Angelina Jolie discusses surgery to avoid ovarian cancer

Angelina Jolie writes of her decision to have surgery to remove her ovaries and fallopian tubes as a way to prevent cancer. Jolie's mother died after battling ovarian cancer and Jolie herself has a mutated BRCA gene associated with increased risk for the disease. Read more about Jolie's decision in the Cancer Center 360.

Two years after undergoing a preventive double mastectomy, actress and humanitarian Angelina Jolie has taken another bold step to protect herself—and her family—from cancer: She had her ovaries and fallopian tubes removed, inducing menopause at age 39.

Jolie’s mother died at age 56 after a 10-year battle with ovarian cancer. Both breast cancer and ovarian cancer, along with other cancers such as uterine and pancreatic, can develop due to a mutation of our BRCA1 or BRCA2 genes. Jolie learned she has a mutated BRCA1 gene, which gave her an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer.

Jolie opted for surgery to remove her breasts, ovaries and fallopian tubes to avoid cancer in those parts of her body altogether. She writes movingly about her latest decision, which was based in part on her doctors finding elevated inflammatory markers that suggested she had early-stage cancer.

“I went through what I imagine thousands of other women have felt,” Jolie says in her op-ed in The New York Times. “I told myself to stay calm, to be strong, and that I had no reason to think I wouldn’t live to see my children grow up and to meet my grandchildren.”

Dr. Justin Chura, Medical Director of Gynecologic Oncology at our Philadelphia hospital, says removing the ovaries and fallopian tubes is an appropriate treatment approach for women with higher cancer risk because of a BRCA mutation. But, for younger women, birth control pills have been shown to decrease cancer risk, as well.

“Interestingly, research suggests that the fallopian tubes may be where the cancer originates, so removal of the tubes while leaving the ovaries intact is an option that can be used to delay surgical menopause,” Chura says. “While not yet proven, this method is being explored as a possibility for high-risk young women who are past child bearing years, but not yet ready for menopause.”

The treatment approach would be to remove the fallopian tubes once a women is done having children and then perform a second surgery to remove the ovaries (and possibly uterus) at a later time. “The approach still needs validation, however, before being adopted into standard practice,” adds Dr. Chura.

Jolie seems to know that her decision to have preventive surgery could influence others to do the same. In her op-ed, she cautions that women with a BRCA mutation should not rush into surgery.

Jolie is part of a growing number of women who have chosen preventive mastectomies over the past decade. While some women have a BRCA mutation like Jolie, the vast majority of women opting for surgery do not. Dr. Dennis Citrin, Medical Oncologist at our Chicago hospital, has urged women who do not have a BRCA mutation to consider other treatment options first. "For most women, a double mastectomy likely isn’t necessary,” he says.

BRCA mutations are responsible for most hereditary breast and ovarian cancers. But the gene mutations are relatively rare. Only 3-5 percent of women with breast cancer and 10-15 percent of women with ovarian cancer have the mutation.

“A positive BRCA test does not mean a leap to surgery,” Jolie writes. “I have spoken to many doctors, surgeons and naturopaths. There are other options. Some women take birth control pills or rely on alternative medicines combined with frequent checks. 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.”

Learn about treatment options for breast cancer and for ovarian cancer.