Due to a mutation in the BRCA1 gene, Angelina Jolie’s risk of developing breast cancer was 87% and her risk of ovarian cancer was 50%. Having lost her mother, grandmother, and aunt to cancer, she also faced a strong family history of the disease. We already knew Jolie wasn’t the average woman. Her cancer risk is yet another way in which she doesn’t represent the majority. In 2013, she wrote about her decision to have a preventive double mastectomy, a procedure thought to lower breast cancer risk by about 95% in women with a BRCA gene mutation, according to the National Cancer Institute. This week, she wrote about a second preventive surgery, a laparoscopic bilateral salpingo-oophorectomy, or the removal of her ovaries and fallopian tubes. Ovary and fallopian tube removal has been shown to cut risk of ovarian cancer in high-risk women by about 90%. MORE: What Every Woman Needs To Know About Ovarian Cancer “Risk-reducing bilateral salpingo-oophorectomy is probably the most important option for preventing ovarian cancers in women with the highest risk of these malignancies,” says Amanda Nickles Fader, MD, the director of gynecologic oncology at Johns Hopkins. While it’s not a cancer-free guarantee—women with a BRCA mutation are still susceptible to a rare but related cancer called primary peritoneal cancer in the lining of the abdomen and pelvis even after having their ovaries removed—it’s one of very few measures that are so effective in preventing cancer, adds Karen Lu, MD, director of the High Risk Ovarian Cancer Screening Clinic at the MD Anderson Cancer Center. Of course, every woman is different, and the decision to opt for surgical treatment is not made lightly. As Jolie writes, “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.” In her particular case, Jolie’s doctors agreed surgery was the wisest option, she writes. Indeed, for most women with an extremely high risk for ovarian cancer, this is the standard of care, says Lu. For women with a BRCA1 mutation like Jolie, the medical recommendation is to remove the ovaries and fallopian tubes between ages 35 and 40. (For women with a BRCA2 mutation, surgery should occur between ages 40 and 45.) “We’re not talking about any woman, or even any woman who has a family history of ovarian cancer,” says Lu. “We’re talking very specifically about women with these gene mutations, who have an extremely elevated risk of a lethal cancer for which there’s no early detection.” By the time a woman shows symptoms of ovarian cancer, she says, it’s already in a later stage. Women with the BRCA genes will have an extraordinarily high risk as long as they still have their ovaries and fallopian tubes. Jolie’s message is appropriate inspiration for women who are also in the high-risk boat. A 2014 UK study examined this so-called “Angelina effect” and found that after she wrote about her first surgery, twice as many women sought genetic testing for BRCA mutations and calls to the UK’s Hereditary Breast Cancer Helpline increased 10-fold. MORE: 10 Cancer Symptoms Most People Ignore “There just isn’t enough public awareness of the below-the-belt women’s cancers,” says Fader, who calls Jolie’s op-ed courageous. “I think by her coming out and talking about the decisions and how she made those decisions makes it easier for women to feel like it’s not so lonely for them to make those decisions,” agrees Lu. The downside of the Jolie effect Most of us don’t have movie-star husbands (let alone movie-star husbands who will hop on a plane from France when we’re facing scary health news). Most of us also don’t have the kind of cancer risk Jolie is facing. In fact, only about 2% of women have a strong family history of breast or ovarian cancer, according to the Centers for Disease Control and Prevention. Greater public awareness inevitably inspires all of us, regardless of our risk, to wonder if we should seek testing. Thing is, most of us simply won’t benefit from it. There is no effective system of early detection for ovarian cancer, says Fader, which is why experts don’t recommend any screening at all for women with average risk. Among the general population, women can lower their risk of ovarian cancer by taking oral contraception for at least 10 years consecutively, says Fader. Getting pregnant, breastfeeding, and having a tubal ligation have also been found to lower lifetime ovarian cancer risk. Should you get tested for BRCA? The more close family members you have who have been diagnosed with breast or ovarian cancer, the greater your risk of developing cancer yourself, particularly if those relatives were diagnosed at a young age. A strong family history is a good indicator that a woman might want to consider genetic testing, says Fader. Mothers, sisters, and daughters are considered particularly relevant “first-degree” cases, while aunts, nieces, grandmothers, and granddaughters are considered second-degree—still relevant, but less so. Examples of what classifies a person as high or low risk can be found on the CDC’s website here. “It is not easy to make these decisions,” writes Jolie. “But it is possible to take control and tackle head-on any health issue. Knowledge is power.” MORE: 9 Things That Impact Your Risk of Breast Cancer
