tag:theconversation.com,2011:/us/topics/angelina-jolie-5546/articlesAngelina Jolie – The Conversation2021-09-28T11:56:03Ztag:theconversation.com,2011:article/1680252021-09-28T11:56:03Z2021-09-28T11:56:03Z‘The Activist’ reality TV show sparked furor, but treating causes as commodities with help from celebrities happens all the time<figure><img src="https://images.theconversation.com/files/423009/original/file-20210923-13-58i90o.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5251%2C3350&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Usher, shown speaking in 2019 at an event hosted by the nonprofit he started, and two other celebrities shot five episodes of the canceled series.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/recording-artist-usher-onstage-during-usher-new-look-news-photo/1164061876?adppopup=true">Paras Griffin/Getty Images</a></span></figcaption></figure><p>CBS quickly backpedaled after an announcement about “<a href="https://web.archive.org/web/20210909212100/https://www.cbs.com/shows/the-activist/about/">The Activist</a>,” a new reality TV series it planned to broadcast, drew widespread backlash.</p>
<p>The show was going to pit teams made up of <a href="https://nonprofitaf.com/2021/09/10-shows-about-nonprofit-and-philanthropy-that-would-be-way-better-than-the-activist/">activists and celebrities against one another</a>. They would be competing to see who could raise the most awareness for a cause connected to health, education or the environment. Winning teams were to advance to the <a href="https://www.g20.org/rome-summit.html">G20 Summit in Rome</a> to get world leaders on board.</p>
<p>Critics panned the show without seeing any footage. Many said the premise embodied <a href="https://www.thedailybeast.com/what-did-we-do-to-deserve-a-celebrity-activist-competition-show">performative activism</a>, <a href="https://i-d.vice.com/en_uk/article/wx59v5/the-activist-tv-show">devalued grassroots activism</a> and was <a href="https://www.buzzfeed.com/ryanschocket2/usher-priyanka-julianne-the-activist-show-backlash">cringeworthy</a>. </p>
<p>On Sept. 15, 2021, less than a week after announcing the five-part series, the network and its two co-producers admitted that the concept was flawed. They said they had canceled it and would <a href="https://variety.com/2021/tv/news/activist-series-reconfigured-apology-cbs-global-citizen-live-nation-1235065908/">turn the show into a documentary</a>.</p>
<p>It isn’t clear yet what role the celebrity hosts – <a href="https://www.looktothestars.org/celebrity/usher">Usher</a>, who founded <a href="https://ushersnewlook.org/">a nonprofit</a> that supports under-resourced teens in 1999; <a href="https://www.looktothestars.org/celebrity/priyanka-chopra">Priyanka Chopra</a>, a <a href="https://www.unicef.org/india/our-partners/celebrities/priyanka-chopra">UNICEF ambassador</a>; and <a href="https://www.looktothestars.org/celebrity/julianne-hough">Julianne Hough</a>, who has helped <a href="https://www.looktothestars.org/news/16475-julianne-hough-empowers-women-to-get-in-the-know-about-endometriosis">raise awareness about endometriosis</a> – will play in the documentary.</p>
<p>Chopra and Hough immediately felt the need to <a href="https://www.bbc.com/news/newsbeat-58587699">apologize to their fans</a> and <a href="https://www.instagram.com/p/CT0SRywB-5-/">voice their concerns</a>. Usher has not spoken out.</p>
<p>That a major broadcaster would expect a show linking celebrities and activism to garner viewers and that the concept would implode didn’t surprise us. We <a href="https://scholar.google.com/citations?user=9Qf8BVUAAAAJ&hl=en">research</a> what happens when <a href="https://www.upress.umn.edu/book-division/books/batman-saves-the-congo">celebrities get involved in activism</a> in tandem with corporations. <a href="https://www.cbs.dk/en/research/departments-and-centres/department-of-management-society-and-communication/staff/lrimsc">Quite often we find</a> that while celebrities may be well-intentioned in their efforts, the machinery behind their activism may undermine the causes it purports to support.</p>
<h2>Enticing the public</h2>
<p>Starbucks, TOMS shoes and other companies often try to turn compassion for suffering strangers, from Congolese farmers to Peruvian kids, into a commodity. Celebrities are brought in as spokespeople to <a href="https://www.fashionroundtable.co.uk/news/2021/4/20/greenwashing-how-brands-use-influencers-and-celebrities-to-market-sustainable-initiativesnbsp">widen the appeal</a> of <a href="https://www.cipd.co.uk/knowledge/strategy/corporate-responsibility/factsheet#gref">corporate responsibility</a> efforts and sell more products. </p>
<p>To be sure, we find that some celebrities, including <a href="https://gardencollage.com/change/climate-change/celebrities-care-environment-want-know/">Meryl Streep</a> and <a href="https://borgenproject.org/tag/angelina-jolie/">Angelina Jolie</a>, are more serious about leveraging their influence burnished through their professions. However, we often see that many celebrities don’t invest enough time and energy to gain the <a href="https://www.taylorfrancis.com/chapters/edit/10.4324/9781315619835-28/world-stage-trevor-thrall-dominik-stecula">credibility and expertise</a> required to make a difference. </p>
<p>Celebrities have engaged in this high-profile advocacy for decades. Movie stars like <a href="https://doi.org/10.1080/14791420.2011.637055">Audrey Hepburn</a> were performing public roles in the mid-20th century as good Samaritans. Because of their fame, celebrities can entice regular people, along with politicians, wealthy philanthropists and corporations, to embrace a cause.</p>
<p>Fans eagerly lap up news about celebrity accomplishments as well as about their private lives and charitable inclinations. Because familiar faces can shine the spotlight on their pet causes, <a href="https://www.routledge.com/Celebrity-Advocacy-and-International-Development/Brockington/p/book/9780415707213">humanitarian agencies and nongovernmental organizations often tap celebrities</a> to draw attention to advocacy campaigns.</p>
<p>For example, the United Nations enlists hundreds of celebrities as <a href="https://www.un.org/en/messengers-peace/page/about-messengers-peace">messengers of peace, goodwill ambassadors and advocates</a> to communicate with the public. The ENOUGH Project promotes <a href="https://enoughproject.org/upstanders/celebrity/luol-deng">NBA star Luol Deng</a>, the model <a href="https://enoughproject.org/upstanders/celebrity/iman">Iman</a> and other famous people as what it calls “<a href="https://enoughproject.org/upstanders/celebrity">celebrity upstanders</a>” to raise awareness of crises in Africa and support efforts to quell conflicts there. </p>
<p>Likewise, corporations get celebrities to promote <a href="https://www.upress.umn.edu/book-division/books/brand-aid">cause-related product lines</a>, such as <a href="https://www.red.org/">(Red)</a>, a project which has worked with Elton John, Scarlett Johansson and Gisele Bündchen to raise money, initially to fight HIV/AIDS and now also to deal with COVID-19 in <a href="https://www.red.org/how-red-works">African countries</a>. </p>
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<figcaption><span class="caption">The Enough Project relies on star power from celebrities like George Clooney.</span></figcaption>
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<h2>The risks of celebrity activism</h2>
<p>Whether the goal is slowing climate change, fighting bigotry or improving access to health care, when celebrities engage in activism, excitement over the celebrities can overwhelm the activism.</p>
<p>The <a href="https://slate.com/news-and-politics/2017/10/why-couldnt-the-save-darfur-movement-stop-the-killing-in-sudan.html">Save Darfur campaign</a>, which at its height brought together more than 190 religious, political and human rights organizations, is a good example.</p>
<p>The campaign eventually collapsed. And yet the <a href="https://www.crisisgroup.org/africa/horn-africa/sudan">people of Darfur today are still in crisis</a>.</p>
<p>Despite research showing that celebrities <a href="https://www.routledge.com/Celebrity-Advocacy-and-International-Development/Brockington/p/book/9780415707213">catch but fail to hold our attention</a>, humanitarian agencies and nonprofits like UNICEF and Oxfam International compete to secure celebrity ambassadors.</p>
<p>When we interviewed aid workers in the field, we learned that visits to crisis zones and refugee camps by celebrities can be extremely disruptive to humanitarian operations. Without the stage management of celebrity ambassadors and control over their media appearances, it’s hard to avoid <a href="https://www.theguardian.com/global-development-professionals-network/2015/jun/30/secret-aid-worker-celebrities-angelina-jolie">gaffes that risk becoming debacles</a>. One example: actress <a href="https://www.theguardian.com/world/2014/feb/19/downton-abbey-elizabeth-mcgovern-celebrity-disaster-relief">Elizabeth McGovern</a> mixed up Dakar, the capital of Senegal, and Darfur when she went to Sierra Leone with World Vision as its “ambassador.”</p>
<p>Those mistakes that occur and the hassles that arise when famous people show up can <a href="http://dx.doi.org/10.1177/1367877914528532">defeat the purpose of celebrity engagement</a>. But since these celebrities often come with corporate sponsors – meaning cash – aid workers and local people put up with them.</p>
<h2>Celebrity activism as an industry</h2>
<p>As demand for star power surges, the machinery behind celebrity activism has become more corporate and professional, we explain in our new book, “<a href="https://www.upress.umn.edu/book-division/books/batman-saves-the-congo">Batman Saves the Congo</a>.”</p>
<p>Today, most major charitable organizations have <a href="https://celebrityanddevelopment.files.wordpress.com/2011/09/third-world-quaterly-2014.pdf">full-time celebrity liaisons</a> to manage dozens of celebrity supporters. There are philanthropic consultants, like the <a href="http://www.globalphilanthropy.com/">Global Philanthropy Group</a>, which help celebrity clients <a href="https://www.theguardian.com/lifeandstyle/2012/jul/29/when-celebrities-become-philanthropists">find causes to represent</a>. </p>
<p>We have tracked dozens of celebrities who have <a href="https://www.elitedaily.com/p/these-celebrity-backed-charitable-foundations-are-doing-so-much-good-22972563">their own nonprofits</a>, suggesting <a href="https://doi.org/10.1080/01436597.2017.1322465">long-term commitments</a>. But these organizations are sometimes founded on shaky premises that ignore local needs and can benefit the celebrity more than the cause.</p>
<p>Consider Ben Affleck’s <a href="https://www.easterncongo.org/">Eastern Congo Initiative</a>. We looked at how, in <a href="https://www.usaid.gov/news-information/frontlines/may-june-2016/drc-coffee-might-be-served-starbucks-near-you">partnership with Starbucks</a>, it claimed to transform the coffee sector in Congo to advance peace and development. Unfortunately, the initiative had no expertise in coffee production and little knowledge of rural development.</p>
<p>Despite professing to serve up a “<a href="https://stories.starbucks.com/emea/stories/2016/starbucks-eastern-congo-lake-kivu/">cup of hope</a>,” research later showed that this collaboration <a href="https://doi.org/10.1016/j.worlddev.2020.105193">made hardly any difference for the farmers it was supposed to help</a>.</p>
<p>Also, it was Affleck’s search for meaning in his own life, aided by <a href="https://www.williamsworks.com/our-story">highly paid consultants</a>, that led him to start this organization, not the Congolese.</p>
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<figcaption><span class="caption">Ben Affleck explains why he chose to ‘shine a spotlight’ on the crises facing the Congolese people in Africa.</span></figcaption>
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<h2>Celebrities and consumer activism</h2>
<p>Many celebrity-led organizations include corporate partnerships in the form of cause-related marketing lines. Now would-be activists are encouraged to “shop to support” Damon’s water.org by buying a <a href="https://water.org/stellaartois/">Stella Artois Limited Edition chalice</a>.</p>
<p>Or, to sustain Christy Turlington Burns’ Every Mother Counts, you can “<a href="https://everymothercounts.org/what-can-i-do/gifts/">shop gifts that make a difference</a>” and purchase <a href="https://stephaniefreidperenchio.com/orange-rose/">a Stephanie Freid-Perenchio Orange Rose Necklace</a>.</p>
<p>For celebrities to promote splurging as activism risks distorting how causes can be addressed more successfully through collective action, grassroots engagement and direct donations.</p>
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<figcaption><span class="caption">Matt Damon co-founded a group that strives to increase access to clean water.</span></figcaption>
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<h2>A boon for the rich and famous</h2>
<p>Without any accountability, <a href="https://www.routledge.com/Celebrity-Humanitarianism-and-North-South-Relations-Politics-place-and/Richey/p/book/9781138854284">we have seen these efforts generally do little</a> to help the causes or beneficiaries they are championing.</p>
<p>After studying this pattern for years, we want to know: What does celebrity activism accomplish?</p>
<p>It makes an impact, but not in the ways you might expect. We’ve observed that getting celebrities to back a cause may bring greater visibility for the celebrity and profits for corporate partners.</p>
<p>Celebrity activism can soften or rehabilitate a celebrity’s reputation, as in the case of <a href="https://www.routledge.com/Celebrity-Humanitarianism-The-Ideology-of-Global-Charity/Kapoor/p/book/9780415783392">Madonna and Jolie</a>.</p>
