Remove breasts first, then the ovaries?
March 25, 2015
It's the second time Angelina Jolie has gone public with a surgical operation that most women would want to keep secret.
The 39-year-old actress, who carries a mutation in the BRCA1 gene (the name stands for breast cancer susceptibility gene), has undergone surgery to have her ovaries and fallopian tubes removed, two years after a double mastectomy.
Jolie says she is sharing her experience to help other "at-risk" women understand their options to try to avoid breast or ovarian cancer.
Her decision to undertake a second operation was also driven by her family's medical record.
Three women in Jolie's family have died of cancer. Her mother, actress Marcheline Bertrand, died of ovarian cancer at 56.
Cancer can run in families, but only a genetic test can provide a more reliable risk assessment.
Angelina Jolie took the test and discovered that her own cancer risk was at 85 percent for breast cancer and 50 percent for ovarian cancer.
How does the genetic test work?
The gene mutation testing requires some DNA from a blood or saliva sample, which is sent to a laboratory for analysis.
It usually takes about a month to get the test results.
The genetic test clarifies whether the patient is carrying the mutations BRCA1 or BRCA2.
However, a positive test does not necessarily mean the individual will develop cancer - it merely indicates an increased probability.
Around 60-80 percent of the women with a BRCA1 mutation develop breast cancer. With BRCA2 it's about 45-80 percent.
Positive test results - what now?
If a test confirms the genetic mutations, BRCA1 or BRCA2, the patient should consider a mammography at least every two years.
Doctors also recommend a magnetic resonance tomography (MRT) every three months.
Then there's the Jolie option: prophylactic surgery.
But this does not rule out the risk of cancer completely because not all at-risk tissue can be removed in such operations.
Some cases have been recorded where women developed cancer despite the surgery.
But according to America's National Cancer Institute, "the mortality reduction associated with this surgery is nonetheless substantial."
The factsheet cites one study that showed "women who underwent bilateral prophylactic salpingo-oophorectomy had a nearly 80 percent reduction in risk of dying from ovarian cancer and a more than 50 percent reduction in risk of dying from breast cancer."