Actress Angelina Jolie has revealed she's had preventive surgery to remove her ovaries and fallopian tubes because she carries a genetic mutation that puts her at high risk of ovarian cancer.
That same mutation also increases the risk of breast cancer, which led Jolie to choose to undergo a double mastectomy in 2013.
She decided on the latest surgery after a blood test showed elevated levels of inflammatory markers that can be a sign of early cancer, she said.
"It is not easy to make these decisions," she wrote in an opinion piece published in The New York Times. But, she said, "I know my children will never have to say, 'Mom died of ovarian cancer.' "
Ovarian cancer begins in the ovaries but then can spread, commonly to the lining of the abdomen, lungs, liver and lymph nodes.
It is difficult to detect and is often well-advanced when it finally is detected, experts say.
The five-year survival rate for all types of ovarian cancer is 45 percent, experts at the American Cancer Society say, meaning the rate of those patients who live at least 5 years after their cancer is diagnosed, including those who are cured. "Women diagnosed when they are younger than 65 do better than older women. If ovarian cancer is found (and treated) before the cancer has spread outside the ovary (stages IA and IB), the 5-year relative survival rate is 92 percent. However, only 15 percent of all ovarian cancers are found at this early stage," the society's fact sheet notes.
Treatment after detection normally involves some combination of surgery, radiation therapy and a course of chemotherapy.
Around 10 percent of cases are linked to genetic mutations known as BRCA1 or BRCA2; women who carry these mutations - Jolie carries the BRCA1 variety - have around a 50 percent chance of developing ovarian cancer.
The National Comprehensive Cancer Network and the American Congress of Obstetricians and Gynecologists have issued strong recommendations that women with BRCA mutations consider having their ovaries and fallopian tubes surgically removed, by age 40 if they have the BRCA1 mutation and by age 45 if it is BRCA2.
In the United States, ovarian cancer affects 1.3 percent to 1.4 percent of women; the incidence is higher in developed countries than it is in developing countries. In 2012, ovarian cancer occurred in 239,000 women and resulted in 152,000 deaths worldwide.
Jolie's surgery effectively means she is in early menopause, and removes the possibility of her having any more children. If a woman has not had children early and wants to delay such surgery, doctors may recommend frequent screenings involving ultrasound and tests for the CA-125 protein, although the tests aren't totally reliable.
The choosing of surgery, based only on the possibility of developing cancer in the future, is a difficult one, she acknowledges, particularly for younger women diagnosed with BRCA mutations.
A number of other celebrities have also dealt with ovarian cancer. Kathy Bates, an Oscar-winning actress was diagnosed with ovarian cancer back in 2004. Bates chose to keep the diagnosis a secret up until 2009. Olympic gymnast Shannon Miller also survived a battle with the disease. Other famous names who have battled ovarian cancer include Heather Menzies, Carol Channing, and Liz Tilberis.
"I feel deeply for women for whom this moment comes very early in life, before they have had their children," she says. "But it is possible to take control and tackle head-on any health issue. 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."
