September 3, 2019
May 11, 2015
Angelina Jolie's well-publicized decision to have a preventive double mastectomy (surgical removal of both breasts), as well removal of her ovaries and fallopian tubes, focused attention on genetic testing and the choices some women may face to prevent cancer. What does this mean for you?
Angelina Jolie is in a very small group of women with a genetic mutation, BRCA1, which made it very likely she would develop breast cancer or ovarian cancer at some point in her life. Her doctors estimated her breast cancer risk to be 87 percent, far more than a woman’s average risk of 12.4 percent. Her risk for ovarian cancer was 50 percent, compared to the average woman who faces a 1.3 percent likelihood of developing the disease.
Jolie’s mother was diagnosed with ovarian cancer at age 49 and died of the disease when she was 56. Her mother’s cancer was caused by the same genetic mutation. When she learned that she too carried the breast and ovarian cancer gene mutation, Jolie decided to have a preventive mastectomy and breast reconstruction. She estimates the surgery lowered her risk to five percent.
Jolie knew she was at increased risk for cancer of the fallopian tube and ovary, and had been planning for some time to have these reproductive organs removed to reduce the risk of developing cancer in the future. Following blood-tests that showed mixed results with a normal CA 125 and other blood tests indicating possible inflammation, Jolie moved forward with her plan to have her ovaries and fallopian tubes removed. This type of surgery decreases an individual’s the chance of getting cancer of the fallopian tube or ovary by 90-95 percent.
A Drastic Choice Not for Women of Average Risk
It is a drastic choice for an extreme circumstance. As one of the world’s most glamorous and influential women, Jolie has certainly raised awareness of the seriousness of carrying the BRCA1 or BRCA2 mutations, and of the importance of genetic testing to give some women potentially life-saving information.
But genetic testing—and preventive mastectomies and bilateral salpingo-oophorectomies (fallopian tube and ovary removal surgery)—are not for women of average risk of breast and ovarian cancer. Testing may be appropriate for people who are likely to have inherited a mutation, who have a personal or family history of cancer, or who have specific types of breast cancer.
Our online Breast Cancer Risk Profiler can help you learn more about your risk for breast cancer.
Risk Evaluation at Lancaster General Health
The University of Pennsylvania Breast and Ovarian Cancer Risk Evaluation Program at Lancaster General Health serves the needs of women like Jolie. We recommend and provide genetic testing where appropriate and develop customized risk reduction plans consistent with individual health and choice. Some of these plans include preventive surgery; some do not. Many cancers have been prevented and lives saved through this program.
Proceed With Caution
Remember, more than 99 percent of women do not have the BRCA1 or BRCA2 mutations, which cause only five to ten percent of all breast cancers and 10-15 percent of all fallopian tube and ovarian cancer. Most women do not have the inherited genetic risk for cancer like Angelina Jolie. They will not face the choices she had to make.
We must make sure that Jolie’s revelation helps the right women—those in the high-risk category—make the personal choices that are right for them. And even these women need to proceed with caution because preventive mastectomies and fallopian tube or ovary removal may not be the best option in all cases.