sympathy respect and well dones poured onto Twitter praising Jolie 37 for her guts grace and candor in announcing her elective surgery and why she had it in an op ed piece in the Tuesday New York Times.
She invoked her mother who died of ovarian cancer the woman who would never live to meet some of Jolie's children. We often speak of 'Mommy's mommy ' she wrote and I find myself trying to explain the illness that took her away from us.
Tweeted breast cancer survivor Sheryl Crow Ladies please check out Angelina Jolie's story today especially if you have breast cancer in your family history. I commend Angelina Jolie for her courage and thoughtfulness in sharing her story today regarding her mastectomy. So brave
The question now is how much the announcement that reverberated across the globe will impact the treatment of breast cancer in a country where 232 000 women are diagnosed with it each year and 40 000 women will die from it.
What's clear already is that people who had no clue what a double mastectomy is and never heard of the breast cancer gene mutation BRCA1 apparently multitudes suddenly know all about them and why this is a big deal.
Am I the only one who had to Google 'mastectomy' Angelina got us learning new things tweeted someone whose name was written in Arabic script.
THE REALITY BEHIND BRCA1
About one in 500 women have a mutation in genes called BRCA1 or BRCA2 which are involved in repairing genetic mistakes.
Jolie said she was tested for the mutation because her mother died at age 56 nearly a decade after being diagnosed.
Having a mutation in BRCA1 gives women a 54% chance of developing breast cancer and a 39% chance of ovarian cancer by age 70 according to the Mayo Clinic Cancer Center. Having a double mastectomy can reduce those risks by more than 90% although there is still a small risk that cancer could develop in the skin left behind or in the armpit.
Yet for the many women who may very well be inspired by Jolie's revelation and moved to act prohibitive costs can stand in the way of these types of proactive treatments.
Genetic testing can cost more than $4 000 and isn't always covered by insurance says Lisa Schlager of FORCE an advocacy group for women with the mutations. But if a positive diagnosis of the mutations is made insurance plans generally do pay for preventive mastectomies for women who have the mutations says Eric Winer a breast cancer specialist at Boston's Dana Farber Cancer Institute.
In her op ed Jolie notes that she underwent reconstruction and that the results can be beautiful. The good news for women considering a path similar to Jolie's A 1998 law requires insurance plans to pay for breast reconstruction says Scott Spear chief of plastic surgery at MedStar Georgetown University Hospital.
The klieg light attention her revelation has already received is invaluable says Hans Sauer deputy general counsel for the Biotechnology Industry Organization. There's not a person in the United States that doesn't know that there is a genetic test available and that's a good thing.
Even so not all women are ready for surgery Winer notes especially if they're young and single. Some women instead choose to have frequent screenings using mammograms and breast MRIs.
Whether the thinking about such aggressive preventive treatment as Jolie's changes the approach toward breast cancer might not be known for years but there's an unmistakable strength in what the Hollywood icon did on Tuesday.
She's sending a message to millions of women around the world It's about taking control of your life and making decisions for yourself says PR pro Howard Bragman vice chairman of Reputation.com.
All the power to her says Jaclyn Smith who talked about her Stage 1 breast cancer 10 years ago. (She had a lumpectomy and radiation and is cancer free now). People listen to her. It can spread light. It takes fear away from other people. Her breasts aren't what she's about by any means.
GETTING AHEAD OF THE TABLOIDS
Even people who are very cynical about her are probably touched and somewhat impressed by how she went about doing this says Hollywood Reporter editor Janice Min. This was a really smart and useful way to communicate her personal story in a way that would impact a lot of women.
Min suggested Jolie may have worried that the news would leak out resulting in a blaring tabloid cover about her health crisis. In fact that has happened before In 2008 actress Christina Applegate was forced into discussing on TV her breast cancer and mastectomy because someone leaked her medical records to The National Enquirer.
In the we'll pay anything media era it's amazing a return to common decency that not one aide nurse or doctor blabbed.
Otherwise it's very rare if not totally unheard of for an actress in the prime of her career to share such news with the world especially a star as guarded as Jolie. Mostly it's people on reality shows third string has beens who reveal their cancer diagnosis posing for photo shoots making the talk show rounds and writing the requisite book.
Not Jolie. She took control of her own narrative and shared in simple clear prose with no histrionics or tears.
Jolie is no stranger to bold decision making. When she was younger those choices were eyebrow raising Her marriage to actor Billy Bob Thornton that vial of blood she wore around her neck the public proclamations of sexual activity.
But in 2002 when she adopted her first son Maddox in Cambodia after spending time in the country shooting Lara Croft Tomb Raider her attention shifted dramatically. Soon she was a United Nations goodwill ambassador flying into war zones like Pakistan Darfur and Afghanistan to shine a light on refugees.
Soon she was dubbed Santa Angelina.
What's been striking about Angelina Jolie for these past seven or eight years is how she marries her public persona for what she perceives to be the public good says People managing editor Larry Hackett. She's very very shrewd by using her celebrity for the public betterment for issues she cares about.
(Indeed People has paid her millions of dollars for photos of her children over the years money she says she donated to charity through her foundation.)
Jolie has everything beauty wealth fame success. And even she is not immune to something like this Hackett says. It's very powerful stuff for people.
WHY IT'S A 'HAPPY DAY'
Because Jolie and Pitt are sparing in what they reveal about themselves anything they do say takes on more significance and importance Min says.
These two do not have publicists. They're in the business of controlling their own images she says. She's this big sex symbol with famous breasts who chose to de sexualize the whole discussion about her body and turn it into a medical thing. Hollywood is scared of aging and sickness. This speaks to the clout Angelina Jolie has.
In her essay Jolie praised Pitt for his support adding tremendously to his already considerable stock as a dreamy good guy.
The fact that he was willing to be there for every part of it in what certainly couldn't have been comfortable appointments is really great says Bea Arthur licensed therapist and founder CEO of the virtual therapy site PrettyPaddedRoom.com.
Jolie's status as a fecund sex symbol who chose the surgery so she could be around to take care of her six children also is symbolically important Arthur says.
Facing your own (mortality) especially with all these children you're responsible for ... it's an action that they did to keep their family together she says. The way that (Pitt) framed it that it's a happy day for them is because she bought them so many more years with her. Rather than thinking of it as a loss they added something to their lives.
But the Jolie Pitts are one of the most famous families on the planet. How did they keep this to themselves
Hackett said he was shocked by the news but he also noted the couple's proven ability to navigate hotels and their life in the south of France largely undercover. These are not people who go out to dinner in Hollywood he says. They don't hang out. They choose a different kind of attention.
Even while enduring a three month process for the surgery and reconstruction Jolie's grit is evident in retrospect. In March a month after beginning treatment she went on a grueling humanitarian visit to the Republic of Congo. She attended the Women in the World Summit in New York in April and then traveled to London for the G8 Summit with British foreign secretary William Hague.
This was during Stage 2 Pitt said in the interview. Literally it was just weeks after she'd had truly major surgery.
Jolie's active life then will fold into the brave narrative taking shape now in a culture if not obsessed with Hollywood certainly in tune with it.
It certainly underscores that not all breasts are created equal says Karuna Jaggar executive director of Breast Cancer Action.
It's hard to say I won't be beautiful without my breasts when you see the most beautiful women in the world in so many ways go through it herself says Bragman the PR professional. She's redefined beauty.
Contributing Donna Freydkin reported from New York Andrea Mandell reported from Los Angeles Maria Puente Cindy Clark Arienne Thompson Liz Szabo and Kim Painter reported from McLean Va. Richard Wolf reported from Washington.