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Angelina Jolie Pitt Again

Posted 3/25/2015

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  No doubt you have all seen or heard the news that was reported in an Op-Ed piece in yesterday's New York Times.  Angelina Jolie Pitt, who ignited a world wide conversation two years ago when she disclosed that she had undergone prophylactic bilateral mastectomies in response to being BRCA1 positive, reported that a few weeks ago, she had her ovaries and fallopian tubes removed. She wrote that she had been considering this surgery for a long time, but had resisted because of the premature menopause that would occur. Recent rising blood markers convinced her that the time had come to act. Blessedly, it appears that her actions were timely, and no cancer was discovered during or after the surgery.

  For lots of non-medical reasons, I suspect that this report will not create the same kind of conversation that happened two years ago. Women who carry a BRCA mutation are told that their risks of developing breast and ovarian cancer are much higher than the normal population. The standard recommendation is to have an oopherectomy, removal of the ovaries, before age 40 (or ten years before the age that one's mother was diagnosed if that is earlier) and either bilateral mastectomies or close surveillance of both breasts.

  We worry more about ovarian cancer because there is no good screening available and it often is not symptomatic and discovered until a later stage. Mammograms are imperfect, as we know, but, combined with annual Breast MRIs, there is an excellent chance of catching a breast cancer very early. Ms. Jolie Pitt's Op-Ed piece indicates that she was having blood markers, the CA-125, done annually, but this is not seen as good screening.

  Young women who are faced with these decisions are in a very tough spot. It is one thing to consider losing one's ovaries if one's family is complete; it is much harder if you are still hoping for a child. An early menopause would not be anyone's first choice, but the experience is variable, and not everyone has a terrible time of it. There are lots of ways to deal with the symptoms, and it eventually gets easier. (and this is not meant to minimize the realities) Ovaries have a vital role, obviously, in fertility, but they are much less obvious day to day. Losing one's breasts is visible all the time, and most women have a psychologically harder time with this loss.

  I want to give you links to two things about this story, both from the Times. The first is a piece that supports her decision with more medical information; the second is her Op-Ed column.

Experts Back Angelina Jolie Pitt in Choices for Cancer Prevention
By PAM BELLUCK MARCH 24, 2015
Cancer experts said Tuesday that the actress and filmmaker Angelina Jolie Pitt was wise to have had her ovaries and fallopian tubes removed last week because she carries a genetic mutation, BRCA1, that significantly
increases the risk of ovarian cancer, a disease so difficult to detect that it is often found only at an advanced,
untreatable stage.
They also said Ms. Jolie Pitt’s decision to discuss her own choices so frankly will encourage women in
similar situations to consider their own options. BRCA mutations cause about 5 to 10 percent of breast cancers
and 10 to 15 percent of ovarian cancers among white women in the United States. It is unclear how common the
mutations are in other racial and ethnic groups.
“Prophylactic removal of ovaries and fallopian tubes is strongly recommended in women before age 40 in
BRCA1 and BRCA2 mutation carriers,” said Dr. Susan Domchek, executive director of the University of
Pennsylvania’s Basser Research Center, which specializes in BRCA mutations. “There is no effective screening
for ovarian cancer and too many women with advanced stage ovarian cancer die of their disease.”
Writing for The New York Times’s Op-Ed page, Ms. Jolie Pitt, 39, said she had expected to have her ovaries
and fallopian tubes removed, a procedure called a laparoscopic bilateral salpingo-oophorectomy, but that a
cancer scare made her decide to undergo the procedure sooner. Her mother, aunt and grandmother died of
cancer.

 Read more: http://www.nytimes.com/2015/03/25/science/experts-back-angelina-jolie-pitt-in-choices-for-cancer-prevention.html

And here is the link to Ms. Jolie Pitt's piece: http://nyti.ms/1LQTwho 

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