Angelina Jolie - whose choice is it anyway?

Two years after she spoke out about her decision to have a preventative double mastectomy, Angelina Jolie has shared the news of her decision to have both her ovaries and fallopian tubes removed. It's clearly not a decision she came to lightly - major surgery never is. While she didn't have a hysterectomy (removal of the womb), taking out her ovaries means that she has gone straight into the menopause and will never have more children.

Angelina Jolie has a strong family history of cancer - she lost her mother, grandmother and aunt to the disease. She tested positive for the faulty BRCA1 gene, which is linked with a greatly increased risk of breast and ovarian cancer. There are different mutations of this gene, but they can increase the chance of getting breast cancer to almost 90%, and the risk of ovarian cancer from one in 54 to one in two. It also tends to strike much earlier - breast and ovarian cancer most commonly affect women over 50, but women with this faulty gene could be diagnosed a decade or more sooner.

Breast cancer is the single commonest cancer in the UK, despite the fact that 99% of people affected are women. That means that millions of women in the UK will have a family member diagnosed with it. This by itself doesn't mean you're at higher risk yourself, but a pattern of cancer might. If you have two or more female members of your family with breast and/or ovarian cancer, work out if they are related to each other and blood relatives of yours (rather than in-laws or step relations). If they are, and they were affected before the age of 50, you're eligible for a test to see if you carry this faulty gene.

Having the test isn't a simple question of putting your arm out and having a blood sample. The results could have far-reaching implications, which is why you'll be offered counselling. Not only will it affect you, but also your children, who could discover at an early and vulnerable age about their risky heritage. By no means all women with a positive test opt for the major surgery Angelina Jolie has had. Some will opt for more frequent screening, using mammograms, a blood test called the Ca125 and ultrasound scans of the ovaries. These tests aren't foolproof, but they offer a better chance of detecting cancer at an early stage, when the chance of cure is better. Others will decide to take medication such as tamoxifen or raloxifene which were approved 'off licence' by the National Institute for Health and Care Excellence (NICE) in June 2013 for women at increased risk of breast cancer.

Whether you're at increased risk of cancer or not, it's vital to be aware of the warning symptoms and to seek help early if you get them.

For ovarian cancer, they include:

  • Persistent bloating, which doesn't come and go over the course of the day
  • Feeling full quickly or loss of appetite
  • Persistent stomach or pelvic pain
  • Needing to pass water more often.

These symptoms are particularly worrying if they're persistent (they don't come and go) or if you get them frequently over any length of time, especially on more than 12 days a month.

For breast cancer, warning signs include:

  • A painless breast lump
  • Turning in of the nipple
  • Discharge from the nipple, especially if it's blood-stained
  •  Change in the texture of breast skin, so it looks dimpled (a bit like orange peel)
  • Changes in the shape or contour of the breast
  • Nipple eczema.

Angelina Jolie hasn't completely eliminated her risk of cancer, and maybe some people will criticise her 'drastic' choices. But they haven't watched three members of their close family die from cancer; and they don't live with the spectre of their children having to do the same. My heart goes out to all of the thousands of women in her position. These are tough choices, and they need all our understanding.

Photo credit: "Angelina jolie by philipp von ostau" by Philipp von Ostau - Own work. Licensed under CC BY-SA 3.0 via Wikimedia Commons 

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.