Angelina Jolie Pitt's Surgeries Will Reduce Cancer Risk, Doctors Say

AUDIE CORNISH, HOST:

It's been nearly two years since actress Angelina Jolie Pitt announced she had a preventive double mastectomy. She wrote about that decision in a New York Times op-ed, explaining she had a high risk of both breast cancer and ovarian cancer. Today, she wrote in The Times that she has had her ovaries and fallopian tubes removed. In being public about these choices, she has said she wants to let women know they have options if they face similar risks.

NPR's health correspondent Rob Stein has been following this and joins us now. Welcome, Rob.

ROB STEIN, BYLINE: Hi, Audie.

CORNISH: So Angelina Jolie Pitt writes that she did this because doctors estimated that she had a 50 percent risk of ovarian cancer. Before her mastectomy she had reported that she had an 87 percent risk of breast cancer. What accounts for such high numbers?

STEIN: Well, she has a mutation in one of the so-called breast cancer genes, BRCA1. And it's called the breast cancer gene, but it also increases the risk for ovarian cancer, and it increases it by a lot, as you just mentioned it. Women who have this mutation - about a third of them or half of them will end up getting ovarian cancer. And ovarian cancer is a really nasty cancer. It's really hard to catch early, and it's really hard to cure. And she has a family history of these diseases. Her mother had breast cancer and died of ovarian cancer, her grandmother died of ovarian cancer, and her aunt died of breast cancer.

CORNISH: So help us understand this latest procedure. The aim is to try to avoid ovarian cancer. Is this something that doctors actually recommend?

STEIN: Yeah, they do, actually, for women in this situation - women who have a mutation in this particular gene, and especially women who have had the family history that she's had. And she had her ovaries and her fallopian tubes removed. And there are other things women in this situation can do to try to reduce their risk. They can get screened often. They can take birth control pills. But screening isn't really good, and taking birth control pills doesn't really reduce the risk as much as this surgery does.

CORNISH: Now, in the op-ed in The Times, Jolie writes, quote, "I did not do this solely because I carry the BRCA1 gene mutation, and I want other women to hear this." She says a positive BRCA test does not mean a leap to surgery. What's another preventative alternative?

STEIN: Well, there is some thought that women might be able to just get their fallopian tubes removed. But I spoke to several experts about that today, and they all said that, you know, that's a possibility, but we don't really have enough evidence yet to know whether that's really an alternative to having both your ovaries and your fallopian tubes removed.

CORNISH: So getting both the ovaries and fallopian tubes removed - I mean, how much does this decrease risk? Does this mean that she or other women who've made this decision don't have to worry about ovarian cancer at all?

STEIN: The surgery really does cut the risk significantly. It cuts it by about 85 to 90 percent, but it doesn't cut it to zero. There's still a chance - a small chance that she could get cancer elsewhere in her body - somewhere else in her abdominal area. So doctors will have to continue to watch her closely.

CORNISH: Rob, Jolie Pitt says that this surgery wasn't as severe as the mastectomy, but said the effects were worse. Now, what are those effects?

STEIN: Well, the big downside is basically put her into menopause much earlier in life than she otherwise would have gone into menopause. She's only 39. So she has all the symptoms of menopause. She'll have hot flashes, night sweats, and she'll be at risk for other diseases, especially the disease osteoporosis which causes bones to get thin. So as a result of that, she's going to be taking what's called replacement hormones, and there's a little bit of controversy about that as well because those hormones carry their own risks. They can increase risk, for example, for breast cancer. Now, in her case, that isn't as much of a concern because she had had a double mastectomy, but like this surgery, that doesn't reduce her risk for breast cancer to zero either. There's still a small risk she could still get breast cancer. And, you know, the big downside for women is that they wouldn't be able to have children the natural way after having their ovaries removed.

CORNISH: Talk about that more. What are the options presented to you if you still want to have children and you find yourself in this position?

STEIN: Yeah. You basically have two options. You can either wait, have children and then get this surgery, or you can have this surgery, have your eggs or embryos frozen and then go through in vitro fertilization to try to have your own children that way.

CORNISH: That's NPR health correspondent Rob Stein. Rob, thanks for explaining it.

STEIN: Oh, sure. Nice to be here.

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