I miss this so much I used to look so bloody bad ass!

Once Again Angelina Jolie Confronts Cancer

A woman, whose face has graced movie screens and magazines around the world, has once again stepped into the spotlight to talk about her personal medical history. Nearly two years ago, actress Angelina Jolie made waves by announcing that she had undergone a preventive double mastectomy.

Her very public announcement brought attention to difficult medical decisions made by many women every day regarding their risk of breast cancer, especially for those carrying a mutation in either the BRCA 1 or 2 oncogene, which increases the risk of breast cancer.

This time, in another New York Times Op-Ed Jolie revealed that she recently underwent a salpingo-oophorectomy, a surgical procedure to remove the ovaries and fallopian tubes. She didn’t make this choice lightly. She did a lot of research and spoke to her medical team.

Jolie wrote: “I did not do this solely because I carry the BRCA1 gene mutation, and I want other women to hear this…I have spoken to many doctors, surgeons and naturopaths. There are other options…The most important thing is to learn about the options and choose what is right for you personally.”

Cheryl Saenz, MD, clinical professor in the Department of Reproductive Medicine and gynecological oncologist at UC San Diego Moores Cancer Center, answers three questions about ovarian cancer risk and treatment.

Question: Is a salpingo-oophorectomy the only option for women, like Jolie, who have a high risk of ovarian and fallopian tube cancers because of family or medical history?

Answer: No, the removal of ovaries and fallopian tubes is not the only option to reduce a woman’s risk of ovarian and fallopian tube cancers. A less invasive option for women that have not yet completed their childbearing could be to take birth control pills to reduce their risk or consider regular screening with blood tests and pelvic ultrasounds. Before a prophylactic treatment option is chosen, a woman’s family history, both on her maternal and paternal side, needs to be thoroughly evaluated, going back two or three generations. We must also ask, has she ever used birth control pills, which helps reduce the risk of these cancers, and is she done with childbearing? This is a very individual decision for a woman to make. Genetic testing may be recommended to further evaluate a woman’s health history.

Q: Will having this surgery remove all risk of cancer?

A: Like any surgical procedure, especially one that can send women into early menopause, there are risks. Although the entire ovaries and fallopian tubes are removed, women with high risk of this disease can still develop primary peritoneal cancer (PPC), a rare cancer that forms in the lining of the pelvis and abdomen (the peritoneum). The cells of this cancer are very similar to those on the surface of the ovaries. The chance of developing PPC is much lower, only 2 to 11 percent, but it is possible. If a woman, like Jolie, has a BRCA mutation her chance of getting breast cancer is also higher than most women. That’s why Jolie chose an elective double mastectomy in May 2013.

Q: Are there other risks to consider when faced with a salpingo-oophorectomy?

A: Younger woman should know that their bodies will go into early menopause. The symptoms of a surgical menopause like this can be more abrupt and severe than a natural state of aging. They can be prescribed hormone therapy to alleviate the symptoms, but there are hazards to prolonged hormone therapy. However, these women are at lower risk of breast cancer related to hormone therapy than women who were already in menopause when they started hormone replacement therapy. The decision to start hormone replacement therapy or not is a personal one and a woman should discuss her options with her doctor.

One reason we advocate for the prophylactic surgery is because there is no effective screening for the early detection of ovarian or fallopian tube cancers. The CA-125 blood test that looks for abnormalities and pelvic ultrasounds help detect cancer, but not at the early stage when we can do more about it.