Angelina Jolie gets her ovaries removed: is getting a salpingo-oophorectomy the ultimate solution to prevent breast/ovarian cancer?

Angelina Jolie opted to get her ovaries and fallopian tubes removed recently and it seems to have caught everybody’s attention. There has been a lot of deliberation over the benefits of opting for a prophylactic mastectomy or salpingo-oophorectomy (removal of breast or ovaries + fallopian tubes to reduce the risk of developing breast or ovarian cancer) and whether it’s really necessary.

Here are some facts that you should know before you seriously consider this option:Angelina Jolie gets her ovaries removed

Why Angelina got her ovaries and fallopian tubes removed.
Angelina Jolie tested positive for the mutation of the BRCA1 gene two years ago. Contrary to popular belief, it is the mutation of this gene and not the presence of it that increases the susceptibility of breast/ovarian cancer. This gene is normally found in all women and it helps in repairing damaged DNA. Any mutation in this gene has shown to indicate an increased risk of getting breast cancer (80-90%) and ovarian cancer (50-60%).

Angelina also has a family history of breast and ovarian cancer. She has lost her aunt, mother and grandmother to cancer and there is a high possibility that she may develop it as well.

She tested negative for the CA-125 protein (an indicator of ovarian cancer) but she had certain elevated tumour markers (substances that are produced by cancer or by other cells of the body in response to cancer or certain noncancerous conditions) which could mean early stages of cancer.

She had a double mastectomy two years ago to reduce her risk of breast cancer; a salpingo-oophorectomy further reduces her susceptibility to both breast and ovarian cancer.

Who may consider prophylactic salpingo-oophorectomy ?
• A family history of breast or ovarian cancer: If your mother, sister or daughter has had breast or ovarian cancer, especially if she was diagnosed before the age of 50, you may be at increased risk.

• Positive results from gene testing: Genetic testing can identify mutations in genes such as BRCA1 and BRCA2 that substantially increase your risk of breast and ovarian cancers.

What are the risks of salpingo-oophorectomy?
Although a salpingo-oophorectomy is a fairly simple procedure compared to a double mastectomy, the consequences of the former is more severe. In women who are yet to undergo menopause, oophorectomy causes early menopause. Early menopause carries many risks, including:

Bone thinning (osteoporosis): Removing your ovaries reduces the amount of bone-building estrogen your body produces.

Hormone therapy: You may have to be undergo hormone therapy with hormones such as progesterone and oestrogen to maintain a balance after the surgery.

Discomforts of menopause: Hot flashes, vaginal dryness, sexual problems, sleep disturbance are problems for some women during menopause.

Increased risk of heart disease: The risk of heart disease may increase if you have your ovaries removed.

Lingering risk of cancer. Prophylactic oophorectomy doesn’t completely eliminate your risk of breast cancer or ovarian cancer. The risk of developing a cancer associated with ovarian cancer called primary peritoneal cancer (although low) is still present.

What are the alternatives?
• Increased screening for ovarian cancer: Screening usually includes a blood test for cancer antigen CA 125 and an ultrasound exam of your ovaries.

• Birth control pills: Studies suggest that taking birth control pills reduces the risk of ovarian cancer in average-risk women. There is good evidence that birth control pills can reduce the risk of ovarian cancer and can also be beneficial in reducing risk in high-risk women, such as those with BRCA mutations.
It is important to note that screening tests are not completely conclusive and further evaluation has to be done to arrive at a clear diagnosis.

Prophylactic salpingo-oophorectomy might relieve much of your anxiety about developing either breast or ovarian cancer, but this type of surgery can also take an emotional toll on you. It is absolutely crucial to take the help of your doctor and take your time to consider and explore all your options. More importantly one must remember that every case is considered unique and you must choose the best possible option for you keeping in mind the risks, limitations and the effects on your quality of life.

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