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<p>It can also lead to <a href="http://news.bbc.co.uk/2/hi/entertainment/4651309.stm">higher album sales</a> or more downloads. That’s what happened for many performers, including British rock band <a href="https://www.forestgoldradio.com/live8">Pink Floyd</a> and the pop singer <a href="https://www.nme.com/news/music/live-8-3-1365228">Robbie Williams</a> after the Live 8 concerts. The point of those widely televised <a href="https://web.archive.org/web/20160323203946/http://live8live.com/whathappened/">concerts, held at venues across the world in 2005</a>, was to increase <a href="https://www.oecd-ilibrary.org/sites/5e331623-en/index.html?itemId=/content/component/5e331623-en">aid to low-income countries</a>. </p>
<p>Even as a canceled TV show, “The Activist,” is destined to spotlight the unaccountable power stars possess, far more than the causes than it’s supposed to be about.</p><img src="https://counter.theconversation.com/content/168025/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alexandra Budabin receives funding from The Shana Alexander Charitable Foundation. </span></em></p><p class="fine-print"><em><span>Lisa Ann Richey receives funding from the Danish Council for Independent Research (Project 6109-00158B Commodifying Compassion).</span></em></p>The producers are recasting the show as a documentary. The original version would have done more harm than good for the causes being showcased, two scholars argue.Alexandra Cosima Budabin, Senior Researcher of Human Rights, University of DaytonLisa Ann Richey, Professor of Globalization, Copenhagen Business SchoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1222202019-08-23T12:48:42Z2019-08-23T12:48:42ZAlzheimer’s: carriers of risk gene show brain changes in their 20s – here’s why we shouldn’t worry<figure><img src="https://images.theconversation.com/files/289065/original/file-20190822-170956-1sa2xi3.jpg?ixlib=rb-1.1.0&rect=215%2C89%2C5434%2C3485&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hand-holding-paper-sheet-human-head-1221758086?src=RalI55W7sS9L68EwXctKvQ-1-5">StunningArt/Shutterstock</a></span></figcaption></figure><p>Dramatic developments in genetics research and the availability of commercial genetics tests have put us in a very modern predicament – we can now find out (quickly, easily and cheaply) whether we <a href="https://theconversation.com/sequencing-your-genome-is-becoming-an-affordable-reality-but-at-what-personal-cost-36720">personally hold genetic risk factors</a> that put us at a substantially increased risk of Alzheimer’s disease. In addition, we have <a href="https://www.sciencedirect.com/science/article/pii/S0197458018303348">recently shown</a> that brain changes can be identified in people holding these genetic risk variants as early as 20 years old.</p>
<p>Should we be testing ourselves? Should we worry? No. Here’s why:</p>
<p>Genetic research has revealed that some individuals carry variants of specific genes that confer an increased risk of developing <a href="https://youtu.be/wfLP8fFrOp0">Alzheimer’s disease</a> in later life. For example, carriers of the ε4 variant of the APOE gene are approximately <a href="https://www.ncbi.nlm.nih.gov/pubmed/8346443">three to eight times</a> more likely to be diagnosed with Alzheimer’s disease after age 60 than individuals without this variant. The more variants, the greater the risk – with a maximum of one inherited from each parent.</p>
<p>In our <a href="https://www.sciencedirect.com/science/article/pii/S0197458018303348">recent research</a>, we looked at these genetic factors in young people (around 20 years old, on average). We split them into “higher-risk” and “lower-risk” groups depending on whether they did or did not carry the APOE-ε4 gene variant, respectively.</p>
<p>Using <a href="https://www.sciencedirect.com/science/article/pii/S001094520800110X?via%3Dihub">advanced brain imaging techniques</a>, we were able to show that it is possible to detect subtle differences in particular brain networks for the “higher-risk” young adults, several decades before any clinical symptoms of Alzheimer’s emerge.</p>
<p>While <a href="https://www.sciencedirect.com/science/article/pii/S0197458018303348">brain structure</a> and <a href="https://www.nature.com/articles/srep16322">function</a> were significantly different between the risk groups on average, it is very important to point out that not all “higher-risk” individuals go on to develop Alzheimer’s disease. (Note that we say “higher” not “high” risk.)</p>
<p>The brains of many of these individuals were comparable to those at lower risk. This means carrying a higher-risk gene variant does not necessarily lead to early brain changes, or an Alzheimer’s diagnosis <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6148649/">later in life</a>.</p>
<h1>Should I get tested?</h1>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/289070/original/file-20190822-170951-k65352.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/289070/original/file-20190822-170951-k65352.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/289070/original/file-20190822-170951-k65352.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/289070/original/file-20190822-170951-k65352.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/289070/original/file-20190822-170951-k65352.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/289070/original/file-20190822-170951-k65352.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/289070/original/file-20190822-170951-k65352.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Oral swaps and saliva samples are used by Direct To Consumer commercial genetic tests.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-putting-ear-stick-into-446399410?src=9EmiICl3YxqNCikbeGBPhg-1-7">B-DSPiotrMarcinsk/Shutterstock</a></span>
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<p>Public interest in genetics and gene testing is <a href="https://www.statista.com/chart/17023/commercial-genetic-testing/">booming</a>. Recent times have also seen highly publicised incidences of people responding to their own genetic risk with drastic interventions. For instance, Angelina Jolie, who <a href="https://theconversation.com/angelina-jolie-pitts-surgery-is-just-one-option-for-women-at-risk-of-cancer-39329">has a faulty copy of the BRCA1 gene</a>, associated with breast cancer – and <a href="https://scienceblog.cancerresearchuk.org/2013/05/14/angelina-jolie-inherited-breast-cancer-and-the-brca1-gene/">had elective surgery</a> to remove both breasts and some of her reproductive organs. </p>
<p>“Direct to consumer” genetic testing kits sold by companies now provide people with convenient and affordable access to their personal genetic information, including their genetic risk for specific diseases, including Alzheimer’s.</p>
<p>But the relatively low cost of these tests reflects the fact that they typically only cover a fraction of the genome. The results, therefore, neglect the contribution of the rest of the consumer’s genetic code. This will include other genes with protective, as well as negative, effects.</p>
<p>Of other concern, these tests have been shown to frequently generate false positive results: indeed, <a href="https://www.nature.com/articles/gim201838">one study found</a> approximately 40% of variants in a variety of genes reported in raw commercial genetic test data were false positives. This could lead to unnecessary distress, treatment and lifestyle adjustments. These tests also come with <a href="https://theconversation.com/were-not-prepared-for-the-genetic-revolution-thats-coming-96574">privacy and social concerns</a>.</p>
<p>On the upside, the popularity of commercial genetic testing partly reflects consumers’ positive desire to be proactive about their health. Consumers concerned about commercial genetic test findings should, however, request confirmatory tests from their clinician. These consumers should also understand that the disease risk reports they have purchased <a href="https://theconversation.com/genetic-home-testing-why-its-not-such-a-great-guide-to-your-ancestry-or-disease-risk-79604">at best provide a partial answer</a> to the question they are trying to address, because disease risk is about much more than genetics alone.</p>
<h1>I am at ‘higher’ risk of Alzheimer’s – what now?</h1>
<p>The next step for our research is to find out what leads some people at “higher-risk” to go on to develop these early brain changes, but not others. Do these people exercise or sleep less, maintain a poorer diet, or have poorer social relationships? Many possible answers involve lifestyle factors that could potentially be altered to “buffer” individuals against their genetic risk.</p>
<p>The only way to properly understand which lifestyle factors may have such a protective effect, is to study large numbers of people with varying degrees of genetic risk over several decades.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/289068/original/file-20190822-170935-14g1d9z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/289068/original/file-20190822-170935-14g1d9z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/289068/original/file-20190822-170935-14g1d9z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/289068/original/file-20190822-170935-14g1d9z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/289068/original/file-20190822-170935-14g1d9z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/289068/original/file-20190822-170935-14g1d9z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/289068/original/file-20190822-170935-14g1d9z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Can lifestyle factors like reading, exercise and socialising protect us from our genetic risks as we age?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/old-father-reading-newspaper-his-son-407783782?src=x4nybLT4uGKUNNhWfSncQA-1-4">RomanSamborskyi/Shutterstock</a></span>
</figcaption>
</figure>
<p>We are part of an international team of scientists undertaking one such study, led by Professors <a href="https://www.cardiff.ac.uk/people/view/151224-graham-kim">Kim Graham</a> and <a href="https://www.cardiff.ac.uk/people/view/357091-lawrence-andrew">Andrew Lawrence</a> at Cardiff University. The project involves collecting advanced brain imaging and cognitive test data from a large group of approximately 240 young adults. These individuals are part of a <a href="http://www.bristol.ac.uk/alspac/participants/">cohort</a> that has been studied since birth, so we can access a wealth of retrospective health and lifestyle data.</p>
<p>Smaller, isolated studies looking at lifestyle factors might currently be missing the big picture. Brain differences have been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3583203/">found</a> in these high risk groups between people who do and don’t exercise regularly. This could suggest exercise has a <a href="https://content.iospress.com/articles/journal-of-alzheimers-disease/jad091531">protective effect</a> on the brain, and may in turn mitigate Alzheimer’s risk. It could also be that exercisers engage in other “protective” behaviours like <a href="https://www.tandfonline.com/doi/abs/10.1586/ern.11.56">eating a healthier diet</a>. It is only with large-scale cohort studies that we can begin to disentangle the genetic and lifestyle contributions to cognitive performance, the brain and Alzheimer’s risk.</p>
<p>Finally, if you are considering making lifestyle changes to offset your “genetic risk” for Alzheimer’s, taking regular exercise and maintaining a healthy lifestyle is seldom bad advice. Other drastic lifestyle changes, however, are likely unjustified.</p><img src="https://counter.theconversation.com/content/122220/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Mark Postans is currently supported by funding from the Medical Research Council (grant MR/N01233X/1; awarded to Professor Kim Graham at Cardiff University)</span></em></p><p class="fine-print"><em><span>Carl J Hodgetts receives funding from Wellcome.</span></em></p>Scientists explain why commercial gene testing should be used with caution.Mark Postans, Postdoctoral research associate, Cardiff UniversityCarl Hodgetts, Research Fellow in Cognitive Neuroscience, Cardiff UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/968082018-05-17T13:14:00Z2018-05-17T13:14:00ZSeven comics with vital things to say about humanity<figure><img src="https://images.theconversation.com/files/219410/original/file-20180517-26295-1pqzvdh.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Taken from Persepolis. </span> <span class="attribution"><span class="source">1. Marjane Satrapi</span></span></figcaption></figure><p>When the Palestinian literary critic and thinker Edward Said read the comic book <a href="http://www.fantagraphics.com/palestine/">Palestine (1997)</a> by Joe Sacco, he called it a work of “extraordinary originality” – and one of the best attempts to capture the country’s turmoil. Originally published as a serial, Palestine was one of the first examples of journalism as graphic art. Sacco uses it to present the Palestinians in a more sympathetic light, telling the story of his travels in the country and the people he met there. </p>
<p>Said, a longstanding Palestine activist who wrote the book’s introduction, compared reading it to the experiences he had as a child – when comics freed him to think and imagine and see the world differently. He <a href="http://journeyofideasacross.hkw.de/anti-narratives-and-beyond/edward-w-said.html">wrote</a>:</p>
<blockquote>
<p>Comics played havoc with the logic of a+b+c+d and they certainly encouraged one not to think in terms of what the teacher expected or what a subject like history demanded. </p>
</blockquote>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/219396/original/file-20180517-155573-5kvi6u.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/219396/original/file-20180517-155573-5kvi6u.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/219396/original/file-20180517-155573-5kvi6u.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/219396/original/file-20180517-155573-5kvi6u.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/219396/original/file-20180517-155573-5kvi6u.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/219396/original/file-20180517-155573-5kvi6u.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=498&fit=crop&dpr=1 754w, https://images.theconversation.com/files/219396/original/file-20180517-155573-5kvi6u.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=498&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/219396/original/file-20180517-155573-5kvi6u.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=498&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Scene from Sacco’s Palestine.</span>
