Angelina Jolie’s Decision

The need for preventing, treating, curing breast and ovarian cancers

mammographyContributed by Heather Pulaski, MD

I recently read Angelina Jolie’s editorial in the New York Times about her decision to have a double mastectomy and, a few days later, about her plans to also have her ovaries removed. You may believe her decision is too extreme or maybe you think it is brave and selfless. For me, what sticks out is that she felt empowered to make her own decision and she wants to empower other women to do the same.

While genetic testing will help women to better understand their risks for breast and ovarian cancer, it also ushers us into a new era where women will be faced with difficult decisions like Ms. Jolie. We in the medical community must be ready to help women understand their options and work through decisions that women didn’t even consider five years ago.

The American Cancer Society estimates that in 2013, about 22,240 new cases of ovarian cancer will be diagnosed and 14,030 women will die from ovarian cancer in the United States. While all cancers develop from changes that occur at the genetic level, not all of those changes are inherited from a parent. Only 5-15 percent of ovarian cancers are thought to occur from an inherited genetic mutation. But for patients with a BRCA mutation like Ms. Jolie, their lifetime risk of ovarian cancer may be as high as 50 percent.

If you’re concerned you may be at high risk for breast and/or ovarian cancer based on your family history, talk to your doctor. A simple, noninvasive test of your saliva can be performed. Women found to have a genetic mutation, should have an extended discussion with their doctor regarding the options for increased screening versus risk-reducing surgery. Armed with this knowledge, she can take some control over her future. Since there is no good screening test for ovarian cancer, many women choose to undergo surgery to remove their fallopian tubes and ovaries once they have completed their families. This can decrease their cancer risk by about 80 percent. This decreased risk for cancer, though, must also be balanced with the risks of surgery and the likely induction of premature menopause.

While we continue to hunt for a cure and better treatment options for breast and ovarian cancer, I hope you will feel empowered to take care of yourself as much as possible. Exercise, eat a healthy diet and be aware of of ovarian cancer symptoms which include swelling or bloating, pain in the belly, trouble eating, and bladder symptoms.

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