Ovarian Cancer and Angelina Jolie

Cancer rates are on the rise and with the attention on women's reproductive health and cancer risks taking the spotlight more information about ovarian cancer and breast cancer are becoming available every day.

Celebrities help raise awareness and increase fundraising for diseases and social issues when they get involved, but in the case of Angelina Jolie, her involvement in raising awareness about breast and ovarian cancers was more on a personal level than charity awareness level.

Angelina Jolie has been through more than her fair share of health concerns. The actress-director-humanitarian revealed in an 2013 op-ed piece in the New York Times that she underwent surgery to have a double mastectomy. Tuesday morning, The New York Times published another of her op-ed articles, this time revealing that she has had more surgeries to remove her ovaries and fallopian tubes.

Jolie carries the mutated BRCA1 gene, which is the breast cancer susceptibility gene. Two years ago, her Eastern and Western doctors, including Naturopaths and surgeons, estimated that she had an 87% risk of breast cancer and a 50% risk of ovarian cancer unless she underwent surgery. In 2013, she had a preemptive double mastectomy to remove the at-risk tissue. Her intention was always to have more surgery someday. Someday happened two weeks ago.

Her yearly cancer-screening blood test detected a number of inflammatory markers that could be pre-cancerous signals. The advice from her doctors was unanimous. To greatly reduce her lifetime risk, she had to undergo preemptive surgery to remove both ovaries and fallopian tubes.

The following is what you need to know now about Ovarian and Breast Cancer

1 Age of Women at Risk

The women who are at the greatest risk of ovarian and breast cancer are over the age of 40. The closer a woman is to menopause the more immediate her need for screening. Screening for ovarian and breast cancers early gives the woman a fighting chance of finding benign tumors before they become cancerous.

Most of these tests are run by OBG's during routine checkups, but blood tests and family genetic predisposition are good predictors of a woman's susceptibility of cancer in general.

For women 50 years and older, positive breast cancer rates increase with age. Ovarian cancer is rare in women younger than 40 years old, but their chances of developing cancer increase after menopause. Half of all ovarian cancers are found in women 63 years old and older.

The earlier you begin screening and testing for the various types of ovarian and breast cancers the better. You can perform a self breast check by feeling from your armpit to your breast and around your nipple. If you feel a new lump or bump, you should contact our doctor immediately.

Jolie’s great-grandmother, Virginia Gouwens, died of ovarian cancer at age 53. Jolie’s grandmother, Lois June Gouwens, also died of ovarian cancer, at the age of 45. Jolie’s mother, Marcheline Bertrand, battled ovarian and breast cancer for seven years, and died at the age of 56.

Bertrand’s younger sister, Debbie Martin, died from breast cancer in 2013 at the age of 61. All of these women carried the mutated BRCA1 gene. This is the same one that Angelina carries.

Having the faulty gene wasn’t the only reason why the actress-turned-activist opted for surgery, but it was a substantial factor. Because of the genetic risk in the maternal side of her family, Jolie’s doctors advised preemptive surgery about 10 years before the earliest diagnosis in her female relatives. Her mother was diagnosed with cancer at age 49. Angelina is 39.

2. Genetic Predisposition

Inherited cancer genes can determine whether or not you are at risk for developing cancerous cells. Not all people who have a history of cancer in their family develop cancer in their lifetime, but those who do have cancer in their immediate family (mother or sister with cancer) are 2 times as likely to develop cancer.

So if your mother, and or sister has been diagnosed with cancer you should go for early screening to test for cancerous cells. The further away in your family history cancer is, the less likely your chances of developing cancer.

Studies found links in family lineage that suggest cancer predictors, and that these are strongest when cancer develops in close family circles. If you have been adopted, you may not have any family history to guage your predisposition. In this case the only way to predict cancer is to screen for it.

You shouldn't live in fear of cancer if it runs in your family, it just means that you should take the precautions necessary to prevent yourself from developing cancer. You can do this by keeping your doctor's appointment and being upfront and insistent about your health care needs.

No one is going to advocate for you and your needs more than you, so if need be, get a second opinion if you feel that your doctor isn't listening to your concerns. Usually getting a second opinion in the matter of cancer or serious ailments is best for putting your mind at ease, or to prepare yourself for an upcoming battle.

Doctor's are predicting an increase in elective preventative surgeries because of Jolie, but in the long run this might save some lives. Although you should always weigh your options carefully, take in all the information you can before making a major life decision like elective surgery.

The more you know about your medical history, and the inherited diseases, the reasoning behind choosing surgery becomes clearer. 

3. Preventative Surgeries

There are a number of preventative surgeries doctors can perform to prevent the spread of cancer or to remove cancerous material from your ovaries and breasts. All of these involve going into your body with surgical tools to cut away cancer cells or to get a piece of the suspect material for testing.