<span class="attribution"><span class="source">Joe Sacco.</span></span>
</figcaption>
</figure>
<p>It’s a long way from comics as mere light entertainment. Comics offer endless ways to tell stories about ourselves and about one another. What follows is my list of six more groundbreaking examples. They all teach us about our world in refreshing and rewarding – not to mention very funny – ways.</p>
<h2>1. Persepolis (2000-03)</h2>
<p>This is a delightful, funny and moving tale about Iran, very much created with non-Iranians in mind. Marjane Satrapi does a brilliant job of demystifying the country by telling the story of her family and her own experiences growing up there. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/219398/original/file-20180517-26266-16e2wyl.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/219398/original/file-20180517-26266-16e2wyl.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/219398/original/file-20180517-26266-16e2wyl.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=911&fit=crop&dpr=1 600w, https://images.theconversation.com/files/219398/original/file-20180517-26266-16e2wyl.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=911&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/219398/original/file-20180517-26266-16e2wyl.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=911&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/219398/original/file-20180517-26266-16e2wyl.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1145&fit=crop&dpr=1 754w, https://images.theconversation.com/files/219398/original/file-20180517-26266-16e2wyl.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1145&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/219398/original/file-20180517-26266-16e2wyl.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1145&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
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</figure>
<p>Using stark black and white drawings that bring an unexpected amount of colour, Persepolis immerses readers in a world where girls play with their new headscarves and a young Marjane converses with God and Karl Marx. </p>
<p>The comic was adapted into a must-see <a href="https://www.imdb.com/title/tt0808417/">animated film</a> in 2007, which Satrapi co-directed with Vincent Paronnaud. Satrapi has <a href="https://www.vogue.com/article/emma-watson-interviews-marjane-satrapi">spoken about</a> how humour can connect people from diverse backgrounds – and the success of Persepolis and her <a href="https://www.goodreads.com/author/list/6238.Marjane_Satrapi">other works</a> are certainly testament to this. </p>
<h2>2. The Four Immigrants Manga (1931)</h2>
<p>Perhaps the first American full-length documentary comic, <a href="http://www.jai2.com/HK.htm">The Four Immigrants Manga</a> was originally self-published by Henry Yoshitaka Kiyama. Over 52 humorous episodes, it recounts the misadventures of four young Japanese migrants in San Francisco in the early 20th century as they try to find work, romance and new way of life. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/219402/original/file-20180517-26295-amd0lc.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/219402/original/file-20180517-26295-amd0lc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/219402/original/file-20180517-26295-amd0lc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=528&fit=crop&dpr=1 600w, https://images.theconversation.com/files/219402/original/file-20180517-26295-amd0lc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=528&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/219402/original/file-20180517-26295-amd0lc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=528&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/219402/original/file-20180517-26295-amd0lc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=663&fit=crop&dpr=1 754w, https://images.theconversation.com/files/219402/original/file-20180517-26295-amd0lc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=663&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/219402/original/file-20180517-26295-amd0lc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=663&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Arrival in San Francisco.</span>
</figcaption>
</figure>
<p>Drawn in a style reminiscent of earlier American strips such as <a href="http://www.tcj.com/chics-blondie/">Blondie</a> by Chic Young and <a href="http://comicskingdom.com/bringing-up-father">Bringing up Father</a> by George McManus, each episode ends with a “gag”. Yet the stories by Kiyama – himself an original Japanese immigrant – also offer invaluable insights into the difficult living conditions and struggles against discriminatory policies and legislation that <a href="http://immigrationtounitedstates.org/642-issei.html">the Issei</a> faced after they arrived in the United States. </p>
<h2>3. The Photographer (2003-06)</h2>
<p>The Photographer: Into War-Torn Afghanistan with Doctors Without Borders tells of the impact of war on civilian populations. Angelina Jolie <a href="http://firstsecondbooks.typepad.com/mainblog/2009/06/angelina-jolie-on-the-photographer.html">lauded it</a> for making “Afghanistan, a distant land, a foreign culture, a courageous and resilient people seem closer, more familiar”. </p>
<p>The story is told from the perspective of Didier Lefèvre, a photojournalist invited to accompany Médecins Sans Frontières on a mission into northern Afghanistan in 1986, during the <a href="https://www.theatlantic.com/photo/2014/08/the-soviet-war-in-afghanistan-1979-1989/100786/">Afghan-Soviet War</a>, to document the devastation of war and the attempts of ordinary Afghans to live their lives. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/219411/original/file-20180517-26263-14wwg9g.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/219411/original/file-20180517-26263-14wwg9g.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/219411/original/file-20180517-26263-14wwg9g.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/219411/original/file-20180517-26263-14wwg9g.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/219411/original/file-20180517-26263-14wwg9g.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/219411/original/file-20180517-26263-14wwg9g.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/219411/original/file-20180517-26263-14wwg9g.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/219411/original/file-20180517-26263-14wwg9g.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Emmanuel Guibert/Didier Lefèvre/Frederic Lemercier</span></span>
</figcaption>
</figure>
<p>The Photographer combines Lefèvre’s photographic contact sheets with drawn strips by Emmanuel Guibert to produce a work that is poignant and often mesmerising. </p>
<h2>4. Billy, Me & You (2011)</h2>
<p>Nicola Streeten’s <a href="https://www.theguardian.com/lifeandstyle/2011/oct/15/nicola-streeten-graphic-book-death-child">graphic memoir</a> tells of the devastating loss of her two-year old son, Billy, after he underwent heart surgery. Drawn on lined paper and built from the diary she kept at the time, Billy, Me & You explores in harrowing detail Streeten’s anger, rage and despair. </p>
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<a href="https://images.theconversation.com/files/219412/original/file-20180517-26281-1s283i7.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/219412/original/file-20180517-26281-1s283i7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/219412/original/file-20180517-26281-1s283i7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=432&fit=crop&dpr=1 600w, https://images.theconversation.com/files/219412/original/file-20180517-26281-1s283i7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=432&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/219412/original/file-20180517-26281-1s283i7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=432&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/219412/original/file-20180517-26281-1s283i7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=543&fit=crop&dpr=1 754w, https://images.theconversation.com/files/219412/original/file-20180517-26281-1s283i7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=543&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/219412/original/file-20180517-26281-1s283i7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=543&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Nicola Streeten</span></span>
</figcaption>
</figure>
<p>In one particularly memorable sequence, the British artist silently awards people marks out of ten for the reaction to Billy’s death. Sadness and bereavement mingle with the absurd and humorous, revealing how loss and recovery can shape a mother’s life. </p>
<h2>5. Big Kids (2016)</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/219414/original/file-20180517-26277-ak92i6.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/219414/original/file-20180517-26277-ak92i6.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/219414/original/file-20180517-26277-ak92i6.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=814&fit=crop&dpr=1 600w, https://images.theconversation.com/files/219414/original/file-20180517-26277-ak92i6.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=814&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/219414/original/file-20180517-26277-ak92i6.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=814&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/219414/original/file-20180517-26277-ak92i6.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1023&fit=crop&dpr=1 754w, https://images.theconversation.com/files/219414/original/file-20180517-26277-ak92i6.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1023&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/219414/original/file-20180517-26277-ak92i6.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1023&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Michael DeForge</span></span>
</figcaption>
</figure>
<p>Coloured in a bright pop style, <a href="https://www.goodreads.com/book/show/25666072-big-kids">Michael DeForge’s story</a> about adolescence is at once familiar and strange. It tells of a teenage boy exploring his sexuality while his body changes, but intermingled with moments when his family and friends transition into twigs. Yes, twigs. </p>
<p>DeForge’s abstract style does a great job of mimicking the feelings of discomfort and alienation and that come with growing up. </p>
<h2>6. American Born Chinese (2006)</h2>
<p>Gene Luen Yang’s comic is <a href="http://cbldf.org/2013/07/using-graphic-novels-in-education-american-born-chinese/">now taught</a> in American high schools, and with good reason. This cleverly constructed work weaves together three distinct narratives about (not) fitting in, which unite at the end of the story. </p>
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<a href="https://images.theconversation.com/files/219415/original/file-20180517-26263-1hvt7xd.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/219415/original/file-20180517-26263-1hvt7xd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/219415/original/file-20180517-26263-1hvt7xd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=343&fit=crop&dpr=1 600w, https://images.theconversation.com/files/219415/original/file-20180517-26263-1hvt7xd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=343&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/219415/original/file-20180517-26263-1hvt7xd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=343&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/219415/original/file-20180517-26263-1hvt7xd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=431&fit=crop&dpr=1 754w, https://images.theconversation.com/files/219415/original/file-20180517-26263-1hvt7xd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=431&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/219415/original/file-20180517-26263-1hvt7xd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=431&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption"></span>
<span class="attribution"><span class="source">Gene Luen Yang</span></span>
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</figure>
<p>It focuses on Chin-Kee, a Chinese boy who comes to America to visit his cousin Danny. Drawing on the Chinese legend of the <a href="http://www.visiontimes.com/2016/11/02/famous-chinese-legends-the-story-of-the-monkey-king.html">Monkey King</a>, as well as cultural stereotypes, it raises penetrating questions about what it means to accept one’s identity and background. It <a href="http://cbldf.org/2013/07/using-graphic-novels-in-education-american-born-chinese/">won</a> the Michael L Printz Award for young adult literature in 2007.</p>
<hr>
<p><strong>Find out how comics are produced:</strong></p>
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<p class="fine-print"><em><span>Golnar Nabizadeh does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Why this art form is rather more than just biff, bang pow.Golnar Nabizadeh, Lecturer in Comic Studies, University of DundeeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/877542017-11-23T00:50:10Z2017-11-23T00:50:10ZWhy we need to end impunity for sexual violence in armed conflict<figure><img src="https://images.theconversation.com/files/195985/original/file-20171123-6072-13ujhn6.jpg?ixlib=rb-1.1.0&rect=29%2C17%2C4000%2C1844&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sexual violence survivors need more than recognition of what they have suffered.
