After hearing news today of Angelina Jolie’s brave decision to remove her ovaries and fallopian tubes in an attempt to prevent ovarian cancer, we asked the Wellbeing of Women why she opted to have this done, and whether such a drastic option is justified.
Why has Angelina Jolie had surgery?
Ovarian cancer is a term that is used to describe several different types of cancer that develop and grow in and around the ovary. The most common type is called “high grade serous”. Most high grade serous cancer just happens by chance but about 15% occurs because of a faulty gene which is passed down through families. There are two genes which can cause this, these are called BRCA1 and BRCA2. Most people carry two normal copies of each of these genes but some people carry a faulty copy of one or other of them (nobody ever has two faulty copies, embryos can’t develop without at least one normal copy).
Angelina Jolie has an abnormal copy of the BRCA1 gene. This means that her risks of developing breast and ovarian cancer are much higher than someone who does not have a faulty gene; the risk of her developing breast cancer is over 50% in her lifetime, compared to about 12% for non gene carriers and her risk of developing ovarian cancer is about 50% compared to 1-2% for non gene carriers.
Surgery, in the form of removing the tubes and ovaries reduces the risk of cancer significantly; removing the tubes and ovaries for Angelina reduces her risk of developing ovarian cancer to about 1%. It’s important to realise though that neither operation removes the risk completely.
How did Jolie know she had the abnormal gene?
Ms Jolie underwent testing because several members of her close family had previously had breast and ovarian cancer. This is how most cases are identified. It’s important to remember though that most cases of breast and ovarian cancer are not related to an abnormal gene.
Testing is relatively simple and just involves a blood test but the implications of having the test are significant. Everyone deals with risk and knowledge differently and whilst some people want to know everything, others would much rather not know. Both viewpoints are equally valid and deciding whether to have the test can be difficult as it needs to include the views of other members of the family.
How can I get the test?
If you appear to be at risk of carrying the gene, because of a strong family history, then you can be referred by your GP to a genetics service who will further assess your risk and discuss with you whether the test is available based on this risk.
Are there alternatives to surgery if I have a faulty gene?
Deciding to proceed to surgery can be a difficult decision, particularly deciding when to have the operation. Screening with ultrasound and blood tests has been considered as an alternative. Although it is not as effective as surgery it can sometimes be used as a strategy until the timing of surgery is right.
If I have the faulty gene what are the implications for the rest of my family?
Each child of someone who has a faulty gene has a 50% chance of inheriting it. For boys this doesn’t seem to cause too much of a problem (a slight increase in prostate cancer and a small increase in the risk of male breast cancer) but of course they then have a 50% chance of passing it onto their own children
Children who do not inherit the faulty gene have the same risks of cancer as the rest of the population and their children are at no increased risk either.
If you wish to invest in research to develop new treatments to tackle gynaecological cancers, please visit Wellbeing of Women’s website.
Professor Richard Edmondson is chair of Gynaecological Oncology at the University of Manchester and runs the Edmondson Lab focused on understanding the role of DNA damage repair in ovarian cancer. He was awarded an MD from Newcastle University in 2002 for his work investigating the biology of the ovarian surface epithelium which led to his current interest in ovarian cancer biology. He was appointed as a consultant in Gateshead and honorary senior lecturer in Newcastle in 2005 and since then, in addition to developing techniques in extended surgery for ovarian cancer, he has developed a translational research group investigating potential therapeutic biomarkers.
Wellbeing of Women has been working with Professor Edmondson since 2010 when he joined their Research Advisory Committee – a unique group of the UK’s top clinical academics who advise the charity on how best to target funds in order to address the key health issues facing women and their babies. The charity has also funded his work directly since 2012 firstly into the use of predictive biomarkers in potentially hormone responsive gynaecological cancers and more recently to support his team in their work on targeting both ovarian and womb cancer through this approach.
And we have just selected a project in 2015 to fund – Dr Lynne Warrander investigating DNA repair in womb cancer cells.