Angelina Jolie Pitt has revealed she underwent surgery to prevent ovarian cancer, and is encouraging women to explore their options. There are many factors that women need to weigh before deciding to have this procedure, experts say.
In a New York Times Op-Ed article, Jolie Pitt said today that she had surgery to remove her ovaries and fallopian tubes to prevent ovarian cancer. Last year, the actress disclosed that she carries a genetic mutation in the BRCA1 gene, which significantly increases her risk of breast and ovarian cancer, and she had undergone a double mastectomy to prevent breast cancer.
But in this latest Op-Ed, Jolie Pitt writes that "a positive BRCA test does not mean a leap to surgery. ... There are other options."
Experts agree that the decision to undergo preventive surgery is not for everyone.
"Every treatment and strategy should be individualized," said Dr. Nathalie McKenzie, a gynecologic oncologist at UF Health Cancer Center at Orlando Health in Florida. "I think it was very smart of Angelina Jolie to specifically mention that this was not an option for every patient," because medical treatments are not cookie-cutter, McKenzie said. [5 Things Women Should Know About Ovarian Cancer]
The women who are strongest candidates for preventive surgery to remove the ovaries are those who are at increased risk for ovarian cancer because of mutations in the BRCA genes, and who also have a family history of the disease, McKenzie said.
About 1 in 400 people have BRCA mutations, according to the National Cancer Institute. Women with mutations in the BRCA1 gene (which Jolie Pitt said she carries) have a 35 to 70 percent risk of developing ovarian cancer by age 70, according to the Susan G. Komen Foundation, a nonprofit organization that funds breast cancer research.
Jolie Pitt said her risk of ovarian cancer, which killed her mother, was 50 percent. Having surgery to remove the ovaries reduces a woman's risk of ovarian cancer by 85 to 90 percent, McKenzie said.
A woman's age may also play a role in her decision — according to some studies, the greatest benefit is seen among women who have the surgery between ages 35 to 40, McKenzie said. (Jolie Pitt is 39.)
Whether a woman wants to have children is another factor because removing the ovaries will mean a woman can no longer have children. Women who still want to have children may choose to delay the surgery, McKenzie said.
And the side effects of the procedure should be weighed against the benefits. Women who have their ovaries removed will go into menopause, sometimes 10 to 20 years before this would naturally occur.
According to a 2009 review article, early menopause is linked with an increased risk of heart disease, neurological problems and osteoporosis and even early death. Taking the hormone estrogen after removal of the ovaries — which Jolie Pitt is doing — can reduce some, but not all, of these risks, according to the review.
But the hormone replacement therapy itself is linked with an increased risk of breast cancer, and so a woman's decision to take hormone replacements after surgery to remove the ovaries may differ depending on whether she has previously had breast cancer, McKenzie said. (Women often discover that they carry BRCA mutations after a breast cancer diagnosis.)
Still, McKenzie noted, one study in 2011 found that, among women with BRCA mutations, those who took hormone replacement therapy were not at an increased risk for breast cancer compared with those who did not take hormone replacement therapy.
McKenzie said that of the patients she has treated who are at risk for ovarian cancer because of BRCA mutations, most patients do choose to have surgery to remove their ovaries.
But for those who do not want to have surgery, or who want to delay it, there are other options. These include getting screened for ovarian cancer once or twice a year, with both a blood test and an ultrasound.
Some studies also suggest that taking birth control pills can reduce the risk of ovarian cancer in women with BRCA mutations, McKenzie said.
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