</span> <span class="attribution"><span class="source">Viktor Petrovich/shutterstock </span></span></figcaption></figure><p>We now have a unique moment to ensure perpetrators of sexual violence in armed conflict do not go unpunished. </p>
<p>In a <a href="http://www.huffingtonpost.ca/2017/11/15/angelina-jolie-full-keynote-address-un_a_23278905/">recent keynote address</a> to the UN Peacekeeping defence ministers’ summit in Vancouver, actor and global campaigner Angelina Jolie said it was a myth that sexual violence was not a “serious” enough crime to warrant prosecution and imprisonment.</p>
<p>She also said it was wrong to think nothing could be done to stop sexual violence in armed conflict, as many countries already have the “laws, the institutions, and the expertise in gathering evidence. What is missing is the political will.”</p>
<p>The <a href="https://www.aph.gov.au/Parliamentary_Business/Hansard/Hansard_Display?bid=chamber%2Fhansards%2Fc88411d8-89e6-4641-9141-3b3f92feb4e6%2F&sid=0120#.WhN0kZ65LFI.facebook">Australian Senate passed a landmark motion</a> last week, recognising the sexual violence Islamic State perpetrated in Syria and Iraq as war crimes, crimes against humanity and genocide. It has now called for thegGovernment to “investigate Australians who have allegedly perpetrated war crimes, crimes against humanity and genocide, including through the use of sexual violence, and prosecute them as appropriate”.</p>
<h2>Survivors need more than recognition of their suffering</h2>
<p>Human rights activist Nadia Murad recently published a book documenting her story of captivity and her fight <a href="https://www.hachette.com.au/nadia-murad-jenna-krajeski/the-last-girl">against Islamic State</a>. </p>
<p>In 2014, Murad was kidnapped from her village of Kocho in northern Iraq. Islamic State sold her into sexual slavery in Mosul, where she was beaten, tortured and gang raped before escaping her captors. She now lives in Germany and advocates for justice for women and girls like her who were subjected to gross sexual violence as part of Islamic State’s <a href="https://www.theguardian.com/world/2014/aug/07/who-yazidi-isis-iraq-religion-ethnicity-mountains">genocide of the Yazidis</a>. Last year, she was nominated for the Nobel Peace Prize. </p>
<p>Despite her heartfelt speeches to the UN calling for the investigation and prosecution of Islamic State fighters, not a single perpetrator has been prosecuted.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/LehFq_3Uigk?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Nadia Murad sharing her story at the UN.</span></figcaption>
</figure>
<p>Several UN agencies <a href="http://www.ohchr.org/Documents/HRBodies/HRCouncil/CoISyria/A_HRC_32_CRP.2_en.pdf">acknowledge</a> what happened to the Yazidis as genocide. The US State Department and <a href="https://www.congress.gov/bill/114th-congress/house-concurrent-resolution/75">US Congress</a>, <a href="http://www.europarl.europa.eu/sides/getDoc.do?type=TA&reference=P8-TA-2016-0051&language=EN&ring=P8-RC-2016-0149">European parliament</a>, <a href="https://hansard.parliament.uk/commons/2016-04-20/debates/16042036000001/DaeshGenocideOfMinorities">UK House of Commons</a>, French and <a href="http://www.parliament.scot/parliamentarybusiness/28877.aspx?SearchType=Advance&ReferenceNumbers=S5M-04130">Scottish parliaments</a>, and <a href="http://www.ourcommons.ca/Content/House/421/Debates/074/HAN074-E.PDF#page=38">Canada’s House of Commons</a> have also recognised the genocide. </p>
<p>But survivors want more than recognition of what they have suffered. They want justice. </p>
<h2>Foreign fighters returning home</h2>
<p>Of the estimated 30,000 people who travelled from 89 countries to fight with Islamic State <a href="https://www.rferl.org/a/foreign-fighters-syria-iraq-is-isis-isil-infographic/26584940.html">in Syria and Iraq</a>, thousands came from countries like Australia, France and the UK. </p>
<p>As Jolie said in her address, suitable legal and justice institutions exist in these countries and sexual violence is criminalised. When sexual violence is perpetrated as part of an armed conflict, it is a war crime. When that violence is widespread or systematic, it’s a crime against humanity. And when it’s used to destroy in whole or in part, an ethnic, racial or religious group, it is genocide.</p>
<p>As the power of Islamic State declines in the region, many foreign fighters are <a href="https://www.forbes.com/sites/niallmccarthy/2017/10/25/scores-of-isis-foreign-fighters-have-returned-home-infographic/#5698e74d5e8e">returning home</a>. Others, like Australia’s Neil Prakash, are <a href="https://www.lowyinstitute.org/the-interpreter/neil-prakash-more-just-terrorist">facing extradition</a>. It is estimated that about 200 Australians travelled to Syria and Iraq to fight. Of the 2,000 French foreign fighters, an estimated 270 have returned home. 850 people joined Islamic State from the United Kingdom, almost half of whom have returned home. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/195446/original/file-20171120-18561-wjeita.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/195446/original/file-20171120-18561-wjeita.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=428&fit=crop&dpr=1 600w, https://images.theconversation.com/files/195446/original/file-20171120-18561-wjeita.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=428&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/195446/original/file-20171120-18561-wjeita.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=428&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/195446/original/file-20171120-18561-wjeita.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=537&fit=crop&dpr=1 754w, https://images.theconversation.com/files/195446/original/file-20171120-18561-wjeita.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=537&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/195446/original/file-20171120-18561-wjeita.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=537&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Returned foreign fighters bar graph.</span>
<span class="attribution"><span class="source">The Soufan Centre</span></span>
</figcaption>
</figure>
<h2>What needs to happen</h2>
<p>The recent motion passed in the Australian Senate builds on one <a href="https://prosecutedontperpetrate.com/2017/09/08/parliamentary-motion-on-crimes-perpetrated-by-terrorist-groups/">passed in the House of Representatives</a> that also called for the investigation and prosecution of sexual violence in war. It is hoped that by the end of the year, the lower house will also pass a motion specifically on the Yazidi genocide. </p>
<p>In Australia, sexual violence in conflict is criminalised under Division 268 of the <a href="http://www8.austlii.edu.au/cgi-bin/viewdoc/au/legis/cth/consol_act/cca1995115/sch1.html">Criminal Code Act</a>. The crimes perpetrated by Islamic State may also come under our slavery and human trafficking legislation, which fall under Divisions 270 and 271 of the Criminal Code.</p>
<p>Once parliament has agreed the government needs to investigate and prosecute these crimes, resources need to be allocated so investigative organisations like the Australian Federal Police can work with their counterparts to can gather sufficient evidence that the <a href="https://www.cdpp.gov.au/">Commonwealth Directorate of Public Prosecutions</a> can make a case, and perpetrators can be convicted and sentenced. </p>
<p>If countries like Australia prosecuted their own nationals for sexual violence they perpetrated while fighting with Islamic State in Syria and Iraq, it would go some way to achieving justice for the victims and ending impunity for sexual and gender based violence in conflict. With Australia’s example, we can advocate for other like-minded countries to do the same.</p>
<hr>
<p><em>Tonight, the <a href="http://genderinstitute.anu.edu.au/prosecute-dont-perpetrate">Gender Institute</a> and <a href="https://law.anu.edu.au/research/cmsl">Centre for Military and Security Law</a> at the Australian National University will host a <a href="http://genderinstitute.anu.edu.au/prosecute-dont-perpetrate">public event</a> bringing together social justice campaigners with political and legal experts and representatives of survivors of the genocide to discuss how to address the barriers to justice for these crimes.</em></p><img src="https://counter.theconversation.com/content/87754/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Hutchinson is the architect of the 'prosecute; don't perpetrate' campaign that calls on governments to investigate and prosecute sexual violence perpetrated as war crimes, crimes against humanity and genocide in Syria and Iraq. She is also on the Steering Committee of the Australian Civil Society Coalition for Women, Peace and Security.</span></em></p>As foreign Islamic State fighters return home, there needs to be proper prosecution of sexual violence in armed conflict.Susan Hutchinson, PhD Candidate, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/840772017-09-14T12:33:10Z2017-09-14T12:33:10ZAngelina Jolie’s new Cambodia movie is powerful but Hollywood can never escape itself entirely<figure><img src="https://images.theconversation.com/files/186021/original/file-20170914-21553-12wt9yc.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sareum Srey Moch plays Loung Ung in this story of the Khmer Rouge genocide.</span> <span class="attribution"><a class="source" href="https://media.netflix.com/en/only-on-netflix/41216">Netflix</a></span></figcaption></figure><p>Of the various kinds of films to address genocide, the biopic is probably the most familiar. We’ve all seen them: “based on a true story”, popular but prestigious, making a vast atrocity comprehensible through the eyes of an individual. <a href="http://www.imdb.com/title/tt0087553/">The Killing Fields (1984)</a>, <a href="http://www.imdb.com/title/tt0108052/">Schindler’s List (1994)</a> and <a href="http://www.imdb.com/title/tt0395169/">Hotel Rwanda (2004)</a> are all classic examples, though there are much earlier ones – <a href="http://www.imdb.com/title/tt0009892/">Ravished Armenia</a> introduced Western audiences to the Armenian genocide as long ago as 1919, for instance. </p>
<p>Angelina Jolie’s new film, <a href="https://www.netflix.com/gb/title/80067522">First They Killed My Father: A Daughter of Cambodia Remembers</a>, fits into this subgenre in many ways. On general international release on Friday September 14, simultaneously in cinemas and Netflix, it is an adaptation of <a href="https://www.goodreads.com/book/show/4373.First_They_Killed_My_Father">Loung Ung’s memoir</a> of the same name from 2000. The book was an unsettlingly beautiful yet harrowing chronicle of a young girl’s experience under the Khmer Rouge’s reign of terror from 1975-79. </p>
<p>Like many other historical dramas, “based on a true story” is not the only way in which Jolie secures the film’s authenticity. Ung contributed to the promotion of the film, and even appeared in it at the end – recalling Schindler’s List’s pairing of actual survivors with their actor counterparts. </p>
<p>The promotional materials make clear that the film was shot on location in Cambodia, and that producer, <a href="http://www.imdb.com/name/nm0659454/bio?ref_=nm_ov_bio_sm">Rithy Panh</a>, is a survivor of the genocide himself. He has made several ground-breaking documentaries about the atrocities, plus his own cinematic memoir, <a href="http://souciant.com/2014/01/remembering-genocide/">The Missing Picture (2013)</a>. And finally, Jolie is not entirely an outsider – she was spurred to her <a href="https://www.looktothestars.org/celebrity/angelina-jolie">humanitarian work</a> after filming <a href="http://www.imdb.com/title/tt0146316/">Tomb Raider (2001)</a> in Cambodia, and also has a son from the country (who has a credit as a producer on the new movie). </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/186024/original/file-20170914-9038-z1n052.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/186024/original/file-20170914-9038-z1n052.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/186024/original/file-20170914-9038-z1n052.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/186024/original/file-20170914-9038-z1n052.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/186024/original/file-20170914-9038-z1n052.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/186024/original/file-20170914-9038-z1n052.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/186024/original/file-20170914-9038-z1n052.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/186024/original/file-20170914-9038-z1n052.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Chaos reigns.</span>
<span class="attribution"><a class="source" href="https://media.netflix.com/en/only-on-netflix/41216">Netflix</a></span>
</figcaption>
</figure>
<p>Creating this sense of legitimacy around First They Killed My Father is particularly necessary in the case of Cambodia. The Killing Fields may have helped to bring the devastation to public prominence in the 1980s, but this is still a genocide characterised by neglect, indifference and silence – from the failure of the international community to intervene while it was happening to the fact that many perpetrators retained high office in the years after without facing trial. </p>
<p>The US did not acknowledge the events as genocide <a href="http://www.nytimes.com/1989/09/27/opinion/don-t-help-pol-pot-try-him.html?mcubz=0">until 1989</a>. <a href="http://www.nytimes.com/1998/04/17/world/death-pol-pot-pol-pot-brutal-dictator-who-forced-cambodians-killing-fields-dies.html?mcubz=0">Pol Pot died</a> shortly after the then American president Bill Clinton <a href="http://edition.cnn.com/WORLD/asiapcf/9804/09/cambodia.clinton.polpot/">ordered</a> his arrest for an international trial in 1998, while <a href="http://thediplomat.com/2017/07/cambodias-khmer-rouge-tribunal-mission-accomplished/">the process</a> to try the remaining Khmer Rouge leaders took nearly 20 more years to come to fruition. </p>
<h2>Risks and rewards</h2>
<p>First They Killed My Father’s bold departures from other standards in this subgenre are both risky and rewarding. Rather than having characters speak an accented English, almost the entire movie is in Khmer. Jolie is clearly willing to risk alienating viewers put off by subtitles to allow others the opportunity to totally immerse themselves. </p>
<p>In fact, one wonders if the subtitles are even needed for a film whose visual storytelling is so sensuous and moving. There is no Western audience surrogate; no heroic white protagonist like <a href="http://www.bbc.co.uk/news/world-asia-36754206">Sydney Schanberg</a> or <a href="https://www.ushmm.org/wlc/en/article.php?ModuleId=10005787">Oskar Schindler</a> to help outsiders understand or narcissistically identify with what took place. </p>
<p>The choice to focus on Ung, the daughter of a high-ranking military police officer under the pre-1975 regime, does not grant the expository clarity of these other films. The camera, which is often low to the ground, moves as if emulating the distractions and curiosity of a child. </p>
<p>She draws on government documents bearing the name <a href="https://www.britannica.com/biography/Lon-Nol">Lon Nol</a>, the president who was deposed by the Khmer Rouge, while her father and his colleague carry on a hushed conversation in the background. An incoming tank may grab her attention, but so too does her sister’s fruit-stained blouse or her brother’s guitar. Affectionate details like these personalise the loss of what is to come. </p>
<h2>The problem with accuracy</h2>
