Angelina Jolie is right: Surgery is one way to reduce ovarian cancer risk


Angelina Jolie Pitt explained her decision to have a preventive surgery to remove her ovaries and fallopian tubes in a New York Times op-ed article on March 24, 2015. She based the decision on her elevated ovarian cancer risk due to her BRCA1 mutation and her family history.

This kind of preventive surgery – called a risk-reducing bilateral salpingo oophorectomy (rrBSO) – is performed for patients at the Harold C. Simmons Comprehensive Cancer Center and Moncrief Cancer Institute here at UT Southwestern.

Our cancer genetics program has identified more than 1,000 patients as carriers of the BRCA1/BRCA2 mutation. About 50 percent of these patients with BRCA mutations are “previvors.” Previvors, as opposed to survivors, have not yet had cancer but do have a mutation that increases their risk to develop cancer. Ovarian cancer is one cancer that BRCA mutation carriers are at risk of developing. Depending on the mutation, they have an up to 40 percent lifetime risk for ovarian cancer (normal risk is 1 to 2 percent). Surgery to remove the patient’s ovaries and fallopian tubes is an option for these patients to decrease their ovarian cancer risks.

Of these patients who are at high risk for ovarian cancer, 54 percent elect to have the preventive surgery. These patients are at high risk due to their family history or the BRCA mutation.

As Ms. Jolie Pitt stated, there are other options for women to reduce their risk of developing ovarian cancer. The use of oral contraceptives (OCPs) is one of them. A 5-year course of oral contraceptives can reduce the risk by 50 percent. For example, if you have an estimated lifetime risk for ovarian cancer of 30 percent, then the risk is predicted to be reduced to 15 percent with OCPs.

Investigation continues into the effectiveness of surgery that leaves the ovaries behind and removes only the fallopian tubes (to preserve fertility). Whether this type of surgery reduces risk is not known and is only advisable if done as part of a clinical trial.

Under the leadership of Dr. Siobhan Kehoe, Assistant Professor in Obstetrics and Gynecology, researchers also are conducting a quality-of-life study of women who opt for risk-reducing removal of their ovaries. We hope the data from this study will assist women at high risk for ovarian cancer who choose to have the prophylactic surgery and deal with the early menopause that results.

The UT Southwestern cancer genetics team also studies the genomes of patients with ovarian cancer predisposing gene mutations. We are searching for secondary genetic changes that modify the patient’s cancer risk due to a mutation like BRCA1. The goal is to precisely predict the risk for each patient. For Ms. Jolie Pitt, her risk for ovarian cancer is not precisely known and the best we can do is predict that based on her family history her risk is likely to be at the higher end of the spectrum (40 percent lifetime risk).

The cancer genetics program at Simmons Cancer Center and Moncrief Cancer Institute has been serving the Dallas/Fort Worth community for more than 15 years, helping more than 15,000 patients with hereditary cancer risk with consultation and testing. Seven board-certified genetic counselors are available at 16 clinics in the Dallas/Fort Worth area.

Women at higher risk for ovarian cancer are encouraged to discuss all options with their health care providers. For more information or to make an appointment, call our Cancer Answer Line at 1-888-980-6050. To learn more about our support groups for those impacted by cancer, please call (214) 645-HOPE (4673).

Dr. Siobhan Kehoe discussed ovarian cancer risks, symptoms, and options in an interview with KDAF-TV CW33. Click here to see the news report and other footage from Dr. Kehoe’s interview.