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April 16, 2015

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Jolie’s surgery not only choice for many

When Hollywood superstar Angelina Jolie announced last month that she had had her ovaries and fallopian tubes removed in preventative surgery over fears she could contract ovarian cancer — to which she is genetically vulnerable — some women questioned whether they should consider the same operation.

Two years ago, Jolie underwent a preventive double mastectomy to avoid breast cancer, to which she is prone to due to a mutation of her BRCA1 gene.

Announcing the latest preventative surgery, 39-year-old Jolie said she had possible markers for early stage cancer, linked to her BRCA1 mutation.

She said this meant that her lifetime risk of developing ovarian cancer was 50 percent.

Though further tests indicated that she was cancer-free, Jolie decided to undergo surgeries anyway.

Women who carry a BRCA1 or BRCA2 mutation have a significantly higher risk of developing breast and ovarian cancers.

Usually, women with the mutations have an 80 percent of risk of developing breast cancer. Women with a mutation on BRCA1 have a 55 percent of developing ovarian cancer, while the figure is 25 percent for those with a BRCA2 mutation.

But city experts said cancer is decided by many factors and removing all the risks is impossible.

Preventative surgery is not appropriate in many cases and may not remove the risk of other forms of cancer, they added.

Dr Kang Yu from the Gynecology and Obstetrics Hospital of Fudan University said BRCA1 and BRCA2 are good genes in themselves, effective in preventing cancer. However, their protection vanishes if they undergo mutations.

“For those with BRCA1/2 mutations, preventative resection of the ovaries and fallopian tubes can lower the risk of breast cancer and ovarian cancer," said Kang.

“However, the mutations are also associated less strongly with several other cancers, such as cervical cancer, uterine cancer, pancreatic cancer, early onset prostate cancer, colon cancer, stomach cancer, gallbladder and bile duct cancer,” Kang said.

“Removing the ovaries doesn’t reduce the risk of these cancers,” she added.

“And we can face problems if we remove the ovaries for cancer prevention. Women who have their overies removed can experience an early menopause, as well as a risk of cardiovascular diseases.

“These are closely related to the dropping of female hormone levels on losing the ovaries,” said Kang.

New drugs are under development to target BRCA1/2 mutation and may offer alternative treatments, experts said.

Kang said Jolie’s choice was necessary and wise, as she not only has the BRCA1 mutation but also has a family history, as her mother, aunt, uncle and grandparents all had cancer.

That’s why she underwent surgery to remove her ovaries and fallopian tubes on the advice of her doctors, even though a cancer marker in a blood test indicated that she may only had a benign tumor after detecting ovarian cyst.

But Kang said women needn’t panic on learning about Jolie’s decision.

For women who don’t have a family history of ovarian cancer, the risk of delevoping the disease is 1.4 percent.

Where there is a family history of breast cancer or ovarian cancer, women shoud receive screening for BRCA1/2 gene mutations.

For those with a family history of BRCA1/2 mutations and cancer, women can undergo preventative ovary and fallopian tube removal surgery at around the age of 40, said Kang.

“A healthy lifestyle, regular health checks and early detection and treatment are the key,” Kang said.

“Trust your doctors. Women need to know that they have many options.

“We encourage every woman, especially those with a family history of ovarian or breast cancer, to talk to doctors in order to make their own informed choices,” she added.




 

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