<p>The film’s fragmented style works to communicate a child’s traumatic experience, with its confusion and gaps in recollections. Yet this more creative approach may leave Jolie open to criticism about historical accuracy. Ung’s own memoir has <a href="https://www.jstor.org/stable/42001241">been criticised</a> for the historical and cultural inaccuracies you might expect from a child’s memory, particularly one shot by trauma and two displacements – once when the Khmer Rouge took over and again when Ung managed to escape the country in 1979. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/186025/original/file-20170914-8980-1uc3vov.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/186025/original/file-20170914-8980-1uc3vov.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/186025/original/file-20170914-8980-1uc3vov.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=395&fit=crop&dpr=1 600w, https://images.theconversation.com/files/186025/original/file-20170914-8980-1uc3vov.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=395&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/186025/original/file-20170914-8980-1uc3vov.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=395&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/186025/original/file-20170914-8980-1uc3vov.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=496&fit=crop&dpr=1 754w, https://images.theconversation.com/files/186025/original/file-20170914-8980-1uc3vov.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=496&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/186025/original/file-20170914-8980-1uc3vov.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=496&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Cambodia burns.</span>
<span class="attribution"><a class="source" href="https://media.netflix.com/en/only-on-netflix/41216">Netflix</a></span>
</figcaption>
</figure>
<p>This does not invalidate what Loung Ung has shared, but it does open up important questions when it comes to testimonies. If the individual does speak for a collective, which collective – and to whom?</p>
<p>These questions apply to the film as well. First They Killed My Father <a href="http://www.phnompenhpost.com/lifestyle/jolie-unveils-new-film-first-they-killed-my-father-siem-reap">premiered</a> in Cambodia in February to an audience reportedly in the region of 1,000, including Jolie and her six children. Yet news about the film has <a href="http://www.hollywoodreporter.com/race/telluride-angelina-jolies-first-they-killed-my-father-takes-fest-by-storm-1034852">been dominated</a> by the recent screening at the Telluride Film Festival in California. We’ve heard little about how it was received in Cambodia or plans for further showings in a country with few cinemas. </p>
<p>And with the global release on Netflix, it raises even more interesting questions for a film about an international crime: who is this testimony aimed at, who is listening and who is supposed to respond? </p>
<p>Perhaps a film like this takes many Western audiences as far as they are willing to go with a harrowing topic about a very foreign country. Perhaps Jolie has done a commendable job of producing a piece of work that is authentic and respectful to Cambodia. Yet movies like this can never quite escape that uneasy sense of cultural annexation that accompanies them. It is not to say they have no value, but at the very least viewers should feel a duty to explore the subject further afterwards themselves.</p><img src="https://counter.theconversation.com/content/84077/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Leshu Torchin does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>First They Killed My Father works hard to achieve authenticity in a genre that is as old as cinema itself.Leshu Torchin, Senior Lecturer in Film Studies, University of St AndrewsLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/402462015-06-30T20:10:43Z2015-06-30T20:10:43ZBrace yourself, genetic testing might give you more than you bargained for<p>Drink red wine to prevent cancer. But don’t drink too much! Get some exercise. But don’t overdo it. Give up, it’s all genetic anyway – think of Angelina Jolie! </p>
<p>We are constantly bombarded with conflicting information about our risk of developing cancer. It is difficult to know who to believe, let alone how to respond. </p>
<p>What if you could take a simple test that would reveal your individual risk of developing not only a range of cancers, but hundreds of other diseases? Imagine if it could also tell you which drugs would be most effective for you, if you did develop cancer or other diseases. </p>
<p>The rapidly reducing cost of DNA sequencing has made this one-time fantastical idea an emerging reality. Only 10 years ago it <a href="https://www.nhmrc.gov.au/health-topics/genetics-and-human-health/genetics-101-overview/sequencing-your-genome">cost about US$10 million</a> to sequence a human genome, so there was little prospect that individuals would, or could, seek out their own unique genetic maps to find out more about their ancestry or their inherited health risks. </p>
<p>Recent advances in genetics mean genetic sequencing is <a href="https://www.scienceexchange.com/services/whole-genome-seq">more affordable</a> (US$1,000 to US$3,000) and already guiding treatment across a range of illnesses from cancer to degenerative brain diseases. </p>
<p>New unregulated direct-to-consumer businesses are emerging, making it possible for anyone to order their individual genetic profile by posting off a saliva sample taken at home. But do you really know what you are signing up for?</p>
<h2>The age of personalised medicine</h2>
<p>Personalised medicine means using a patient’s genome to both predict their likelihood of developing certain diseases, and to guide which treatments are most likely to be effective in a particular individual. It’s also called customised medicine, precision medicine, individualised medicine, bespoke medicine and targeted medicine. </p>
<p>Our genes hold our hereditary information. Every cell in the human body is made up of about 20,000 genes that are passed down from parents to child. Genes contain information that instructs the growth, development and function of the human body. Some genes control simple characteristics such as hair colour and height, others influence complex characteristics such as intelligence. Some genes control how other genes work, telling them when to switch on and off. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/84995/original/image-20150615-6496-1eh4xg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/84995/original/image-20150615-6496-1eh4xg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/84995/original/image-20150615-6496-1eh4xg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/84995/original/image-20150615-6496-1eh4xg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/84995/original/image-20150615-6496-1eh4xg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/84995/original/image-20150615-6496-1eh4xg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/84995/original/image-20150615-6496-1eh4xg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some genes control simple characteristics such as hair colour and height, others influence more complex characteristics like intelligence.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>We all have alterations, or mutations, in our DNA. Mutations can be passed down from parents to children, or can occur spontaneously, especially as we age. Some are harmless and may determine, for example, <a href="http://udel.edu/%7Emcdonald/mythearwax.html">whether our ear wax</a> is wet or dry.</p>
<p>However, a mutation in an important gene that prevents it from working properly, or a gene that is missing altogether, can have serious consequences. Early genetic testing focused on debilitating inherited diseases, such as cystic fibrosis and Huntington’s disease, that are caused by mutations in single genes. Tests looked only for a known mutation in a specific gene to confirm or rule out the associated condition. </p>
<p>As testing has become more sophisticated, we have been able to extend this approach to more complex conditions such as cancer. Mutations in two genes called BRCA1 and BRCA2 are associated with an increased risk of developing breast and ovarian cancer, and can be inherited within families. </p>
<p>BRCA1 and BRCA2 normally help clean up mistakes in our DNA that our cells can make when they divide, a process called DNA repair. When either of these genes is altered or mutated, this protective function is disabled, leading to uncontrolled replication of cells with mistakes. This can lead to cancer. </p>
<p>The good news is that we can test for these mutations, and patients can then use the results of this test to assess their risk of developing cancer, and make informed choices. This is the same hereditary genetic mutation that prompted Angelina Jolie to have a preventative <a href="http://www.nytimes.com/2013/05/14/opinion/my-medical-choice.html?_r=0">double mastectomy</a> two years ago, and preventative <a href="http://www.nytimes.com/2015/03/24/opinion/angelina-jolie-pitt-diary-of-a-surgery.html?referrer=&_r=3">surgery to remove her ovaries</a> this year.</p>
<p>The other good news is that in recent years scientists have discovered that patients with mutations in BRCA1 and BRCA2 are exquisitely sensitive to some forms of chemotherapy and a second type of drug called a PARP inhibitor. The same mutation that generates the mistakes in these cells can actually <a href="http://www.onclive.com/conference-coverage/mbcc-2015/Excitement-Building-for-PARP-Inhibitors-in-BRCA-Mutated-Breast-Cancer">make them more responsive</a> to this drug. Decisions about treatment can then be “personalised” to the individual.</p>
<h2>What does the future hold?</h2>
<p>Currently, health systems in Australia and overseas do not offer patients the option of sequencing their entire genome as a means of identifying and managing future health risks. Today genetic testing is only available in Australia for specific genes, is tightly regulated and is used only when symptoms are apparent, or a genetic risk is likely, such as a close relative developing a particular cancer or condition.</p>
<p>In five to 10 years’ time, however, we may be facing very different choices, including the option to look for future diseases before they actually occur. </p>
<p>As many cancers do not appear until middle age or later, a young healthy person might discover they have various elevated risks among the many anomalies a DNA test could throw up. Such results might not be provided by a medical professional, but by a commercial operator, and without genetic counselling to explain what they mean to the individual and their family.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/84996/original/image-20150615-6479-enisbm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/84996/original/image-20150615-6479-enisbm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=705&fit=crop&dpr=1 600w, https://images.theconversation.com/files/84996/original/image-20150615-6479-enisbm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=705&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/84996/original/image-20150615-6479-enisbm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=705&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/84996/original/image-20150615-6479-enisbm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=886&fit=crop&dpr=1 754w, https://images.theconversation.com/files/84996/original/image-20150615-6479-enisbm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=886&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/84996/original/image-20150615-6479-enisbm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=886&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Insurance companies could use genetic profiles to deny higher-risk individuals various types of insurance, or increase their premiums.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>What might the implication be of a high-risk result? Should an individual’s relatives be informed, as their risk may also be high, or do they have a right not to know? And what about minors: will parents have the right, or even an obligation, to test babies and children for potential genetic risks, even if medical science offers no prevention or treatment options? </p>
<p>Are we psychologically equipped for these kinds of dilemmas and scientifically literate enough to interpret our own results? </p>
<p>There are currently many reasons to be cautious. First, there are potentially millions of genetic alterations. Most are still not understood. Personalised medicine cannot currently give anyone a comprehensive picture of individual risk simply because far too much remains unknown.</p>
<p>Second, personalised medicine can only indicate elevated risks, it cannot determine whether or not a patient will actually go on to develop a certain type of cancer. Environment and lifestyle also play a big role in our health. </p>
<p>Insurance companies, however, deal entirely in risk. That means genetic profiles could be used to deny higher-risk individuals various types of insurance, or increase their insurance premiums.</p>
<p>Third, health outcomes for some individuals may be based on the financial viability of developing drugs. Many drugs and therapies are currently used for large numbers of patients, making them financially viable for pharmaceutical companies to develop. Genetically targeted cancer drugs, suitable for much smaller groups of patients, may be extremely expensive or might not be brought onto the market at all if society is not willing or cannot afford to pay for them. </p>
<p>Fourth, we may be at risk of eroding our quality of life by creating a new state of “worried wellness”, waiting for disease to strike.</p>
<p>Finally, we may not be sufficiently savvy consumers. New commercial operators are coming onto the global market offering a range of largely unregulated services. Currently, you don’t get much more than details of your ancestry for a US$99 DNA test. But more specialised businesses are emerging that <a href="https://lifeletters.com/">offer</a>, for example, to “identify potential health risks that are present now or may develop in the future”. </p>
<p>Is this just hype, and offering unsubstantiated hope to consumers, or does this represent the first stage of patient empowerment over their own health and lifestyle choices? It will be fascinating to watch this new age of personalised medicine develop in the coming years.</p><img src="https://counter.theconversation.com/content/40246/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>What if you could take a simple test to reveal your individual risk of developing a range of cancers and hundreds of other diseases?Caroline Ford, Lab Head, Metastasis Research Group, Lowy Cancer Rearch Centre, UNSW SydneyOrin Chisholm, Program Authority and Senior Lecturer, Pharmaceutical Medicine, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/393222015-03-26T11:08:39Z2015-03-26T11:08:39ZAngelina Jolie’s surgery got you worried? Here’s what you should know about ovarian cancer risk<p>Following <a href="http://www.nytimes.com/2013/05/14/opinion/my-medical-choice.html">her 2013 announcement</a> in the op-ed pages of The New York Times that she was having a double mastectomy, US actress <a href="http://www.nytimes.com/2015/03/25/science/experts-back-angelina-jolie-pitt-in-choices-for-cancer-prevention.html">Angelina Jolie Pitt has published another piece</a> this week discussing her decision to have her ovaries and fallopian tubes removed to mitigate her high genetic risk of cancer. </p>
<p>Jolie Pitt carries a faulty BRCA1 gene, which predisposes women to developing breast and ovarian cancer. Three women in her family – her mother, aunt and grandmother – were diagnosed with breast or ovarian cancer while still under the age of 60. All three died of their illness.</p>
