Actress Angelina Jolie has made headlines the last two years as she has given details about surgeries to have her breasts, ovaries and fallopian tubes removed in an attempt to reduce her chances of getting cancer.
She said she had the surgeries because of a family history of cancer and the discovery of an inherited mutation in the BRCA1 gene. Doctors had given her an estimated 87 percent risk of breast cancer and 50 percent of ovarian cancer.
Columbus obstetrician/gynecologist Timothy Villegas said Jolie has done a good service by bringing awareness about genetic testing for those people with a family history of cancer.
Surgeon Kenneth Smith, the medical director of breast surgery services for Columbus Regional, agreed and called Jolie's candor about her health "brave."
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"She could save lives," he said.
The physicians also agreed with what Jolie said in an article for the New York Times about a positive BRCA test not meaning a leap to surgery. The film star said there are other options.
"There is more than one way to deal with any health issue. The most important thing is to learn about the options and choose what is right for you," Jolie wrote.
"Getting a positive result on the test can mean we just have to do a good job of surveillance. We have to do more regular testing, so if the patient does get cancer, we catch it early," Villegas said.
Smith added that when talking about breast cancer it should not be forgotten that it also affects men.
The National Cancer Institute describes BRCA1 and BRCA2 as human genes that produce tumor suppressor proteins. These help repair damaged DNA and play a role in ensuring the stability of the cell's genetic material. When either of the genes is mutated or altered, such that its protein product is not made or does not function correctly, DNA damage may not be repaired properly. As a result, cells are more likely to develop genetic alterations that can lead to cancer. Together, BRCA1 and BRCA2 mutations account for 20-25 percent of hereditary breast cancers, 5-10 percent of all cancers and 15 percent of all ovarian cancers.
Removal of the ovaries is called a prophylactic oophorectomy. Villegas said it can reduce the woman's ovarian cancer risk by 80 percent.
Smith said the removal of the breasts, a prophylactic mastectomy, reduces the risk of developing breast cancer by 90 percent.
"It is a proven way to substantially reduce risk but nothing can be 100 percent," Villegas said.
In Jolie's family history, her mother, grandmother and aunt had died from cancer.
Columbus resident Sheryl Wise had her ovaries removed and said the reason she got tested was that her mother died at 58 of ovarian cancer and a sister is a survivor of colon cancer.
Villegas said it is very difficult to detect ovarian cancer until it is in an advanced stage. Symptoms such as bloating, back pain, feeling full and constipation might not seem that serious.
Wise called ovarian cancer the silent killer. "You don't know you have it until its too late," she said.
Her mother began to feel pressure in her stomach and tumors were found. "One was the size of a grapefruit," Wise said.
She said the family hoped the problem was just fibroid tumors. With the help of chemotherapy, her mother lived four years after the diagnosis. Wise had two children and at her age was not having anymore in 2010 when following genetic counseling she decided to have the operation.
"It just made sense to me. It is a tougher decision for someone younger who still might want another child," she said.
Unlike a mastectomy, still a major surgery, Villegas said removal of the ovaries is now done by laparoscopy. Wise was home the same day.
"I had three small incisions. Two weeks later, I was back out running," she said.
Villegas said having the ovaries removed does produce changes to the body.
Losing the hormones produced by the ovaries causes early menopause. Bone-thinning osteoporosis is the result of a reduction in bone-building estrogen.
There is also an increase in the risk of high blood pressure and heart disease.
There are few physical side effects following a mastectomy. Reconstructive surgery is available.
"These surgeries to remove breasts or ovaries are an individual choice, Some people will say do whatever it takes. I think for many people it gives them a little peace of mind," Smith said.