Angelina Jolie's Second Preventive Surgery: FAQs
Why the actress had her ovaries removed, and how other women can reduce their risk of ovarian cancer
On Tuesday, actress and filmmaker Angelina Jolie Pitt, 39, once again told the world intimate details about her health, describing in a New York Times' opinion piece how she has undergone a second preventive surgery, this time having her ovaries and fallopian tubes removed to reduce her risk of ovarian cancer.
Two years ago, Jolie Pitt was just as candid about her double mastectomy, done as a precaution to reduce her risk of breast cancer. After her mother died of ovarian cancer, the actress found out she carries a mutation in the BRCA 1 gene, which boosts her risk of breast cancer by 87 percent and her risk of ovarian by 50 percent. Besides losing her mother to cancer, Jolie Pitt has had an aunt and grandmother succumb to cancer, too.
While surgery isn't the only option for people at dramatically increased risk of ovarian cancer, Jolie Pitt explains that she and her doctors decided it was best for her.
SafeBee turned to C. Bethan Powell, MD, a gynecologic oncologist at Kaiser Permanente Northern California Gynecologic Cancer Program, San Francisco, to address questions about the surgery Jolie Pitt had, the ovarian cancer risk associated with BRCA mutations and how to reduce it.
What exactly did Jolie Pitt have done and how will it reduce her cancer risk?
She had surgery to remove the ovaries and fallopian tubes (which carry a woman's eggs from the ovaries to the uterus), a procedure known as a bilateral salpingo-oophorectomy, Powell says. It was done laparoscopically, which means a lighted thin tube and a camera were used to make the procedure less invasive. "The reason to take out the tubes, which is important, is that we think a lot of ovarian cancer originates in the fallopian tubes," Powell says.
"It's a pretty straightforward surgery and it's recommended for people who have BRCA mutations or other genetic mutations [that increase ovarian cancer risk]. It's recommended in women who have hereditary risk because it is incredibly effective at reducing ovarian and fallopian tube cancer, up to 80 or 90 percent," Powell says.
Why did she decide on surgery?
In her New York Times piece, Jolie Pitt explains that this second surgery has been in the plan, but she opted to do it now after recent tests revealed elevated levels of inflammatory markers that might indicate signs of early cancer. While her doctors found no evidence of cancer, she decided now was a good time to undergo the preventive procedure.
What are the other options to reduce risk?
Birth control pills can reduce a woman’s risk of getting ovarian cancer by about 50 percent, Powell says. Another approach, tubal ligation, which removes a portion of the fallopian tube, may also reduce risk, as may removing the fallopian tubes while preserving the ovaries, she says. But the amount of risk reduction is not clear. It may be up to 50 percent, she says, but the evidence is not conclusive. A national study is under way to better evaluate that approach, she says. Or women can choose to be closely monitored.
How risky is the kind of surgery Jolie Pitt had?
"It's low risk," Powell says. If just the tubes and ovaries are removed, while leaving the uterus intact (the approach chosen by Jolie Pitt), the risk of any major complications is less than 1 percent, Powell says. The procedure takes about 45 minutes. If the uterus is also removed, that can add a half hour, Powell says.
What are the effects of the surgery Jolie Pitt had?
"She will be in premature menopause," Powell says. However, she can opt for hormone replacement, Powell says, to minimize menopausal symptoms such as hot flashes and night sweats. Jolie Pitt writes that she is wearing a patch that delivers bio-identical estrogen (made from plant chemicals) and had an IUD inserted that releases progesterone. In general, Powell says, doctors believe women like Jolie Pitt can stay on the estrogen replacement, depending on their level of risk, until about age 45. Jolie Pitt may be able to stay on longer, Powell says, since her risk of breast cancer has also been reduced due to the preventive mastectomies.
How many other women are in the same situation and will be faced with this decision?
In the United States, about 1 in 400 women have mutations in BRCA 1 or BRCA 2 or other mutations that elevate their risk of breast and ovarian cancer, Powell says. "But only 25 percent know they have it." In some groups of women, such as women of Ashkenazi Jewish descent, the chances of having the mutations are much higher, Powell says.
Was the surgery the right decision for Jolie Pitt?
Decisions are individual, Powell says, and should be tailored to the person, the type of genetic mutation they have, family history and other factors. The actress' decision is in line with national guidelines from professional organizations such as the American College of Obstetricians and Gynecologists, which recommends offering women the option of removal of their ovaries and fallopian tubes by age 40, or when childbearing is finished, Powell says.