For Angelina, the surgery uncovered a small, benign tumor on one ovary. Although tests came back negative, she remained at risk. Because of her predisposition to cancer and her family medical history with cancer that spans generations, she elected to have these surgeries.

Jolie wants young women to be informed if they are interested in undergoing the same precautionary reproductive organ surgery. Women have the option to take out their fallopian tubes, but still retain their ovaries. This procedure would postpone menopause and allow women to still bear children.

A bilateral prophylactic salpingo-oophorectomy involves removal of the ovaries and fallopian tubes. Another less invasive surgery involves small incisions in the woman's abdomen near the belly button where the doctors insert tubes and tools to cut and cauterize the fallopian tubes.

This is another form of birth control commonly referred to as, 'getting the tubes tied.' This surgery is preferred by doctors to a hysterectomy, in which the whole uterus is removed. Most of these surgeries are decided on an individual basis.

A bilateral prophylactic mastectomy involves removing part, but not all of the breast tissue. In order to reduce cancer rates by 90-95% in BRCA carriers doctors will present patients with 2 choices.

The first is a total, or simple mastectomy where slightly more breast tissue is removed to decrease the chances of cancer in the breast. A subcutaneous mastectomy preserves the nipple-areola area and usually involves cutting out the cancerous or suspect material only.

There isn't enough information on the risk reduction of these surgeries to clearly define what benefits can be determined in harm reduction or cancer reduction rates.

4. Alternative Treatment

Surgery isn't always the right course of action for all patients. Although you can opt to have one, you shouldn't necessarily put yourself under the knife if you don't need to. As mentioned above, sometimes an outpatient procedure is enough to prevent a woman from developing cancer, rather than surgery where whole organs are removed.

Studies have shown that the use of oral contraceptives, the birth control pill, are beneficial in lowering rates of ovarian cancer. Some women will benefit from a 50% reduction in ovarian cancer just from taking the birth control pill for more than 4 years.

However, if you've been diagnosed with ovarian cancer, depending on the type and its intensiveness you might prosper from a mixture of chemotherapy and oxygenation and vitamin shots.

Scientists have found that when the cancerous cells are exposed to an increased amount of oxygen and vitamins they are more likely to reduce and become benign (non threatening) from allowing more chemo into the cell to kill the cancerous material.

The treating physician will refer you to the best course of action for you and your medical needs. They will base this decision on your age, genetical predisposition, and stage of cancer you have, if you have any.

Of course, any decision you make regarding surgery will have effects on your body and overall health. Since Angelina has removed her ovaries and fallopian tubes, menopause has been triggered. This comes with complications and side effects. Firstly, this marks the end of the reproductive stage of Jolie’s life.

Secondly, early menopause increases her risk of developing osteoporosis and cardiovascular disease. Since there were no indications of risk in her uterus, nor any uterine cancer in her family, Angelina chose not to have a hysterectomy. 

5. Pregnancy's Impact on Cancer

Studies have shown that women who become pregnant reduce their risk of developing ovarian and breast cancer simply by having children. During the course of pregnancy your cells change to accommodate the developing baby, but at the same time these changes drop your chances of developing these cancers.

Women who have abortions and miscarriages also benefit from the changes in their pysiology because of their body's preparation for childbearing. Carrying a child to full term had no bearing on lowering the risk, simply becomnig pregnant was enough.

Unfortunately, this means women who are unable to have children have a higher risk of developing ovarian cancer. But this doesn't mean that they will definitely develop cancer, just that they are at higher risk.

Prevention is key with cancer. If you get yearly checkups, and take the proactive steps with your doctor and in your life to live healthy and be on top of your well being, you will be in sync with your body and hopefully be able to detect changes early on by getting tests done when you need them or feel that hey are necessary.

Of course if you develop cancer before you have children, you will likely encounter problems with fertility. There are a number of steps you can take to preserve your fertility in this case, such as freeze your eggs, or use a surrogate with your eggs. Whatever you choose to do, know it's in the best interest of your health.

Angelina’s natural child bearing days are done, but her decisions for surgery will set an example for her six kids. Three of her children are adopted while three are biological. Half of all people who inherit the faulty BRCA1 will pass the gene on to their children. Not only is she doing all that she can to live as long as possible for her family, her goal is to help and inform others.

6. Health Impact of Surgery

Ovarian cancer is insidious. It’s a cancer that begins in the ovaries, and often goes undetected until the later stages. When it spreads to the pelvis and the abdomen, it’s difficult to treat, and usually fatal. By the time it shows itself, it’s often too advanced to be curable. An early stage means it’s limited to the ovary when treatment is more likely to be successful.

