Angelina Jolie’s Surgery and What You Should Know

In a moving and personal op-ed piece, Angelina Jolie announced today that she has undergone surgery to remove her ovaries and fallopian tubes as a preventative measure to lower her risk of cancer.

The actress had planned to have the surgery, but went ahead with it earlier than expected after a test indicated she could be at risk for a tumor.

“I went through what I imagine thousands of other women have felt,” she wrote in today’s New York Times. “I told myself to stay calm, to be strong, and that I had no reason to think I wouldn’t live to see my children grow up and to meet my grandchildren.”

The surgery called, laparoscopic bilateral salpingo-oophorectomy, meant removing her ovaries and Fallopian tubes as a preventative measure, which effectively put the actress into earlymenopause.

Experts say they appreciate how the actress and humanitarian has shined a light on the choice that thousands of women are forced to decide in their lifetime whether to go through a life-changing surgery or live with the risk. We talked to a number of experts to look at the surgery Jolie underwent and its effects.

Who Should Consider Surgery?

After undergoing a bilateral mastectomy two years ago, Angelina Jolie wrote in a previous op-edin the New York Times that she had tested positive for the BRCA1 gene mutation that had left her at a higher risk for both breast and ovarian cancer. Combined with her family history, Jolie said in her op ed today, her doctors recommended she have the surgery to remove her ovaries early, in order to significantly lower her risk of ovarian cancer.

Experts say each woman who tests positive for the BRCA gene mutation (either BRCA1 or BRCA2) or who has a family history of either breast or ovarian cancer should have a discussion with their doctor about preventative measures, including possibly surgery.

Dr. Robert DeBernardo, a gynecologic oncologist in the Department of Gynecologic Oncology at Cleveland Clinic Ob/Gyn & Women’s Health Institute, said women with a BRCA mutation have about a 20 to 40 percent chance of developing the cancer, depending on whether they have the BRCA1 or BRCA 2 mutation, compared with a 1.3 percent chance for all women, according to the National Cancer Institute.

“This is a cancer we can’t detect until it’s advanced,” DeBernardo said. “Once my patients understand the risks, they [often] opt to have the surgery.”

The overall five-year survival rate for ovarian cancer is just 45 percent, according to the American Cancer Society.

Women who have a family history are told to have surgery about 10 years before the cancer first appeared in their family. In Jolie’s case, she had the surgery at 39 because her mother was diagnosed with ovarian cancer at 49, according to her op-ed.

What Does the Surgery Entail?

The surgery is generally safe and can be done laparoscopically through the bellybutton, DeBernardo said. The ovaries and Fallopian tubes are usually removed, although the uterus can also be removed.

“It will take 30 minutes and people go home the same day,” DeBernardo added.

Can You Screen for Ovarian Cancer?

Unlike breast cancer, experts say there is no good screening or test for ovarian cancer that can help doctors find the disease in its early stages.

There’s no “accepted screening test for ovarian cancer; we use things like CA-125 blood test and ultrasounds,” ABC News medical contributor Dr. Jennifer Ashton said. “[They’re] not great screening methods, but it’s all we have.”

PHOTO: Brad Pitt, actress Angelina Jolie and son Maddox Jolie-Pitt arrive at The Board Of Governors Of The Academy Of Motion Picture Arts And Sciences Governor Awards at Dolby Theatre, Nov. 16, 2013, in Hollywood, Calif.
PHOTO: Brad Pitt, actress Angelina Jolie and son Maddox Jolie-Pitt arrive at The Board Of Governors Of The Academy Of Motion Picture Arts And Sciences’ Governor Awards at Dolby Theatre, Nov. 16, 2013, in Hollywood, Calif.

What Are the Effects of the Surgery?

By removing the ovaries in the operation, women will end up going into early menopause. Side effects of early menopause can initially include hot flashes, mood swings and sleep problems.

While hormone-replacement therapy can help, going into early menopause can increase risks for a number of other conditions including osteoporosis and heart disease, according to Dr. Laura Corio, an obstetrician-gynecologist and clinical professor at Mt. Sinai Hospital in New York City.

“There’s risk factors about going through menopause; you have to worry about bones and heart,” Corio said, adding that early menopause can also raise the risk of colon cancer.

Are There Other Options Besides Surgery?

Experts stress there are other options for women at high risk of ovarian cancer besides surgery. Women can take birth control, breast-feed their children or just have their fallopian tubes removed to reduce their risk of ovarian cancer.

Young women who have a family history but have not had children can be closely monitored by their doctors until they’ve finished with family planning and then decide to have the surgery.