Angelina Jolie Has Ovaries Removed in Move Against Cancer

Zosia Chustecka

March 24, 2015

Two years after announcing her prophylactic double mastectomy, world superstar Angelina Jolie has now announced that she has undergone prophylactic salpingo-oophorectomy, having her ovaries and fallopian tubes removed in further preventive surgery against cancer.

Jolie carries the BRCA1 mutation, which is associated with an estimated 87% increased risk for breast cancer and a 59% risk for ovarian cancer, and has lost many close female relatives to cancer (mother, grandmother, aunt).

As before, Jolie made her announcement through an op-ed in the New York Times, explaining that she wants women who are also at risk to know about the options that are available.

After her previous New York Times piece, which revealed for the first time that she is a BRCA1 mutation carrier, there was a huge surge of stories in the media about the issue, which led to an increase in testing for BRCA status. One clinic reported a doubling of testing in the 6 months following the announcement.

This illustrates "the profound impact that prominent figures like Jolie can have on public awareness of health issues," commented lead author Jacques Raphael, MD, clinical fellow at Sunnybrook Odette Cancer Center in Toronto, at the time.

"People in the community who see high-risk breast cancer have been very aware of what has been dubbed the 'Angelina Jolie effect,' this phenomenon of more women and their families seeking out genetic testing," added Harold Burstein, MD, from the Dana-Farber Cancer Institute in Boston.

Latest Surgery Planned for Some Time

Angelina Jolie

In her latest New York Times piece, Jolie says that she has been planning the next preventive surgery, to remove her ovaries and fallopian tubes, for some time.

"It is a less complex surgery than the mastectomy, but its effects are more severe," she writes, as "it puts a woman into forced menopause. So I was readying myself physically and emotionally, discussing options with doctors, researching alternative medicine, and mapping my hormones for estrogen or progesterone replacement. But I felt I still had months to make the date."

But then came news, after blood tests that she has regularly been monitoring, that while the level of CA-125 (a protein marker associated with ovarian cancer) was normal, a number of inflammatory markers were elevated, which "could be a sign of early cancer," she was told by her doctor.

An examination and an ultrasound found nothing that was concerning. A further PET/CT scan also looked clear, and the tumor test was negative.

"There was still a chance of early-stage cancer, but that was minor compared with a full-blown tumor," she writes. "To my relief, I still had the option of removing my ovaries and fallopian tubes and I chose to do it."

Jolie emphasizes that prophylactic surgery is not the only option, and some women choose to take oral contraceptives or alternative medicines combined with frequent checks.

"I did not do this solely because I carry the BRCA1 gene mutation, and I want other women to hear this. A positive BRCA test does not mean a leap to surgery," she writes.

"In my case, the Eastern and Western doctors I met agreed that surgery to remove my tubes and ovaries was the best option, because on top of the BRCA gene, three women in my family have died from cancer, " she writes. "My doctors indicated I should have preventive surgery about a decade before the earliest onset of cancer in my female relatives. My mother's ovarian cancer was diagnosed when she was 49. I'm 39."

Surgery Dramatically Reduces Risk

That surgery dramatically reduces the risk for cancer in women who carry the BRCA1/2 mutations was confirmed by a 2009 meta-analysis of 10 studies (J Natl Cancer Inst. 2009;101:80-87). This meta-analysis found that prophylactic salpingo-oophorectomy reduced the risk for breast cancer by 50% and the risk for ovarian and fallopian tube cancer by 80% in women who carry mutations in the BRCA1 or BRCA2 gene.

"It's really very clear that this surgery is protective. That's not controversial anymore. Our study quantifies the cancer risk reduction and is the most authoritative review to date," Timothy R. Rebbeck, PhD, professor of epidemiology at the University of Pennsylvania School of Medicine in Philadelphia, commented at the time.

Approached for comment, Maurie Markman, MD, clinical professor at Drexel University College of Medicine and senior vice president for clinical affairs at the Cancer Treatment Centers of America in Philadelphia, said: "Based on what has been reported, including not only the genetic abnormalities, but also the family history of cancer, the decision by Ms Jolie was quite appropriate as a documented effective strategy to decrease the risk for the development of both breast and ovary cancer. Removal of the ovaries is not 100% effective as a cancer prevention strategy, as the entire lining of the abdominal cavity (which cannot be removed at surgery) has the theoretical potential of being 'at risk' for the development of a malignant condition. However, this strategy decreases that lifetime risk by at least 80%."

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