<p>The publicity surrounding her double mastectomy led to what researchers and <a href="http://www.usatoday.com/story/life/movies/2015/03/24/angelina-jolie-alerts-women-to-cancer-threat-again/70372166/">the media have dubbed</a> the “Jolie effect”. An <a href="https://www.mja.com.au/insight/2013/44/genetic-testing-appropriate">Australian study</a> published six months after Jolie Pitt’s disclosure found referrals to familial cancer centres in Victoria more than doubled, and 64% involved people with a high risk of breast cancer. A <a href="http://breast-cancer-research.com/content/16/5/442">similar UK study</a> showed that in the year following her May 2013 announcement, referrals to 12 family history clinics increased over twofold. </p>
<p>But ovarian cancer, as you will see, is very different to breast cancer in that it’s very rare. So those of us who work in the field actually hope there’s no Jolie effect in this instance because it’s likely to cause a lot of worry to women who don’t need to be concerned and to divert resources away from those who do.</p>
<h2>BRCA and cancer risk</h2>
<p>The genes known as BRCA1 and BRCA2 usually help prevent cancers. Everyone has two copies of both but, in some people, one of the copies of either has an error or fault so it doesn’t work properly. The result is a high risk of developing breast and ovarian cancer at younger ages than usual.</p>
<p>The <a href="http://ovarian.org.uk/about-ovarian-cancer/ive-tested-positive-for-a-genetic-mutation">lifetime risk of ovarian cancer</a> for a woman with a faulty BRCA1 gene is about 40% to 60%. This risk increases from her late 30s and continues on an upward trajectory with age. Breast cancer risk is also higher for these women and can be up to 80% depending on family history. </p>
<p>The ovarian cancer risk for a BRCA2 fault is not as high as for BRCA1, at between 15% and 25%. </p>
<p><a href="http://jco.ascopubs.org/content/early/2012/06/18/JCO.2011.39.8545.abstract">An estimated one in five ovarian cancers</a> occurring at or before the age of 60 is due to a faulty BRCA gene. But only around 1% to 2% of women carry a faulty BRCA gene. Most women without it have only a 1% risk of developing ovarian cancer and a 10% risk of developing breast cancer. </p>
<p>Other gynaecological cancers, such as cervical or uterine cancer, are not known to be associated with the BRCA genes. </p>
<h2>Mitigating risk</h2>
<p>The surgery Jolie Pitt has just undergone involved the removal of both her ovaries, as well as fallopian tubes. That’s because <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3380637/">evidence suggests</a> cancer can start in the tubes and travel to the ovaries. </p>
<p>Removing both ovaries and tubes of women with a BRCA fault reduces ovarian cancer risk by 90%. The remaining risk is due to cancer cells that may have already travelled to other sites. </p>
<p>It’s important to note that some women with a BRCA fault who have had their ovaries and tubes removed go on to develop what’s called primary peritoneal cancer some years later. This can happen even if the tubes looked normal when they were removed. A cancerous cell may have already spread into the peritoneal cavity before surgery, or cancer could have developed there independently. Cells lining the peritoneum can cause a cancer that looks indistinguishable from ovarian cancer. </p>
<p>Removing both ovaries also has the benefit of reducing breast cancer risk by 50%, likely due to the onset of early menopause. A downside of having this surgery is that it prompts the change of life, or menopause, at a younger age. Most women having their ovaries and tubes removed because of a high ovarian cancer risk do so five to ten years before the age of natural menopause, which is around 50-years-old. </p>
<p>Early menopause can result in health issues such as an increased risk of heart disease and osteoporosis, which can be mitigated by hormone replacement therapy. Because of this, a doctor will advise the woman about whether she should use hormone replacement, which may also help delay or reduce the onset of menopausal symptoms, such as hot flushes, premature ageing of tissues, vaginal thinning (causing sexual discomfort) and decreased libido. </p>
<p>One way to reduce the risk of ovarian cancer is by using the oral contraceptive pill, <a href="http://www.ncbi.nlm.nih.gov/pubmed/19190154">which can halve your risk with five years of use</a>. </p>
<h2>Don’t panic</h2>
<p>Of course, it would be far better to have a reliable screening test to detect ovarian cancer at an early, curable stage before women develop symptoms. Sadly, neither of the two tools we have now can do this. </p>
<p>The CA-125 blood test is no longer recommended because it detects cancer at a point when it can no longer be cured. And internal pelvic ultrasounds, which look for abnormalities in the ovary, are not sensitive enough to pick up early changes. Both help diagnose established cancers that would usually be picked up within three months anyway because of symptoms. </p>
<p>Jolie said she had planned to have her ovaries and tubes removed ten years before the youngest woman in her family was diagnosed, but this is not a universal rule for women who carry a BRCA fault. Usually, we use the more blanket approach of surgery around 40 years of age, which is when most women have had their children. Earlier surgery would further increase the risk of problems associated with early menopause.</p>
<p>Women who have had ovarian cancer and are concerned about others in their family should ask their doctor whether the BRCA genes might have played a role in their illness. Those who have a close relative, such as a mother or a sister, who was diagnosed with ovarian cancer while younger than 70 should contact <a href="http://ovarian.org.uk/">Ovarian Cancer Action (UK)</a>, <a href="https://ovariancancer.net.au/">Ovarian Cancer Australia</a>, <a href="http://www.ovariancancer.org/">Ovarian Cancer National Alliance (US)</a> or consult their doctor. </p>
<p>Genetic counselling and testing through a familial cancer centre may be recommended for some. For women who have the faulty BRCA genes, there’s ongoing peer and professional support.</p>
<p>Women who don’t have a close relative with ovarian cancer do not need to seek advice based on the surgery Jolie has just undergone. </p>
<p>Jolie Pitt’s op-ed about her double mastectomy had a positive impact as it galvanised many women to have their risk of breast cancer assessed, including some who needed to be tested for the BRCA mutation. This latest announcement should not have the same effect as far fewer women are at high risk of ovarian cancer.</p>
<p><em><strong>Acknowledgement</strong>: This article was co-authored by Maira Kentwell, senior genetic counsellor and manager of the Department of Genetic Medicine and Familial Cancer Centre, The Royal Melbourne Hospital.</em></p><img src="https://counter.theconversation.com/content/39322/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Clare Scott does not work for or own shares in or receive funding from any company or organisation that would benefit from this article. She acts in an advisory capacity to AstraZeneca (all Honoraria donated to Medecins Sans Frontiers) and has received travel support from AstraZeneca.</span></em></p>Jolie Pitt has announced more surgery, this time to mitigate her risk of developing ovarian cancer. But this should ideally not have the same “Jolie effect” as her last operation.Clare Scott, Medical Oncologist and Laboratory Head, Walter and Eliza Hall InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/393292015-03-26T09:16:02Z2015-03-26T09:16:02ZAngelina Jolie Pitt’s surgery is just one option for women at risk of cancer<figure><img src="https://images.theconversation.com/files/75948/original/image-20150325-14526-zd2td.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Jolie Pitt: wants other women at risk to know about the options. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/gageskidmore/4840431698/in/photolist-8nJtGW-nDRoFv-bnJ6DC-8nJuQm-oXRRx5-nUhsSm-nVfwMi-2tcKwJ-BbQ6F-41Gn9-d8dPRj-d8dPGw-nEkL9X-zHfjD-e6gD6u-p9kwZ8-6uYDGk-7Ku9Wj-41Gnu-e6gD6b-6jVLTS-ogvd7c-qF7rAt-pkwGT2-auWwBn-41GmD-2D2hHu-41Gow-41GnY-9wq5f6-oENEMF-osnUD3-4fCohx-4Qt4vn-oXmMF8-bCKVtU-8JWa46-oZAqU8-o12Tq4-oejxCU-cS6oFh-p3jBkT-8U1SBa-oMbTBR-qB1bWU-pDbVjJ-82YwjC-d8dPNm-d8dPKC-d8dPWC">Gage Skidmore</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Hollywood actress Angelina Jolie Pitt has <a href="http://www.nytimes.com/2015/03/24/opinion/angelina-jolie-pitt-diary-of-a-surgery.html?_r=0">revealed in the New York Times</a> that she had her ovaries and fallopian tubes removed to prevent ovarian cancer. Two years ago she underwent a double mastectomy and breast reconstruction after she was found to carry a mutation, or alteration, on the BRCA1 gene. This was inherited from her mother, who developed ovarian cancer aged 49.</p>
<p>The BRCA1 and BRCA2 genes were first identified more than 20 years ago. They can increase the risk of breast and ovarian cancer, if a person carries an alteration in one of these genes. The <a href="http://www.cancerresearchuk.org/about-cancer/type/breast-cancer/about/risks/breast-cancer-genes">risk of breast cancer</a> with BRCA1 and BRCA2 is around 50-80% over a lifetime and around 10-50% for ovarian cancer. </p>
<p>In addition to knowing she had alteration on her BRCA1 gene, Jolie Pitt also had other tests to monitor for signs of early cancer. These included an annual check for elevated levels of the protein CA-125 in her blood. She said she had been planning on removing her ovaries for some time but opted to have the operation sooner after other tests revealed an elevated “number of inflammatory markers” that could be together a sign of early cancer. </p>
<h2>The salpingo-oophorectomy</h2>
<p>Jolie Pitt’s decision to undergo a <a href="http://www.obgyn.med.umich.edu/sites/obgyn.med.umich.edu/files/handouts/ph_lap_bilat_salpingo-oopherectomy.pdf">laparoscopic bilateral salpingo-oophorectomy</a> – when both ovaries and fallopian tubes are removed using a fibre-optic camera and surgical tools inserted through several small incisions in the abdomen – was linked to her family history. Her mother, grandmother and aunt all died of the disease. As she put it: “I know my children will never have to say, ‘Mom died of ovarian cancer.’” </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/75950/original/image-20150325-14494-1f026nk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/75950/original/image-20150325-14494-1f026nk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/75950/original/image-20150325-14494-1f026nk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=562&fit=crop&dpr=1 600w, https://images.theconversation.com/files/75950/original/image-20150325-14494-1f026nk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=562&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/75950/original/image-20150325-14494-1f026nk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=562&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/75950/original/image-20150325-14494-1f026nk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=707&fit=crop&dpr=1 754w, https://images.theconversation.com/files/75950/original/image-20150325-14494-1f026nk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=707&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/75950/original/image-20150325-14494-1f026nk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=707&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">fallopian.</span>
<span class="attribution"><a class="source" href="http://en.wikipedia.org/wiki/Fallopian_tube#/media/File:Scheme_female_reproductive_system-en.svg">Mysid</a></span>
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</figure>
<p>Up to 70% of female BRCA carriers, like Angelina, opt for this kind of surgery, which reduces the risk of developing ovarian cancer by around 95%. It is usually offered to women who are at high risk of developing ovarian cancer but have completed their family – and not usually before the age of 35-40. If this type of surgery is carried out before a woman is 45 it can also reduce her risk of getting breast cancer. There is a small risk of complications including bleeding and infection, but women can return to full activity after two to six weeks. However they will enter the menopause early afterwards and will be offered hormone replacement therapy.</p>
<p>However, as Jolie Pitt acknowledged, there are different options out there for women who are at risk of cancer through a mutation in one or both genes. Options include monitoring signs of early cancer, or removing fallopian tubes but keeping ovaries, which would leave the option for having more children or avoiding early menopause. </p>
<h2>Tests, drugs and screening</h2>
<p>Breast MRI scans are carried out annually in the UK for women between the ages of 30 and 50 (and mammograms from 40). But extra breast screening is offered to women in the who carry a BRCA gene alteration. </p>
<p>We still don’t know how far drugs can prevent cancer developing in BRCA gene carriers. Tamoxifen, for example, can help protect against breast cancers that respond to the female hormone oestrogen, but data on its use in BRCA carriers is limited.</p>
<p>Ovarian screening is unproven. Research studies <a href="http://www.instituteforwomenshealth.ucl.ac.uk/womens-cancer/gcrc/ukfocss">such as UKFOCSS</a> (the UK ovarian cancer screening study), which recruited 5,000 high-risk women to an ovarian screening programme where they were offered annual ultrasound and CA-125 blood tests, has not yet shown any definite benefit in detecting the cancer early. Symptoms of ovarian cancer are non-specific, and often diagnosis is delayed. </p>
<p>A number of research groups are looking for new markers for ovarian cancer to improve detection, such as the <a href="http://www.ucl.ac.uk/hbrc/research/cancer_screening/understanding_screening_attitudes_behaviour/promise16">PROMISE 2016 project</a> at UCL’s Institute for Women’s Health. These tests are not yet ready for clinical use. </p>
<p>The contraceptive pill and tubal ligation (where the fallopian tubes are cut or tied in a woman who has completed her family) may reduce ovarian cancer risk, but for BRCA carriers this risk remains significantly increased.</p>
<p>Testing for BRCA1 and BRCA2 is <a href="https://theconversation.com/greater-access-to-genetic-testing-in-nhs-will-help-cancer-fight-14448">becoming more widely available</a>, and women who have breast or ovarian cancer may not need a family history to be offered genetic testing. This group includes women under 50 who have a type of breast cancer called triple negative, and women with high-grade serous ovarian cancer. The outlook for women with BRCA gene alterations will improve, with greater access to genetic testing and screening and risk reducing surgery for women who have not yet developed cancer. </p>
<p>As Jolie Pitt said, there are options but not easy decisions, and “you can seek advice, learn about the options and make choices that are right for you.”</p><img src="https://counter.theconversation.com/content/39329/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lucy Side receives grant funding from Cancer Research UK, looking at risk prediction for ovarian cancer at UCL's Institute for Women's Health, and Eve Appeal
</span></em></p>Genetic testing for cancer will become more common and risk reducing surgery is one way to cut the risk.Lucy Side, Consultant Senior Lecturer in Clinical Genetics, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/279452014-06-13T12:17:45Z2014-06-13T12:17:45ZNot all messages about rape were welcome at Hague and Jolie’s sexual violence summit<p>An important shift has taken place in our awareness of sexual violence. The <a href="https://www.gov.uk/government/topical-events/sexual-violence-in-conflict">Global Summit to End Sexual Violence in Conflict</a>, co-chaired by foreign secretary William Hague and Angelina Jolie, the UN’s special envoy for refugees, is the biggest, highest-profile global meeting ever convened on this topic. </p>
<p>But the event has been marred by the silencing of Congolese sexual violence survivors, who found themselves locked out of a public forum. The security for the event was handled by G4S – on behalf of the Foreign Office.</p>
