Jolie says routine testing revealed some signs that concerned her doctor. She was tested for ovarian cancer, and to her relief, the results were negative. But after consulting her doctors, she opted to have her ovaries and Fallopian tubes removed as a preventative measure.
Jolie wants to be clear: “A positive BRCA test does not mean a leap to surgery.” She wants women to know there are other options, such as taking birth control pills. “There is more than one way to deal with any health issue,” she says, “The most important thing is to learn about the options and choose what is right for you personally.”
We spoke with Dr. Steven Waggoner Division Chief, Gynecological Oncology, UH Case Medical Center Associate Professor, Obstetrics and Gynecology, CWRU School of Medicine, to find out what else women should know about the risks for ovarian cancer and the implications of having your ovaries removed before menopause.
1. “The risk of getting ovarian cancer before 40 with a mutation in the BRCA1 gene is quite small,” Dr. Waggoner says. “It averages a few percent.” And in fact, not every woman with that genetic mutation is destined to get ovarian cancer. “Most would not,” he says.
2. On the other hand, we still have no proven way to detect ovarian cancer at a stage where it can be reliably cured.
3. As Jolie points out, an alternative to her surgery is to have only your Fallopian tubes removed, leaving your ovaries intact. This makes it possible for a woman to still get pregnant or have her eggs harvested (you can’t do that if your ovaries are removed). However, Waggoner points out that this method is still being tested. It looks promising so far, but doctors don’t have incontrovertible proof that it prevents death by cancer, yet.
4. Jolie mentions that she was advised to have her surgery 10 years before she reached the same age when her mother had cancer. However, this advice also depends on how close you are to 40, when your risk level rises significantly.
So, Waggoner says, “If a woman’s mother was unfortunate enough to develop ovarian cancer at 35, we would not normally advise removal at age 25.” On the other hand, if her mother had ovarian cancer at 65, and that cancer was related to a BRCA mutation, he would not advise her to wait until she was 55 to have her ovaries removed.
5. Ovaries don’t just produce eggs. They also serve important functions in your hormonal activity. You will go into menopause immediately when you have them removed. That’s not the case if you have only your Fallopian tubes removed.
6. “Removing your ovaries prior to menopause does seem to lower your risk of developing breast cancer,”Waggoner says. It also lowers your chances of previously treated breast cancer from recurring in women with BRCA mutations.
7. On the other hand, doctors are still learning about all the possible consequences of removing ovaries are(aside from early menopause). “We’ll need to wait another 10 to 20 years before enough women [who had their ovaries removed as a preventative measure] have been studied for a long enough period of time to see what the long-term consequences are.”
We do know that your risk of osteoporosis rises following surgically-induced menopause. Waggoner adds that there are signs could your risk for coronary heart disease as well, but that’s not conclusive.
8. Bottom line, women should know that this is a complex question with many factors to weigh. “It’s an individual decision,” Waggoner says, “and the assessment of risk has to be based carefully on family history, number of relatives with cancer, as well as the results of ongoing tests to screen for conditions which could predict the onset of ovarian cancer more than just the gene mutation itself.”
Jolie takes great pains to make the same point in her op-ed. But there were certain aspects of the question that seemed starkly simple. “The beautiful thing about such moments in life is that there is so much clarity. You know what you live for and what matters. It is polarizing, and it is peaceful,” she writes. “I know my children will never have to say, ‘Mom died of ovarian cancer.'”
What do you think of Angelina Jolie’s decision to have her ovaries removed?