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Angelina Jolie: Diary of a Surgery

March 24, 2015

Angelina Jolie has revealed that she has had her ovaries and fallopian tubes removed to prevent her from developing ovarian cancer in a candid piece for theNew York Times.

Actress Angelina Jolie announced she had had her ovaries and fallopian tubes removed to avoid the risk of cancer. Two years ago the star had both breasts removed because of an inherited high risk of cancer. (Reuters)

Nearly two years after writing a much-discussed essay in the New York Times detailing her decision to have a double mastectomy, Angelina Jolie has followed up with more health news: Last week, she underwent surgery to remove her ovaries and fallopian tubes.

“It is not easy to make these decisions,” she wrote in an opinion piecepublished Tuesday. But, Jolie said, “I know my children will never have to say, ‘Mom died of ovarian cancer.’ ”

The surgery, like the double mastectomy Jolie underwent in 2013, was preventive. She carries a gene mutation called BRCA1 that puts her at high risk for breast and ovarian cancers, and three women in her family have died of cancer.

After a blood test revealed high levels of inflammatory markers that could be signs of early cancer, Jolie immediately underwent testing for a tumor. The surgeon who conducted the ultrasound was the same one who treated her mother, Jolie wrote, and the two teared up when they saw one another.

“But we smiled at each other and agreed we were there to deal with any problem, so ‘let’s get on with it,’ ” Jolie wrote.

The tests were negative, but Jolie opted for surgery anyway. Though there are several routes for preventing cancer in women with the BRCA1 mutation, Jolie and her doctors — both Eastern and Western — decided that removing her ovaries and tubes was best for her.

The surgery, called a laparoscopic bilateral salpingo-oophorectomy, effectively puts Jolie in early menopause. The 39-year-old will not be able to have any more children.

“But I feel at ease with whatever will come, not because I am strong but because this is a part of life,” she wrote.

For advocates of breast cancer awareness, Jolie’s essays are a welcome dose of candor on a subject they say is often stigmatized.

A few decades ago, “it would not have been the norm for someone of Angelina’s stature to come out and talk about having this disease, having preventive surgery like this,” Nancy Brinker, the founder of Susan G. Komen for the Cure, told The Washington Post in 2013. “It’s a real testimony to her and to the journey we’ve all gone on in the last 30 years.”

Here is the whole Chronicle of Angelina’s point of view:

LOS ANGELES — TWO years ago I wrote about my choice to have a preventive double mastectomy. A simple blood test had revealed that I carried a mutation in the BRCA1 gene. It gave me an estimated 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer. I lost my mother, grandmother and aunt to cancer.

I wanted other women at risk to know about the options. I promised to follow up with any information that could be useful, including about my next preventive surgery, the removal of my ovaries and fallopian tubes.

I had been planning this for some time. It is a less complex surgery than the mastectomy, but its effects are more severe. It puts a woman into forcedmenopause. So I was readying myself physically and emotionally, discussing options with doctors, researching alternative medicine, and mapping my hormones for estrogen or progesterone replacement. But I felt I still had months to make the date.

Then two weeks ago I got a call from my doctor with blood-test results. “Your CA-125 is normal,” he said. I breathed a sigh of relief. That test measures the amount of the protein CA-125 in the blood, and is used to monitor ovarian cancer. I have it every year because of my family history.

But that wasn’t all. He went on. “There are a number of inflammatory markers that are elevated, and taken together they could be a sign of early cancer.” I took a pause. “CA-125 has a 50 to 75 percent chance of missing ovarian cancer at early stages,” he said. He wanted me to see the surgeon immediately to check my ovaries.

I went through what I imagine thousands of other women have felt. I told myself to stay calm, to be strong, and that I had no reason to think I wouldn’t live to see my children grow up and to meet my grandchildren.

I called my husband in France, who was on a plane within hours. The beautiful thing about such moments in life is that there is so much clarity. You know what you live for and what matters. It is polarizing, and it is

peaceful.

That same day I went to see the surgeon, who had treated my mother. I last saw her the day my mother passed away, and she teared up when she saw me: “You look just like her.” I broke down. But we smiled at each other and agreed we were there to deal with any problem, so “let’s get on with it.”

Nothing in the examination or ultrasound was concerning. I was relieved that if it was cancer, it was most likely in the early stages. If it was somewhere else in my body, I would know in five days. I passed those five days in a haze, attending my children’s soccer game, and working to stay calm and focused.

The day of the results came. The PET/CT scan looked clear, and the tumor test was negative. I was full of happiness, although the radioactive tracer meant I couldn’t hug my children. There was still a chance of early stage cancer, but that was minor compared with a full-blown tumor. To my relief, I still had the option of removing my ovaries and fallopian tubes and I chose to do it.

I did not do this solely because I carry the BRCA1 gene mutation, and I want other women to hear this. A positive BRCA test does not mean a leap to surgery. I have spoken to many doctors, surgeons and naturopaths. There are other options. Some women take birth control pills or rely on alternative medicines combined with frequent checks. 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 personally.

In my case, the Eastern and Western doctors I met agreed that surgery to remove my tubes and ovaries was the best option, because on top of the BRCA gene, three women in my family have died from cancer. My doctors indicated I should have preventive surgery about a decade before the earliest onset of cancer in my female relatives. My mother’s ovarian cancer was diagnosed when she was 49. I’m 39.

Last week, I had the procedure: a laparoscopic bilateral salpingo-oophorectomy. There was a small benign tumor on one ovary, but no signs of cancer in any of the tissues.

I have a little clear patch that contains bio-identical estrogen. A progesterone IUD was inserted in my uterus. It will help me maintain a hormonal balance, but more important it will help prevent uterine cancer. I chose to keep my uterus because cancer in that location is not part of my family history.

It is not possible to remove all risk, and the fact is I remain prone to cancer. I will look for natural ways to strengthen my immune system. I feel feminine, and grounded in the choices I am making for myself and my family. I know my children will never have to say, “Mom died of ovarian cancer.”

Regardless of the hormone replacements I’m taking, I am now in menopause. I will not be able to have any more children, and I expect some physical changes. But I feel at ease with whatever will come, not because I am strong but because this is a part of life. It is nothing to be feared.

I feel deeply for women for whom this moment comes very early in life, before they have had their children. Their situation is far harder than mine. I inquired and found out that there are options for women to remove their fallopian tubes but keep their ovaries, and so retain the ability to bear children and not go into menopause. I hope they can be aware of that.

It is not easy to make these decisions. But it is possible to take control and tackle head-on any health issue. You can seek advice, learn about the options and make choices that are right for you. Knowledge is power.