There are alternatives and not everyone has to jump into surgery. You should choose what's right for your body. Based on Angelina's family history, it was a good decision for her. Jolie encourages others to get advice and learn about life-saving options.

Jolie reminds New York Times readers that these surgeries have not entirely eliminated her risk. You cannot extract all of the danger, but you can extract as much as possible. She also recognizes that every patient is different. It’s a very individual decision that won't be the same for everyone.

She admitted that the decision to have a mastectomy was not easy, but being proactive reduced her likelihood of developing cancer. By undergoing surgery, her risk dropped from 87% to a mere 5%.

Jolie is currently having hormone replacement therapy for a smoother changeover into menopause. Anyone woman who has had a period, taken the birth control pill, or been pregnant can attest to the importance of regulating hormone levels. She also continues to find methods to bolster her immune system to prevent an early demise.

Hormone replacement thereapy is common in women who have hystorectomies and bilateral prophylactic salipingo-oophorectomies. These hormones are neceswsary to offset the menopause that they would go through before their bodies are ready.

Surgery has given Angelina, her six children, and her husband a sense of reassurance. She is fighting the life-threatening disease which took her mother. Still, the inner turmoil must be overwhelming at times. Losing so many family members to the same disease is scary and sad. 

7. Mortality Rate

Thinking about the many others who fought, but didn’t survive is humbling. Staying strong for your partner and children is challenging. It’s enough for anyone to withstand.

Pleasing the public is not her priority. That doesn’t mean that her actions haven’t been influential. Her decision to have a double mastectomy has brought about a demand for genetic testing. This has been dubbed “The Angelina Effect.” There are benefits to hearing about the experiences of others.

Cancer is a very relatable issue for the general public, but Angelina’s high-profile awareness of annual testing is leading other women to follow suit. Jolie has been very open and detailed about her many surgeries.

Considering that ovarian cancer detection is hard is enough to make a woman think surgery is the best course of action. The younger a woman is diagnosed--usually 65 years and younger--the better her chances of survival.

The survival rate sdepend on a number of factors:

  • - how invasive the cancer
  • - the type of cancer
  • - her age
  • - her predisposition

Ovarian stromal tumors, germ cell tumors and fallopian tube carcinoma all have positive survival rates upwards of 35% based on the severity of the disease and the stage the cancer is in when it's found.

Much like ovarian cancer, breast cancer's mortality rate is calculated the same way; stage, age, severity, ecetera. For example a atge 1 cancer patient has a 100% survival rate versus a stage 4 who's rate of survival is only 22%.

Her candor will spark discussions. Making her story public will mean that more lives are likely to be saved. Her bravery also gives hope to those enduring the same fight. Jolie’s revelations educate men and women worldwide, and the options that are available.

I applaud her for being candid about her experiences and choosing to help other women by stimulating the conversation. With the power of people listening to her, advocating for women’s health is commendable. If other women with hereditary cancer get tested, she has undertaken a valuable public service.

It takes courage to remove your breasts and to face the subsequent surgeries. I understand the desire to be around as long as possible for children. I would do anything to extend my high quality of life for not only me, but also my daughter, and other family. If being proactive in treatment would help to avoid such fate, then so be it. My life and my family are more important than having breasts and ovaries.

Someday, we will all be but a memory. It’s simply a matter of how and when. I would be willing to extract any part of my body that threatened my life, even to have just one more day with my family.

Some may find her decision to remove both breasts, both ovaries, and fallopian tubes extreme and severe, yet three immediate relatives died from the same disease that she carries. None of them made it to 62 years of age. I call that extreme and severe. To her, it’s just tissue and organs. Angelina has more important things in her life to preserve.

For Jolie, there is no hesitation to do whatever it takes to improve her chances of a longer life with her partner and her kids. It’s understandable that she wants to be there for her family. She is giving herself a fighting chance, so that her great-grandmother, grandmother, mother, aunt, and all others who have succumbed to this disease did not die in vain.

Looking at the numbers, her doctors thought it was a reasonable thing to do. She elected to have these surgeries, but I would hardly call this elective surgery. Why leave it to chance when you can greatly reduce the risk with surgery, especially is you are at a very high risk? With six children and a husband to think about, it seems like a no brainer.

Jolie is showing us her true self with her actions. While being a beautiful actress, she doesn’t value narcissism as much as others do. Aside from film, Angelina has devoted her life to humanitarian causes. She has worked worldwide on behalf of the homeless, and troubled refugees. Her most recent New York Times message may save even more lives. She is altruistic to the core.

We are all human, regardless of wealth or fame. Fear and pain remain a constant in our lives. Those that offer knowledge and courage give hope to us all. The world is a better place with Angelina Jolie in it.

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