By now, millions of women will have read about Angelina Jolie's latest surgery. It was only two years ago that she first revealed that she had prophylactic surgery to remove her breasts in order to prevent breast cancer.
The positive public awareness generated by her revelations is comparable to the Ice Bucket Challenge for ALS and the pink cleats worn by NFL players for breast cancer awareness. This type of awareness saves lives.
In her Diary of a Surgery Op-Ed piece published in the New York Times last week, Ms. Jolie eloquently explains her brave, educated decision to have her ovaries removed.
There are no good screening tests to identify who will get ovarian cancer. In addition, 75 percent of women who get ovarian cancer are diagnosed with advanced stage disease. The American Board of Obstetrics and Gynecology recommends that women who have BRCA1 or BRCA2 mutations be offered risk-reducing salpingo-oophorectomy by age 40 or when childbearing is complete. This surgery yields a 96 percent reduction in ovarian cancer risk.
It is true that ovarian removal in a premenopausal woman will place her into a surgical menopause. While the effects of menopause can be severe in some, others may be completely asymptomatic or have minimal effects. In addition, there are strategies for minimizing these effects, including calcium and vitamin D supplementation for bone health, exercise, vaginal lubricants, and medications that suppress hot flashes.
Hormonal options may work better, but some fear they may be dangerous. Low-dose estrogens with a progestin to help gain a hormonal balance are usually effective.
For those women who choose ovarian preservation, there are options. Oral contraceptive pill use is protective against ovarian cancer. Close surveillance is required to ensure that early changes in the ovaries can be identified as soon as possible. This includes routine pelvic ultrasounds and serial CA-125 blood tests. In addition, there is new evidence that removal of the tubes only (salpingectomy) may be effective in reducing the risk of ovarian cancer.
Once a woman decides to have surgery, it is important to choose a surgeon she is comfortable with and a hospital where she feels safe and well cared for, and to have it scheduled in a timely, convenient manner.
Often overlooked is the proper pathologic consultation. According to the American College of Obstetrics and Gynecology, all tissue from the ovaries and fallopian tubes should be removed, and a complete, serial sectioning that includes microscopic examination for occult cancer should be conducted.
This may require consultation with a large, university-based pathology practice.
The best way to treat cancer is to prevent cancer. By better identifying high-risk women, we can employ treatment strategies that can help save lives.
– Brian M. Slomovitz, M.D.
Dir., Ovarian Cancer Early
Sylvester Comprehensive Cancer Center
–Ira Karmin, M.D.
Chairman, Department of OB/GYN
UM Miller School of Medicine