Two years ago, actress and director Angelina Jolie had a bilateral mastectomy to reduce her risk of breast cancer. At that time, Jolie, the mother of six, who had lost her 49-year-old-mother to ovarian cancer, tested positive for an abnormal BRCA1 gene.
On Tuesday, Jolie made headlines again when her op-ed appeared in the New York Times. In the piece, Jolie shared her decision to have her ovaries and fallopian tubes surgically removed following tests that revealed there was a chance of early stage ovarian cancer.
Terry Gibbs, DO, FACOG, an obstetrician/gynecologist with ProMedica Physicians and the medical director for the cancer genetics clinic at Hickman Cancer Center, encourages women who test positive for an abnormal BRCA1 gene to also examine their options.
“There are a number of genes that can cause an increased risk of breast and ovarian cancer,” states Dr. Gibbs. “However, an abnormal BRCA1 gene in particular is the one responsible for an 80% increased risk for breast cancer and a 40-50% increased risk in ovarian cancer. Approximately 1 in 500 people carry the abnormal gene.”
While surgery isn’t the only option, it’s a viable consideration for women who test positive for an abnormal BRCA1 gene. “Surgery should always be a discussed option if you have this abnormal gene,” says Dr. Gibbs. “The risk associated with the elective removal of fallopian tubes and ovaries is usually low” and could be a worthwhile for women with a high risk for ovarian cancer.
That being said, there are post-surgical issues that may need to be addressed. “Taking the ovaries out of a premenopausal woman will cause her to go into early menopause and experience menopausal symptoms,” states Dr. Gibbs. “Many times, the menopausal symptoms, including hot flashes, are often more severe and intense for women after a surgical menopause than those of natural menopause. Also, there is an increased risk of heart and bone problems as well.”
For these reasons, Dr. Gibbs says it’s important for women who elect to remove their ovaries for preventive reasons to receive follow-up treatment to address these concerns. “There are so many treatment options available for bone density and cardiac issues. It’s important to discuss these with your healthcare provider following surgery.”
While screening the BRCA1 gene is a simple blood test, the decision to have genetic testing can be complicated. Dr. Gibbs says that ProMedica’s certified genetics counselor, Kelly Morse, works with patients and physicians to determine if genetic testing is right for a patient, taking into account factors such as family history of cancer.
Surgery may not be the best option for everyone with an abnormal BRCA1 gene, but Dr. Gibbs believes that Jolie made an informed, courageous and wise choice to reduce her cancer risk. “It’s important for patients to have the knowledge and guidance they need to make decisions regarding their current and future health,” he says.
“Even more vital, is that once a patient is given a positive BRCA1 test result, you need to support them the best you can.”
For more information about genetic counseling, please visit ProMedica cancer genetics’ site.