In a moving op-ed published by The New York Times in 2015, Angelina Jolie revealed that she had preventive cancer surgery to remove her ovaries and fallopian tubes. Jolie's announcement came two years after she disclosed that she had a preventive double mastectomy in 2013, touching on a national conversation about cancer risk.
Jolie carries a mutation in the BRCA1 gene, giving her a high risk of breast cancer and ovarian cancer. More specifically, her healthcare providers estimated she had an 87% chance of breast cancer and a 50% chance of ovarian cancer—though the risk varies from case to case. Jolie has a family history of cancer and has lost her mother, grandmother, and aunt to the disease.
Here's what you should know about preventative cancer surgery like Jolie's, including the effects and benefits.
What Is the BRCA Gene?
Everyone has two copies of breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2), with one copy from each parent. Those genes produce proteins that help repair DNA.
However, some people inherit harmful mutations of those genes, increasing the risk of certain kinds of cancer, the most common of which is breast cancer. If you have a parent who carries such a variant, you have a 50% chance of inheriting it yourself.
A healthcare provider may recommend surgery to prevent certain cancers if you have a high-risk mutation in these genes (or other genes). Jolie had a prophylactic (preventative) mastectomy as well as a prophylactic salpingo-oophorectomy.
What Is Preventative Mastectomy?
A prophylactic mastectomy is when a surgeon removes the breasts to prevent breast cancer. A healthcare provider may recommend this surgery for people with an increased risk of breast cancer—for example, if they have a family history of breast cancer or a mutation in their BRCA1 or BRCA2 genes.
A prophylactic mastectomy can reduce the risk of breast cancer by 90% or more. While the surgery doesn't guarantee you won't get breast cancer, it decreases your risk.
Effects of Preventative Surgery for Breast Cancer
If you undergo a prophylactic mastectomy, you may have psychological side effects. Those side effects may include anxiety and concerns about body image. Some people feel less feminine after getting the procedure.
After a prophylactic mastectomy, there is also a loss in nipple sensation, changing or reducing sexual arousal.
What Is Preventative Surgery for Ovarian Cancer?
A prophylactic salpingo-oophorectomy removes the ovaries and fallopian tubes to prevent ovarian cancer. A healthcare provider may recommend this surgery for people with a high risk of ovarian cancer if they don't wish to become pregnant.
People with mutations in their BRCA1 or BRCA2 genes also have an increased risk of fallopian tube cancer. So, healthcare providers usually recommend removing the fallopian tubes along with the ovaries.
Surgery reduces the risk of ovarian cancer by 85% to 95%. The risk of breast cancer also reduces by at least 50%.
Effects of Preventative Surgery for Ovarian Cancer
Removing the ovaries puts you into early menopause if you haven't already gone through the natural change. Menopause causes symptoms like:
- Hot flashes
- Memory problems
- Urinary problems
- Mood changes
- Depression and anxiety
- Vaginal dryness
Removing the fallopian tubes and ovaries will also take away the ability to become pregnant. Additionally, the risk of bone loss and heart disease increases following the surgery.
To reduce menopause symptoms and the risk of osteoporosis and heart disease, a healthcare provider may suggest hormone therapy. Hormone replacement therapy (HRT) has long been controversial due to its link to increased breast cancer risk.
Still, some evidence suggests that short-term estrogen replacement therapy is safe for people with mutations in their BRCA1 or BRCA2 genes after a prophylactic salpingo-oophorectomy and might not raise the risk of breast cancer.
Are There Other Preventative Treatment Options?
Surgery isn't the only option for people who carry a mutation in their BRCA1 or BRCA2 genes. Other strategies to reduce the risk of ovarian and breast cancer may include:
- Getting the recommended screenings
- Quitting smoking
- Getting genetic counseling and testing
- Staying physically active
- Taking medications as prescribed
Also, you might reduce your risk of breast cancer if you limit your alcohol intake and breastfeed.
Birth control pills may reduce the risk of ovarian cancer, but they carry other health risks, including a slightly increased risk of breast cancer. It's important to discuss the risks and benefits with a healthcare provider.
Should You Get Preventative Surgery?
You may be wondering if preventative cancer surgery is right for you. You may want to consider preventative surgery for any of the following reasons:
- You have a high-risk mutation in your BRCA1 or BRCA2 genes or certain other genes.
- You have a strong family history of breast cancer.
- You had radiation therapy to the chest before the age of 30.
- You have previously had breast cancer.
You should discuss preventative options with a healthcare provider, especially if you meet any of the criteria above.
Both of those surgeries are irreversible, so taking into account the effects that may occur post-op is important. With any surgery, there are risks of bleeding and infection. However, each surgery also comes with its own benefits.
A Quick Review
Angelina Jolie decided to have surgery to remove her breasts, ovaries, and fallopian tubes because she inherited a mutated BRCA1 gene. After losing her mother, grandmother, and aunt to cancer, she opted for preventative surgery to reduce her cancer risk.
Preventative cancer surgery may not be for everyone. Still, you may want to consider surgery if your family history of breast cancer is strong or you have a mutated BRCA1 or BRCA2 gene.
If you think you're at risk of breast or ovarian cancer, discuss preventative treatment options—and their potential risks and benefits—with a healthcare provider.
The New York Times. Angelina Jolie Pitt: Diary of a surgery.
The New York Times. My medical choice.
National Cancer Institute. BRCA gene mutations: Cancer risk and genetic testing.
TIME. Angelina Jolie: Medical Advances in Women's Health Are Important. But They're Only Part of the Picture.
American Cancer Society. Preventative surgery to reduce breast cancer risk.
National Cancer Institute. Surgery to reduce the risk of breast cancer.
American Cancer Society. Can ovarian cancer be prevented?
American Cancer Society. Surgery for ovarian cancer.
Office on Women's Health. Menopause symptoms and relief.
Office on Women's Health. Hysterectomy.
Kaunitz AM, Kapoor E, Faubion S. Treatment of women after bilateral salpingo-oophorectomy performed prior to natural menopause. JAMA. 2021;326(14):1429. doi:10.1001/jama.2021.3305
Kotsopoulos J, Gronwald J, Karlan BY, et al. Hormone replacement therapy after oophorectomy and breast cancer risk among brca1 mutation carriers. JAMA Oncol. 2018;4(8):1059. doi:10.1001/jamaoncol.2018.0211
American Cancer Society. Ovarian cancer risk factors.
American Cancer Society. Can I lower my risk of breast cancer?