<p>This was not your average conference. It was certainly more glamorous than any sexual violence event I have ever attended. With more than 100 countries represented at ExCel London and a fringe event advertised as open to the public, the summit had a number of noble aims: to shatter the culture of impunity for sexual violence in conflict, to take practical steps by training soldiers and peacekeepers, to increase support for survivors of sexual violence, and to produce a “seismic shift in attitudes”. </p>
<p>As the press release stated: </p>
<blockquote>
<p>We want people, governments, faith leaders and civil society across the world to condemn the horrors of warzone sexual violence, to see the cycles of conflict it creates and to grasp the role they have to play in ending this crime once and for all. </p>
</blockquote>
<p>Even those of us who have been working in the area of violence and abuse of women and girls for a long time are horrified by the stories of sexual violence that women in conflict situations experience and their subsequent treatment.</p>
<h2>Congo locked out</h2>
<p>It is the situation in the Democratic Republic of Congo (DRC), dubbed the “rape capital of the world” that has received the most attention in recent years. In 2011, research in the American Journal of Public Health estimated that in the 12 months prior to the survey, approximately <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3093289/">1,150 women aged 15-49 were raped every day</a>. And it is not just the sheer amount of rape that is shocking – it is women’s stories of their treatment afterwards. </p>
<p>At a recent Rape Crisis conference I attended, you could have heard a pin drop as a woman from Common Cause UK who fled the DRC told her story. And that was an audience made up almost exclusively of Rape Crisis volunteers, staff, and trustees, all of whom listen to women and girls’ experiences of abuse on a daily basis. It is the voices of women survivors turned activists that have informed the views of women’s groups in the UK, and which have led to public acts of solidarity seen at events such as <a href="http://www.millionwomenrise.com/">Million Women Rise</a>. Congolese activists and women’s groups have done much to raise awareness about the situation of sexual violence in the DRC.</p>
<p>In the context of this, it was surprising to hear claims that multinational security company G4S, which was providing the summit’s security, had refused entry to a group of Congolese activists and Rape Crisis women attempting to attend the fringe event. </p>
<p>G4S is increasingly involved in the provision of services for rape survivors in the UK, where it runs several <a href="http://www.g4s.uk.com/en-GB/Media%20Centre/Case%20Studies/Facilities%20management/SARC/">Sexual Assault Referral Centres</a>.</p>
<h2>Postcards from a warzone</h2>
<p>So why were charity workers refused entry to the Global Summit? We asked G4S, but have not had a response. </p>
<p>The women were carrying with them a stack of postcards, which bore a message that was not welcome at the summit: that sexual violence in the DRC is supported by the war in the DRC, which in turn is about an economic situation in which the UK is deeply entangled. </p>
<p>The message read: “No end to rape without the end to war”, and petitioned Hague to “listen to the voices of Congolese women and of civil society who repeatedly say that the main cause of sexual violence in DR Congo is the economic war for illegal exploitation of its wealth”. It highlighted that the UK does business with Ugandan, Rwandan and Congolese heads of states – all former armed rebels – and that multinational companies directly or indirectly sponsor armed groups. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/51057/original/dtr7nwvt-1402656145.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/51057/original/dtr7nwvt-1402656145.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/51057/original/dtr7nwvt-1402656145.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=421&fit=crop&dpr=1 600w, https://images.theconversation.com/files/51057/original/dtr7nwvt-1402656145.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=421&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/51057/original/dtr7nwvt-1402656145.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=421&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/51057/original/dtr7nwvt-1402656145.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=529&fit=crop&dpr=1 754w, https://images.theconversation.com/files/51057/original/dtr7nwvt-1402656145.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=529&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/51057/original/dtr7nwvt-1402656145.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=529&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The offending postcard.</span>
<span class="attribution"><span class="source">Nicole Westmarland</span></span>
</figcaption>
</figure>
<p>The DRC conflict principally centres around a struggle for control of the country’s rich mineral resources, which include 80% of the world’s colton ore – in huge demand in the manufacture of microchips. The UK both sells and manufactures items that are made with DRC resources. It also donates huge amounts of overseas aid to Rwanda and Uganda, who in turn support violent militia groups known for the widespread rape of women and girls. </p>
<p>Activists from the Bradford Congo Campaign, who were part of the group turned away from the supposedly open fringe event. One activist told me: “The fringe event was open to the public and should have been a space for people to share ideas, but it was a closed space when it came to discussion about the economic basis of the war.”</p>
<p>William Hague and Angelina Jolie have played an important role in bringing the issue of sexual violence to the fore on the global stage. But any banning of Congolese activists and Rape Crisis women to a part of the event that was open to the public because of the political message they carried is unacceptable. It reminds us of the dirty nature of politics, of the power of Western governments, and of the power of rich white men in controlling the world’s resources and women’s bodies. </p><img src="https://counter.theconversation.com/content/27945/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Westmarland has previously volunteered as Chair of Rape Crisis (England and Wales) and has conducted research as a consultant for them. </span></em></p>An important shift has taken place in our awareness of sexual violence. The Global Summit to End Sexual Violence in Conflict, co-chaired by foreign secretary William Hague and Angelina Jolie, the UN’s…Nicole Westmarland, Professor of Criminology, Durham UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/276362014-06-11T04:27:04Z2014-06-11T04:27:04ZTime to act: can the world prevent sexual violence in armed conflict?<figure><img src="https://images.theconversation.com/files/50662/original/vjxh56xy-1402375636.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The plight of women and girls facing sexual violence in Syria, for example, does not elicit global diplomatic outrage – yet.</span> <span class="attribution"><span class="source">EPA/Tolga Bozoglu</span></span></figcaption></figure><p>The <a href="https://www.gov.uk/government/topical-events/sexual-violence-in-conflict">Global Summit To End Sexual Violence in Conflict</a> is underway in London. It is an extraordinary manifestation of UK soft power, the influence of global social movements, <a href="http://www.worldpoliticsreview.com/articles/12062/beyond-activism-emerging-models-of-celebrity-diplomacy">celebrity diplomacy</a> and digital activism. </p>
<p>British foreign secretary William Hague is co-chairing the summit with actress Angelina Jolie, in her capacity as special envoy for the UN High Commissioner for Refugees. The summit’s aims are high: to end impunity, prevent the use of mass rape as a weapon of war and transfer the stigma of crimes of sexual violence from the survivors to the perpetrators.</p>
<h2>What’s it all about?</h2>
<p>The 122 governments that have endorsed the non-binding <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/274724/A_DECLARATION_OF_COMMITMENT_TO_END_SEXUAL_VIOLENCE_IN_CONFLICT.pdf">Declaration of Commitment To End Sexual Violence in Conflict</a> were invited to attend. There will be 70 ministers present, including US Secretary of State <a href="http://www.standard.co.uk/news/world/end-war-rape-2014-john-kerry-leads-global-fight-to-stamp-out-sexual-violence-in-conflicts-9512726.html">John Kerry</a>. Some 630 officials, including Australia’s <a href="https://www.dfat.gov.au/women/">Ambassador for Women and Girls</a> Natasha Stott-Despoja, about 1000 experts and more than 100 NGOs will participate, complete with a fringe festival, film screenings and a hackathon. </p>
<p>This is the modern way to exert normative power. It is the sort of conference the United Nations used to be expected to put together to create a new treaty. Soft power coalitions are beginning to fill the void left by <a href="http://www.ft.com/cms/s/0/18d8f8b6-fa2f-11de-beed-00144feab49a.html#axzz346bQHf00">“messy multilateralism”</a>. </p>
<p>The summit also represents a new phase of gender-aware foreign policy, where the <a href="https://theconversation.com/boko-haram-the-terror-group-that-kidnapped-200-schoolgirls-25931">kidnapping of Nigerian girls</a> is a terrorist act or the shooting of a <a href="http://www.theage.com.au/comment/malala-yousafzai-when-a-teenage-ambition-to-change-the-world-might-actually-work-20140417-zqw1u.html">Pakistani schoolgirl</a> elicits a global diplomatic response.</p>
<p>And yet the plight of women and girls facing similar issues in Syria or the Central African Republic or Sudan does not elicit this same response. Principled and consistent political leadership on issues of gender justice is what I hope comes from the summit.</p>
<h2>Whose job is it to prevent sexual violence?</h2>
<p>Under the UN Charter, the <a href="http://www.un.org/en/sc/">Security Council</a> is responsible for the maintenance of international peace and security. </p>
<p>After a long campaign, the Security Council acknowledged in <a href="http://unscr.com/en/resolutions/doc/1325">Resolution 1325</a> that women experience peace and security in different ways to men, are important actors to negotiate and build peace, and have a differentiated experience of violence in conflict, including sexual violence. </p>
<p>The <a href="https://theconversation.com/women-peace-and-security-the-theme-of-australias-security-council-presidency-17490">Women Peace and Security agenda</a> has progressed and gained momentum ever since. Countries are urged to make national action plans and include more women in their own contingents of peacekeepers and mediators with sufficient training. </p>
<p>Since 2002, the <a href="http://www.icc-cpi.int/en_menus/icc/press%20and%20media/press%20releases/Pages/pr1011.aspx">International Criminal Court</a> has been able to impose individual criminal responsibility for war crimes, crimes against humanity, genocide and other offences under the <a href="http://www.icc-cpi.int/nr/rdonlyres/ea9aeff7-5752-4f84-be94-0a655eb30e16/0/rome_statute_english.pdf">Rome Statute</a>. But it is a court of last resort, and only for countries who accept its jurisdiction. </p>
<p>While international institutions can play a significant role in elaborating legal standards, they are inaccessible for most victims of sexual violence. That means the main job of preventing sexual violence is a state responsibility. In practice, this often falls to military and humanitarian actors.</p>
<h2>Australia’s role</h2>
<p>It is important that Australia has its own unlikely <a href="https://www.youtube.com/watch?v=QaqpoeVgr8U">YouTube sensation</a> attending the summit in the form of the Chief of Army, Lieutenant General David Morrison. </p>
<p>The Australian Defence Force (ADF) will face more international scrutiny from attending this event than ever before because of the <a href="http://www.aspistrategist.org.au/gender-issues-in-the-adf-the-other-shoe-drops/">continuing impunity</a> for sexual abuse within the ADF. While the summit needs political masters, it also needs those deployed to conflict zones to fully understand the context from the perspective of all those involved, not just armed male elites.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/50543/original/vknshzvn-1402285516.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/50543/original/vknshzvn-1402285516.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/50543/original/vknshzvn-1402285516.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/50543/original/vknshzvn-1402285516.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/50543/original/vknshzvn-1402285516.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/50543/original/vknshzvn-1402285516.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/50543/original/vknshzvn-1402285516.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/50543/original/vknshzvn-1402285516.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Angelina Jolie is co-hosting the summit in London.</span>
</figcaption>
</figure>
<p>As the UN special representative of the Secretary-General, Zainab Hawa Bangura, <a href="http://www.un.org/sexualviolenceinconflict/statement/statement-by-srsg-zainab-hawa-bangura-to-the-security-council-17-april-2013/">said</a>:</p>
<blockquote>
<p>… there can be no credible security approach that does not take into account the security of women as part of its central calculus. </p>
<p>Today it is still largely ‘cost-free’ to rape a woman, child or man in conflict. Sexual violence has been used through the ages precisely because it is such a cheap and devastating weapon.</p>
</blockquote>
<p>Justice for victims of sexual abuse in the ADF is important for Australia’s credibility, and for our ability to respond appropriately when deployed. Leadership during our time on the Security Council is fundamental. Funding and implementing our <a href="http://www.dss.gov.au/our-responsibilities/women/publications-articles/government-international/australian-national-action-plan-on-women-peace-and-security-2012-2018">National Action Plan</a> on Women, Peace and Security is crucial. Helping our neighbours ratify the Rome Statute and build regional mechanisms like the new <a href="http://www.asean.org/news/asean-secretariat-news/item/asean-institute-for-peace-and-reconciliation-kicks-off-in-jakarta">ASEAN Institute for Peace and Reconciliation</a> is an investment. </p>
<p>Under the Women, Peace and Security agenda, the area states have most neglected – but which has most transformative potential to improve the lives of women – is the focus on engaging and funding local women’s organisations. They are the real first responders and conflict monitors. They often try to prevent conflict, and they try to negotiate peace when they are allowed at the table. And such women rarely benefit from the peace. </p>
<p>While joining the global campaign, Australia should also invest in women’s leadership right here and in the region. It’s time to act.</p><img src="https://counter.theconversation.com/content/27636/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Harris Rimmer does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Global Summit To End Sexual Violence in Conflict is underway in London. It is an extraordinary manifestation of UK soft power, the influence of global social movements, celebrity diplomacy and digital…Susan Harris Rimmer, Director of Studies, Asia Pacific College of Diplomacy, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/142562013-05-16T20:06:55Z2013-05-16T20:06:55ZPanicking about breast cancer? Here’s what you need to know<figure><img src="https://images.theconversation.com/files/23947/original/tp7jgxrd-1368686268.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Angelina Jolie should be seen as a model for seeking information about her options and making a decision that best suited her.</span> <span class="attribution"><span class="source">EPA/Facundo Arrizabalaga</span></span></figcaption></figure><p>Angelina Jolie’s recent announcement about her double mastectomy likely caused many women to think about their own chance of developing breast cancer. But before you rush off to have a bunch of possibly unnecessary tests, take a deep breath and read on.</p>
