Angelina Jolie’s Recent Choice

What a brave step for Jolie to share publicly her very personal decision to have her ovaries and breast tissue removed (See her op-ed in the May 14, 2013, issue of the New York Times: My Medical Choice). Hopefully she will accomplish her dual goals of cutting her own risk of developing cancer and prompting other women to explore their options so they can be proactive.

The genetic testing for BRCA 1 and BRCA 2 gene mutations can identify specifics risks for breast and ovarian cancer.

Women with a particular Jewish genetic heritage are found to have higher likelihood of these genetic mutations. The testing sometimes has been paid for by insurance, but a consult is usually required (and is recommended) with an OB/GYN oncologist and/or genetic counselor to help determine the level of risk and implications for a particular woman considering the testing and treatment. I do think this step is an important one, and one I chose myself due to my mother’s cancer history. My well-informed OB/GYN oncologist and I could then put into perspective the relative risk I face – which is substantially lower than Jolie’s.

I first heard of this type of surgery about 30 years ago when an old college chum decided to take the step. Back then it was considered way beyond sane, and there was a lot of negative reaction to her “extreme” choice. It took some work to even find a doctor who was willing to do the surgery. Yet, she felt it was the only thing she could do to cut her risk. After all, it was her decision regarding the health of her body, and my friend wanted to be alive a long time for her twins.

Over my career, there have been several women in my practice who have chosen to take the step of removing breast tissue and ovaries due to a strong family history and/or mutant genes. By creating a plan before the surgery, we were able in the immediate post-operative period to keep their hormones well balanced so as to avoid unpleasant and life altering symptoms.

Hormones typically fall dramatically as production stops with ovarian removal.

This is called surgical menopause, and happens with any hysterectomy that includes ovarian removal. And, even when ovaries are not completely removed, there can be a dramatic decline in hormone production after the surgical event that can cause substantial symptoms and begin the process of menopause.

These women, like Jolie, are taking action to create the lowest risk that they can and they need our support with their decision and the adjustments afterwards. If you know of someone faced with this decision, I hope you will be a supportive voice as she decides what is right for her.

If you have a strong family history of some of these diseases and/or a higher risk ethnical background, you know that the option for testing and preventive surgery is there for you.

And, women are not the only ones at risk here.

The last patient I worked with undergoing this type surgery pointed out to me that men who have the BRCA 1 or BRCA 2 gene mutations are also at risk and need to be counseled regarding testing and treatment options. She and her father are speaking out on this issue in an effort to educate more women and men about their risks and choices.

As we learn more about genes, how they get turned on, how they can change due to their environment (epigenetic), and how our gut flora determine a lot about their function, we have a greater ability to find more and more reason to live healthy life styles focused on prevention and optimal life practices that promote balance in our bodies. Stay tuned!

Epigenetics to me means that we have a choice in the environment of our genes – something we can control.

More on that in a future issue!

Happy Summer!

Jane Kennedy, CFNP, MN, MPH

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