By Dennis Thompson
HealthDay Reporter
TUESDAY, March 24, 2015 (HealthDay News) -- Angelina Jolie's decision to talk about the removal of her ovaries has brought new public attention to what is actually standard preventive care for women whose genetics dramatically increase their risk of ovarian cancer, experts say.
In a column published Tuesday in the New York Times, Jolie wrote about deciding at age 39 to have her ovaries and fallopian tubes removed, based on the increased risk of ovarian cancer posed by a mutation she carries in the BRCA1 gene.
"It can seem awfully young, but that really is the standard of care, to consider removing the ovaries and fallopian tubes in the late 30s to early 40s, after women have completed their families," said Dr. Jill Whyte, a gynecological oncologist at the North Shore-LIJ Cancer Institute in Lake Success, N.Y. "That's because the risk of cancer does seem to increase quite a bit after age 40."
Two years ago, Jolie announced that she had undergone a preventive double mastectomy, after learning that she carried a mutation in the BRCA1 gene that gave her an estimated 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer.
She already had planned to follow up her mastectomy with removal of her ovaries, according to her column, but decided to move ahead with the surgery earlier than expected after a dodgy blood test renewed her cancer worries.
Jolie lost her mother, grandmother and aunt to cancer. Her mother's ovarian cancer was diagnosed at age 49.
In her article, Jolie stressed that the decision to have her ovaries removed was personal, and should not be read as a call for all women with a BRCA1 gene mutation to follow in her footsteps.
"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 wrote. "There is more than one way to deal with any health issue. The most important thing is to learn about the options and choose what is right for you personally."
Dr. Otis Brawley, chief medical officer for the American Cancer Society, said that's a very important point that should be underscored.
Jolie's specific BRCA1 mutation dramatically increases her risk of breast and ovarian cancer, but other women carry BRCA mutations that only influence their risk mildly or moderately, Brawley explained. Surgery might not be the best option for them.
"If I had been advising her, I would have advised her to do much as she has done, including the research that she did before making her decisions to have surgery," he said. "At the same time, I do worry there's a lot of very low-risk women who opt for surgery, and if they understood how low their risk is, they would not."
Other women might benefit more by receiving regular check-ups and taking medications shown to reduce cancer risk, Brawley said.
But by so openly discussing her decision, Jolie has removed some of the mystery surrounding what is a common procedure to prevent a particularly deadly cancer, said Dr. David Fishman, a gynecological oncologist at The Mount Sinai Hospital and director of the Mount Sinai Ovarian Cancer Risk Assessment Program.
"I think her willingness to make a topic common knowledge and take it out of the shadows is heroic, because she's going to make individuals think about this and I think she's going to be responsible for saving many people's lives," Fishman said.
About 1.4 percent of women in the general population will develop ovarian cancer sometime during their lives, according to the U.S. National Cancer Institute.
By contrast, 39 percent of women who inherit a harmful BRCA1 mutation and 11 percent to 17 percent of women who inherit a harmful BRCA2 mutation will develop ovarian cancer by age 70, the cancer institute says.
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