<p>When celebrities such as Jolie and Kylie Minogue talk about their personal experiences, the statistics about breast cancer risk suddenly become very real. This seems to be particularly true when those celebrities are young women. </p>
<p>Media reports of Kylie Minogue’s breast cancer, for instance, <a href="https://www.mja.com.au/journal/2005/183/5/impact-news-celebrity-illness-breast-cancer-screening-kylie-minogues-breast">led to a 40% increase</a> in overall bookings for cancer screening within two weeks.</p>
<h2>“Faulty” genes and other risks</h2>
<p>In the <a href="http://www.nytimes.com/2013/05/14/opinion/my-medical-choice.html?_r=3&">New York Times op-ed</a> where Jolie made her surgery public, she spoke about the “faulty” gene that can cause both breast and ovarian cancer. The way these genes (BRCA1 and BRCA2) are sometimes described can be confusing because, usually, they help stop cancers from developing. </p>
<p>Everyone has two copies of BRCA1 and BRCA2. But, in some people, like Jolie, one of the copies has a fault and doesn’t work properly to prevent cancer. The result of inheriting a faulty copy of either BRCA1 or BRCA2 is a high risk of developing breast and ovarian cancer at younger ages than usual.</p>
<p>Even though all women have some risk of being diagnosed with breast cancer, most of us are not in Jolie’s situation. In fact, roughly ten out of every 11 women not carrying one of the gene mutations won’t ever develop breast cancer. </p>
<p>Most breast cancer is diagnosed in women older than 50. For this reason, and because breast cancer is one of the more common cancers, Australian women over 50 are encouraged to have a free mammogram every second year through the BreastScreen program.</p>
<p>We now know more about the factors that can increase breast cancer risk. Some of these can be changed, for example by drinking less alcohol and avoiding weight gain after menopause. Cancer Australia has an <a href="http://canceraustralia.gov.au/affected-cancer/cancer-types/breast-cancer/your-risk/calculate">online risk calculator</a> you can check out. </p>
<p>Family history also plays a large part, but breast cancer is quite common, so many people have a relative who has had it. </p>
<p>The <a href="http://canceraustralia.gov.au/sites/default/files/publications/nbocc-bog-2010-web-a4-printable_504af02a673fd.pdf">National Breast and Ovarian Cancer Centre</a> describes women who have not had breast cancer as being in one of three categories based on how many of their blood relatives on the same side of the family have had breast cancer and the age at which their cancer was diagnosed (as well as a few rarer features).</p>
<h2>What you need to do</h2>
<p>Media coverage of a celebrity’s experience, a friend’s revelation that she has cancer or turning the same age as a close relative when she was diagnosed can provoke quite a lot of anxiety about the illness. People respond in different ways to these feelings with some actively seeking testing and check-ups, while others avoid information for fear that it will make them feel worse. </p>
<p>What you need is good advice tailored to your own situation so you can avoid the harms from too many unnecessary tests or too few beneficial ones.</p>
<p>The first step is to have an initial assessment through a general practitioner or the Cancer Helpline (13 11 20). They will ask you questions about your family’s medical history and suggest the appropriate next step based on your level of risk. </p>
<p>Women with a high-risk family history can be referred to a <a href="http://www.genetics.edu.au/Genetics-Services/family-cancer-services">family cancer service</a>, where medical professionals and genetic counsellors provide specialised advice and information about inherited cancer risk, testing and management options. These services are in public hospitals so there’s no direct cost to the patient for a consultation.</p>
<p>About one in 1000 women has a faulty BRCA1 or BRCA2 gene. Testing to find an error in these genes is usually performed through a familial cancer service, either on women with breast or ovarian cancer and a high risk of having inherited cancer (rather than it occurring by chance alone). </p>
<p>The test, which is paid for by the service, costs approximately A$2500, but is very unlikely to be informative for other women. If a gene mutation is found in a woman with cancer, her relatives can be tested to see if they’ve inherited it too.</p>
<p>Although testing sounds straightforward, it can have a large impact on those undergoing it. And this impact is often not only on the person tested but also on her or his children, who – like Jolie’s biological children – may learn they have a risk of inheriting a tendency to develop breast or ovarian cancer. </p>
<p>Genetic counselling helps people prepare for the potential emotional and social consequences of testing and provides support as needed afterwards. Medical advice provides options to lessen the chance of developing breast and ovarian cancer, and for early detection.</p>
<h2>Choosing the right path</h2>
<p>Jolie said that surgery to reduce her risk was the right option for her. After discussion with their doctors, some women with BRCA mutations do choose to go down that path. But others prefer to have regular examinations and mammograms. </p>
<p>Some women at high risk are also eligible for screening by MRI. And hormone treatment with Tamoxifen is another option to reduce risk. </p>
<p>Each of these options has pros and cons that need consideration. Women with BRCA mutations also have a higher risk of ovarian cancer and are advised to have their ovaries and tubes removed (for example, around the age of 40) as there’s currently no effective way of detecting ovarian cancer early.</p>
<p>The decision to have surgery is a very personal one and should be made after full discussion with specialists. Risk management clinics provide this service to women with BRCA mutations. </p>
<p>Surgery and breast reconstruction is covered within the public hospital system in Australia when performed to reduce a high risk of breast cancer. But the majority of women do not have a risk high enough to warrant surgery.</p>
<p>Jolie finished her piece by saying that the challenges we can take control of shouldn’t scare us. Remember that control is as much about not pursuing unnecessary tests and procedures as it is about doing those that are beneficial. </p>
<p>Jolie clearly obtained information about her personal risks and options, and then made difficult decisions based on her own values and circumstances. It’s important to remember that her situation is a relatively uncommon one and many women wouldn’t need to make the same choice. </p>
<p>Instead of being blindly followed, Jolie should be seen as a model for having sought to better understand her risk, received medical help to become aware of her options and then made a decision that best suits herself and her family. </p>
<p>If you are worried about your risk of developing breast cancer, take the online risk assessment test or contact the cancer helpline, then seek guidance from your doctor.</p><img src="https://counter.theconversation.com/content/14256/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Clare Scott receives funding from Cancer Council Victoria and the Victorian Cancer Agency (Sir Edward Dunlop Cancer Research Fellowship). She is affiliated with Cancer Council Victoria, as well as The Royal Women's Hospital and The Royal Melbourne Hospital where she is a consultant medical oncologist.</span></em></p><p class="fine-print"><em><span>Clara Gaff does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Angelina Jolie’s recent announcement about her double mastectomy likely caused many women to think about their own chance of developing breast cancer. But before you rush off to have a bunch of possibly…Clara Gaff, Program Leader, Melbourne Genomics Health Alliance, Walter and Eliza Hall InstituteClare Scott, Medical Oncologist and Laboratory Head, Walter and Eliza Hall InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/117172013-05-16T04:39:14Z2013-05-16T04:39:14ZSex, sexuality and cancer: let’s break the taboo<figure><img src="https://images.theconversation.com/files/23922/original/z9z8gwzx-1368674444.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women whose partners accepted their bodily changes after cancer are more likely to feel positive and sexy.</span> <span class="attribution"><span class="source">Christophe Karaba/EPA</span></span></figcaption></figure><p>Angelina Jolie has attracted much attention for revealing her recent experience of a double <a href="http://www.guardian.co.uk/film/2013/may/14/angelina-jolie-double-mastectomy-breast-cancer">mastectomy</a>. But her personal attractiveness draws attention to a neglected aspect of cancer treatment and survival – sexuality.</p>
<p>As a carrier of the BRCA1 gene, Jolie reduced her risk of breast cancer from an unusually-high 87% to less than 5% through the preventative procedure. And as a woman who has frequently been voted the “most sexy woman alive”, she directly challenges the myth that cancer surgery means the end of sexuality. </p>
<p>“I do not feel any less of a woman,” she wrote in an op-ed in the New York Times. “I feel empowered that I made a strong choice that in no way diminishes my <a href="http://www.nytimes.com/2013/05/14/opinion/my-medical-choice.html?_r=1&">sexuality</a>.” </p>
<p>Jolie is not alone. Recent <a href="http://www.ncbi.nlm.nih.gov/pubmed/22222680">research</a> conducted at the University of Western Sydney in collaboration with Breast Cancer Network Australia (<a href="http://www.bcna.org.au/">BCNA</a>) found a significant proportion of women felt sexually attractive post-mastectomy. But around 20% did not, reporting that they felt “maimed”, “grotesque”, “mutilated”, “undesirable”, “deformed”, or like “damaged goods”. These feelings led some women to hide their body from their partner. </p>
<p>One woman said, “I don’t want my husband to see or touch my breast.” Another told us, “I don’t feel like exposing my breast and have my partner touching it and seeing it.” </p>
<p>Many women also reported feeling “like I was a different person”, or “my femininity was ripped off overnight”. This is in line with previous Australian <a href="http://fap.sagepub.com/content/17/1/75.short">research</a> where some women said they felt like “half a woman” after a mastectomy.</p>
<h2>Meet my partner</h2>
<p>The response of a woman’s partner is central to her sense of desirability after a mastectomy. Angelina Jolie wrote that her partner Brad Pitt was “loving and supportive” and that the surgery had made them closer. </p>
<p>In our research, women whose partners accepted their bodily changes were more likely to feel positive and sexy. One woman told us, “I worried that my husband wouldn’t love my body as before. He tells me over and over that he loves me even more now. So I have to believe him.” </p>
<p>In contrast, some partners rejected such bodily changes. One man told his wife, “you have mutilated your body”. It’s not surprising that a woman in this situation would feel bad about herself.</p>
<p>Angelina Jolie had a preventative mastectomy, and breast reconstruction, in the absence of cancer. This is a major surgical procedure that requires a period of adjustment. </p>
<p>Women whose mastectomy follows a cancer diagnosis have it much worse. They are dealing with the shock of illness <em>and</em> the impact of a range of cancer treatments on their sexuality. Chemotherapy can cause vaginal dryness, making sex painful or uncomfortable. </p>
<p>It can also cause extreme tiredness, and diminished sexual response or <a href="http://www.ncbi.nlm.nih.gov/pubmed/20439140">desire</a>.</p>
<h2>Everything changes</h2>
<p>Fears of cancer returning can cause anxiety and <a href="http://www.ncbi.nlm.nih.gov/pubmed/23137124">depression</a>, which in turn affects sexual relationships. Many women also have <a href="http://www.uws.edu.au/centreforhealthresearch/research/cancer_and_fertility">fertility</a> concerns. </p>
<p>For some, changes to sexuality and fertility are the most <a href="http://jco.ascopubs.org/content/24/18/2815.full.pdf">devastating</a> long-term consequence of cancer. One woman told us: “I feel a sense of loss, as if part of me has died.” Another said, “I felt like my heart had been ripped out. Very empty.”</p>
<p>Changes to sexuality are not confined to women with breast cancer. In a second study we conducted across a range of cancer types (including leukaemia, melanoma, lymphoma, prostate, gynaecological, lung, colorectal, bowel and anal cancers), we found that sexual issues were often at the fore. </p>
<p>Many women reported disinterest in sex, discomfort, and body image <a href="http://www.ncbi.nlm.nih.gov/pubmed/23137124">concerns</a>. Men <a href="http://www.ncbi.nlm.nih.gov/pubmed/23656602">reported</a> erectile difficulty, decreased desire, and difficulty with orgasm. </p>
<p>Being single brings additional problems, including anxiety about how to explain a changed body to a new partner. Or fear that cancer will frighten a new partner away. </p>
<p>At the same time, <a href="http://www.ncbi.nlm.nih.gov/pubmed/19444088">partners</a> of the person with cancer have their own sexual concerns. This can include guilt for still wanting sex when your partner has cancer, feeling tired due to caring, and not wanting to cause discomfort or pain.</p>
<h2>The same but different</h2>
<p>Sexuality doesn’t have to be negatively affected by cancer. Many people find ways of coping with sexual changes, through developing new sexual <a href="http://www.ncbi.nlm.nih.gov/pubmed/23151502">practices</a>, or focusing on intimacy rather than sex. </p>
<p>Some couples even find their sex lives are better after cancer, as they spend more time exploring each other. One woman told us, “we spend a bit more time in foreplay, to sidestep the vaginal dryness”. Other people talked of using sex toys, or trying oral sex, or mutual masturbation, if penetration was difficult. </p>
<p>Despite its importance, sexuality is rarely mentioned by <a href="http://www.ncbi.nlm.nih.gov/pubmed/17391082">health professionals</a> who work with cancer patients. This means that there’s an absence of <a href="http://www.uws.edu.au/centreforhealthresearch/research/cancer_and_sexuality">information</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/22500731">support</a> on how to deal with sexual or body image concerns that stem from cancer-related surgery. </p>
<p>Angelina Jolie has effectively, if unwittingly, put sexuality and cancer on the public agenda. For that we should thank her and applaud her bravery. It will benefit many other women – and men.</p><img src="https://counter.theconversation.com/content/11717/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jane Ussher has received funding from the Australian Research Council, Cancer Council NSW, National Breast Cancer Foundation (NBCF), and Breast Cancer Network Australia (BCNA), for research on sexuality and fertility in the context of cancer. </span></em></p>Angelina Jolie has attracted much attention for revealing her recent experience of a double mastectomy. But her personal attractiveness draws attention to a neglected aspect of cancer treatment and survival…Jane Ussher, Professor of Women's Health Psychology, Centre for Health Research, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.