Angelina Jolie Pitt Shares Concerns About Ovarian Cancer RisksJuly 7, 2016
The link between mothers and daughters is enduring and elemental — besides the “family looks” and emotional bonds, mothers may also transmit the genetic risk for cancer. That risk could be substantial. When a family history reveals that four or more close relatives were diagnosed with breast cancer before age 60, the daughter’s chance of developing hereditary breast and/or ovarian cancer is approximately 80 percent.
As actress and filmmaker Angelina Jolie Pitt wrote recently in The New York Times, her doctor commented on how much she looked like her mother. Along with her incandescent beauty, Jolie Pitt inherited a BRCA1 gene mutation that carries an “estimated 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer.” Jolie Pitt considered the risks — three close family members with cancer and her mother’s early death at age 49 — and chose the path that offered more time with her husband and children.
In 2013, Jolie Pitt had a mastectomy to help prevent the occurrence of breast cancer. At the time, her announcement opened the window on women’s gynecological cancer issues. Again, in 2015, Jolie Pitt elected to have preventive surgery. After discussing the alternatives with her doctors, she underwent a laparoscopic bilateral salpingo-oophorectomy — taking out both her fallopian tubes and ovaries.
For Jolie Pitt, who is known to value privacy, the decision to share her family tree and her medical history was a generous act. Thanks to her initiative, we can take three lessons from Jolie Pitt: All women should be educating themselves about HBOC, weighing the costs and benefits of alternative interventions, and acting before it’s too late.
A Quick Breakdown of HBOC
One in 500 women will have an autosomal dominant mutation in the BRCA1 or BRCA2 gene, which is called HBOC syndrome. HBOC increases the risk of breast, ovarian, pancreatic, and prostate cancers and carries a 23-54 percent risk of ovarian cancer.
Less than 1 percent of the general population has a mutation in either the BRCA1 or BRCA2 genes. So if only one family member has had breast cancer diagnosed under age 50, the risk of HBOC is estimated to be 10 percent or less. While genetic predisposition to cancer is considered rare, genetic testing is recommended for a woman:
When her medical history shows that four or more women on one side of her family were diagnosed with breast cancer before the age of 60. (Her chance of HBOC is approximately 80 percent.)
When one female family member has been diagnosed with a gynecological cancer before age 45.
When her family history includes multiple members with diagnoses of breast, ovarian, or pancreatic cancers and she’s of Ashkenazi Jewish ancestry.
When a male relative receives a breast cancer diagnosis.
When a close family member has had more than one cancer of the breast, womb, or bowel.
The Path to Proactivity
For women who have a high risk of developing ovarian cancer, preventive surgery may be indicated. Jolie Pitt, whose risk was elevated by family history and a BCRA1 gene mutation, elected for preventive surgery. This offered her the best chance of long-term survival. Certainly, preventive surgery is a highly individual choice, and some women may decide in favor of one or all surgical interventions — or even an alternative strategy.
While there’s no overall strategy to prevent ovarian cancer, some life events may decrease the risk. For example, research suggests that women who used oral contraceptives for five or more years have about a 50 percent lower risk of developing ovarian cancer, compared to women who never used oral contraceptives.
Women who have given birth or women who have breastfed for one year or more have modestly reduced risks as well. Finally, women who have had a tubal ligation (had their tubes tied), a hysterectomy, or both ovaries removed also have a decreased risk of developing gynecological cancer.
So What’s Next?
For those whose family histories suggest an increased risk of developing ovarian cancer, a blood test may be ordered periodically to measure the level of CA-125, a protein often seen in ovarian cancer cells. This test, although helpful, has limited predictability — CA-125 levels may be elevated in women who do not have ovarian cancer, or they may be low in women who do.
Women considered high-risk may contemplate a transvaginal sonography screening, which images the ovaries with sound waves and does not involve radiation.
Finally, for women with a family history of cancers, the best step in prevention is to seek genetic counseling. They can and should discuss testing for mutations in the BRCA1 or BRCA2 genes with a genetic counselor, who can give detailed information about the testing process. Through genetic testing, women can determine their risks of HBOC, and from there, take action to safeguard their health.
When Angelina Jolie Pitt had the courage to open up about a very personal health matter, it shined a light on the importance of becoming an agent of your own health. Take a cue from her, and assess your risk of developing HBOC — doing so could save your life.