This week Hollywood star Angelina Jolie raised cancer prevention awareness through an op-ed she wrote in The New York Times that described how, after a scare from a blood test tracking cancer markers, she completed a laparoscopic bilateral salpingo-oophorectomy in which her ovaries and fallopian tubes were removed.
Two years ago, Jolie publicized her decision to undergo a prophylactic double mastectomy after learning she carried a cancer-linked mutation on her BRCA1 gene, one that has been found to occur more frequently among Ashkenazi women. The foremost researcher of these mutations, Dr. Steven Narod told The Times of Israel at the time that “She didn’t ask me, but I would have recommended an oophorectomy [removal of the ovaries] as well.”
Narod’s recommendation then, which Jolie followed this week, is based on a recently published study showing that women with BRCA1 and BRCA2 mutations who underwent this surgery experienced a 77 percent reduction in their overall risk of death by age 70.
The idea behind these prophylactic surgeries in BRCA carriers, as Narod explained it, is simple: it is easier to prevent cancers than detect them; therefore the removal of potential tumor locations will almost always defeat the cancer.
Most women have a 12 percent risk of breast cancer; those carrying a mutation on a BRCA gene have a five times higher likelihood. A new conclusion from Narod’s international study, published in 2014 in the Journal of Clinical Oncology, suggests that women with BRCA1 mutations should have preventive ovarian surgery by age 35.
“To me, waiting to have oophorectomy until after 35 is too much of a chance to take. These data are so striking that we believe prophylactic oophorectomy by age 35 should become a universal standard for women with BRCA1 mutations,” said Narod, professor of medicine at the University of Toronto in Canada and director at the Women’s College Research Institute’s Familial Breast Cancer Research Unit.
Jolie, 39, stated in her op-ed that she’d been advised to undergo the surgery at her current age, which is a decade before the onset of her mother’s ovarian cancer at 49. Jolie also lost her grandmother to ovarian cancer.
Jolie’s genetic profile as a woman of French-Canadian descent puts her, like Ashkenazi Jewish women, in a higher risk category for the gene mutations. Back in 1995, Narod and a team of scientists discovered the link between Ashkenazi Jewry and the BRCA mutations. In Jewish women, the mutation is linked to 12% of breast cancers and 40% of ovarian cancers.
Narod’s new Hereditary Ovarian Cancer Clinical Study, which began in 1995 and concluded in 2011, included researchers from Canada, the United States, Poland, Norway, Austria, France, and Italy, who identified women with BRCA mutations from an international registry.
The researchers found that oophorectomy reduced the risk of ovarian cancer for BRCA1 carriers by 80 percent overall, but delaying the surgery until age 40 raised the risk of ovarian cancer to 4% (from 1.4% in the general population), and waiting until age 50 increased the risk to 14.2%.
Other findings from this study showed that a prophylactic oophorectomy for carriers of the BRCA1 mutation reduced the risk of breast cancer by 48%. Once a patient was diagnosed with breast cancer, the surgery still lowered the risk of death from the disease by 70%.
‘When a woman has a mastectomy or oophorectomy, she has a tremendous sense of relief’
“When a woman has a mastectomy or oophorectomy, she has a tremendous sense of relief,” Narod told The Times of Israel in 2013.
Jolie echoed Narod’s statement in her op-ed.
“I feel feminine, and grounded in the choices I am making for myself and my family. I know my children will never have to say, ‘Mom died of ovarian cancer,'” she wrote.
Narod is vehement about the importance of early testing, especially in Israel where the rates of potential BRCA mutation carriers are much higher per capita than elsewhere in the world.
“It is natural to do it in Israel… natural to offer it when women go into the army,” said Narod. He suggested that just as testing for Tay-Sachs and other Jewish-linked genetic diseases is sponsored by the government, so too should testing for BRCA mutations. The earlier women are aware of their genetic status, the more options they have.
In her op-ed, Jolie also pushed women to become informed about their healthcare choices.
“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,” wrote Jolie.
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