News analysis: Angelina Jolie's surgery to 'cut ovarian cancer risk'

Writing in the New York Times, actress Angelina Jolie has announced she recently had her ovaries and fallopian tubes removed as tests showed she had an estimated 50% chance of developing ovarian cancer. This is because previous testing found she was carrying high-risk genes linked with ovarian as well as breast cancer.

This follows a previous announcement in 2013 when Ms Jolie announced she had undergone a double mastectomy (where both breasts are surgically removed) followed by breast reconstruction surgery. This was because the same high-risk genes gave her an 87% chance of developing breast cancer.

Jolie explained: “I had been planning this for some time. It is a less complex surgery than the mastectomy, but its effects are more severe. It puts a woman into forced menopause. So I was readying myself physically and emotionally, discussing options with doctors, researching alternative medicine, and mapping my hormones for estrogen or progesterone replacement.

“Regardless of the hormone replacements I’m taking, I am now in menopause. I will not be able to have any more children, and I expect some physical changes. But I feel at ease with whatever will come, not because I am strong but because this is a part of life. It is nothing to be feared.”

What genes contribute to ovarian cancer risk?

BRCA1 and BRCA2 are faulty genes linked to ovarian cancer. They’re also known to increase the risk of breast cancer.

Having a family history of ovarian cancer, especially if the cancer developed before the age of 50, could mean the faulty genes run in your family.

You may be at a high risk of having a faulty gene if you have:

• one relative diagnosed with ovarian cancer at any age and at least two close relatives with breast cancer whose average age is under 60; all of these relatives should be on the same side of your family (either your mother’s OR father’s side)
• one relative diagnosed with ovarian cancer at any age and at least one close relative diagnosed with breast cancer under the age of 50; both of these relatives should come from the same side of your family
• two relatives from the same side of the family diagnosed with ovarian cancer at any age 

If you’re at a higher risk of having a faulty gene, your GP can refer you for tests to check for faulty BRCA1 and BRCA2 genes.

Ovarian Cancer Action has developed a tool to help you check whether your family history puts you at risk of ovarian cancer. 

What does preventative surgery involve?

If testing suggests you have a high risk of developing ovarian cancer, your doctor may recommend a type of surgery called bilateral salpingo-oophorectomy. This is where both of your ovaries as well as your fallopian tubes are surgically removed.

This should significantly reduce your chance of developing ovarian cancer, though it will trigger the menopause if you have not already gone through it.

This can cause symptoms such as hot flushes and night sweats. Symptoms usually respond well to hormone replacement therapy (HRT). 

Alternative treatments are also available for women who cannot or do not want to use HRT.

What other steps can I take to reduce my risk of ovarian cancer?
Stopping ovulation and the contraceptive pill

Each time you ovulate, your ovaries are damaged by the egg as it breaks through the surface of the ovary and is released into your reproductive system.

The cells that make up the surface of your ovaries divide and multiply rapidly to repair the damage caused by the egg. It’s this rapid cell growth that can occasionally go wrong and result in ovarian cancer.

Anything that stops the process of ovulation can help to minimise your chances of developing ovarian cancer. This includes:

• pregnancy and breastfeeding
• the contraceptive pill
• hysterectomy surgery
• surgery to remove the ovaries

Diet and lifestyle

Research into ovarian cancer has found that the condition may be linked to being overweight or obese. Losing weight through regular exercise and a healthy, balanced diet may help lower your risk of getting ovarian cancer. Aside from this, regular exercise and a healthy, low-fat diet are extremely beneficial to your overall health, and can help to prevent all forms of cancer and heart disease.

Edited by NHS Choices. Follow Behind the Headlines on Twitter.

Links To The Headlines

Angelina Jolie Pitt: Diary of a Surgery. New York Times, March 24 2015

Angelina Jolie reveals she had ovaries removed after cancer scare. The Guardian, March 24 2015

Jolie Has Ovaries Removed After Cancer Scare. Sky News, March 24 2015

Angelina Jolie has ovaries and fallopian tubes removed. BBC News, March 24 2015