Angelina Jolie Pitt Takes Action to Reduce a High Cancer Risk

Lessons about cancer and genetic testing from the case of the Oscar-winning actress

In March 2015, Angelina Jolie Pitt wrote an op-ed piece for the New York Times describing her decision to have her ovaries removed to eliminate her risk of developing ovarian cancer. Two  years earlier, in May 2013, Ms. Jolie Pitt made a similar announcement that she had undergone double mastectomies after testing positive for a mutated BRCA1 gene. 

Why did Jolie Pitt decide to get tested for hereditary breast and ovarian cancer (BRCA1/2) genes in the first place?  It was because her mother, actress Marcheline Bertrand, died from ovarian cancer at age 56, and this was a red flag that cancer might run in her family.

After her double mastectomy in 2013, Jolie Pitt was followed very closely for early signs of the disease. This screening included blood tests looking for an ovarian cancer-associated biomarker called CA-125, as well as other less specific biomarkers of inflammation. She anticipated that at some point she would decide to have her ovaries and fallopian tubes removed to eliminate her high risk.

In the Times piece, Jolie Pitt says her doctor told her that although her CA-125 numbers were normal,

"[He said] '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."

Jolie Pitt underwent an ultrasound, a CT scan, and a PET scan. Fortunately, no tumors were found, although the possibility of a very early stage cancer could not be completely ruled out. After speaking to "many doctors, surgeons, and naturopaths," Jolie Pitt decided to undergo a laparoscopic bilateral salpingo-oophorectomy -  i.e., she had both her ovaries and fallopian tubes removed. No signs of cancer were found.

One important consequence of this type of surgery is that it forces a woman into early menopause, and replacement hormones are needed to prevent severe symptoms. Jolie Pitt explained:

"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."

Jolie Pitt says she has come forward to speak about her medical journey to let "other women at risk to know about the options."

"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."

A Note About BRCA Genes

It is important to realize that all women (and men) have BRCA1 and BRCA2 genes that normally function to protect us from environmental damage to our DNA.  It’s only when these BRCA genes harbor certain genetic mutations that our ability to repair DNA is lost, and this leads to cancer.

According to the National Cancer Institute (NCI), only 5 percent to 10 percent of breast cancers are caused by mutated BRCA genes that are inherited in families.  For about 90 percent of women, having a negative BRCA1/2 test does not reduce their risk of developing sporadic (non-hereditary) breast cancer.

A Quick Anatomy Lesson

The ovaries are a pair of organs in the female reproductive system. They are in the pelvis, one on each side of the uterus. The ovaries make eggs and female hormones (estrogen and progesterone).

The fallopian tubes are a pair of long, slender tubes, one on each side of the uterus. Eggs pass from the ovaries, through the fallopian tubes, to the uterus.

The peritoneum is the tissue that lines the abdominal wall and covers organs in the abdomen.

A New Development About "Ovarian" Cancer

The latest research on ovarian cancer indicates that this cancer is not a cancer of the ovaries at all, but rather starts in the finger-like ends of fallopian tubes (called fimbriae) and then spreads to the ovary and rest of the pelvis.

The potential impact for patients could be immense.  If what we now call ovarian cancer actually comes from the fallopian tubes, surgeons in the future might only have to remove the tubes and not the ovaries, thus sparing patients forced menopause and infertility. 

Because cancer of the ovary is one of the most common gynecologic cancers and the fifth most frequent cause of cancer death in women (per the NCI), this new model of pelvic serous carcinoma may have huge implications for future treatment and prevention of the disease.

Studies are underway to assess whether the tubectomy (removal of the fallopian tubes) alone will be as protective as removal of the tubes and ovaries and which patients would be the best candidates for the less drastic surgery.

Take-Home Lesson

  • One out of eight women will develop breast cancer in their lifetime, even if their BRCA1/2 test is negative. For women who have a positive BRCA1/2 test, at least three out four of them will develop breast cancer, and about one out of two will develop ovarian cancer.
  • If cancer seems to run in your family, you should consider asking your primary care doctor or gynecologist for a referral for genetic counseling.  A qualified genetic counselor will assess your risk and may or may not recommend genetic testing.

*

Celebrity Diagnosis: Teachable Moments in Cancer is produced by Celebrity Diagnosis LLC to raise awareness and knowledge of health and medical issues. The information on the subjects of these articles is derived from public news sources. Celebrity Diagnosis LLC and its employees are not involved in the care of any of the subjects nor do they have access to, or knowledge of, the subjects' medical records or personal health information. Celebrity Diagnosis LLC is solely responsible for the contents of these articles.

The American Association for Cancer Research (AACR) is a 501c3 registered nonprofit organization with offices at 615 Chestnut Street, 17th Floor, Philadelphia, PA 19106 | 215.440.9300