Yale: Two years after actress Angelina Jolie’s preventive double
mastectomy, her doctors removed her ovaries and fallopian tubes when a
blood test showed early signs of ovarian cancer. For women with the same
genetic mutations considering a similar surgery, a personalized
approach that examines age and other factors should be considered,
according to Yale ovarian cancer experts.
“The current clinical
standard of care is for women with certain genetic mutations to undergo a
risk review, and, if necessary, to remove the ovaries and fallopian
tubes between the ages of 35 and 40,” said Dr. Elena Ratner,
assistant professor of obstetrics, gynecology, and reproductive
sciences at Yale School of Medicine, and a member of the Smilow Cancer
Hospital at Yale-New Haven’s Gynecologic Oncology Program, and Yale
Cancer Center’s Cancer Prevention and Control Program.
“This
surgery immediately puts the body into a postmenopausal state so the
decision needs to be made on an individual basis to determine which
risk-reducing procedures are necessary,” Ratner added.
She said
that there are many other pharmacologic and lifestyle modifications that
can be used to reduce cancer risks before turning to surgery. If
surgery is chosen, Yale provides clinical quality-of-life programs that
can help counteract the side-effects of menopause.
New research
has shown that malignant cancer cells are more likely to come from cells
outside of the ovaries that travel through the fallopian tubes,
according to Dr. Gil Mor,
professor of obstetrics, gynecology, and reproductive sciences at Yale
School of Medicine, a member of Yale Cancer Center, and director of the
Discovery to Cure Program.
“Removing the ovaries is a sound
approach for postmenopausal women, but for younger women, removing the
fallopian tubes could be a better approach to preventing ovarian
cancer,” said Mor. “In younger women who have the surgery, the body goes
through a postmenopausal state in 24 hours, while in nature this
process takes 10 years. This sudden lack of hormones has consequences
like bone loss, loss of memory and libido, and negative effects on the
cardiovascular system. This decision should be made based individual
circumstances and the age of the patient.”