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Angelina Jolie undergoes surgery to prevent cancer

24th March: The BBC reported today that actress Angelina Jolie has had her ovaries and fallopian tubes removed as a preventative measure against ovarian cancer.

Jolie – whose mother, grandmother and aunt all died of cancer – carries the mutated gene BRCA1, which significantly increases the carriers risk of developing cancer, specifically breast and ovarian cancer.

Two years ago, having discovered that she carried the BRCA1 gene, giving her an 87% chance of developing breast cancer, she opted to have a double mastectomy. The removal of both breasts – which was followed by breast reconstruction surgery – greatly reduced her chances of developing this cancer, but a 50% risk of ovarian cancer remained.

In the past two weeks, a blood test had revealed markers that were potential early signs of cancer. Further investigation revealed that Jolie was free of any tumours, but she nonetheless took the bold step of opting for immediate preventative surgery. "It is not easy to make these decisions," she said. "But it is possible to take control and tackle head-on any health issue." In the UK screening for ovarian cancer is not routinely arranged, because, as in this case, blood testing for cancer markers is not reliable.

Gordon Wishart, Professor of Cancer Surgery and Medical Director of Check4Cancer, comments: “We can’t fight what we don’t know, and the first step towards reducing our likelihood of developing cancer is to become more aware of the risk factors we are subject to. High-profile cases can help greatly with this. When Angelina Jolie announced her double mastectomy two years ago, we saw a surge of awareness and interest in breast cancer, with referrals to breast cancer clinics across the UK more than doubling in the months that followed. A major factor within this was increased awareness of the BRCA1 and BRCA2 genes, and the potential value of genetic testing and genetic counselling in high-risk families.”

Vicki Kiesel – Genetic Director at GeneHealth UK, heading a team of genetic counsellors– explains how this works: “GeneHealth UKprovides genetic testing and genetic counselling for people who are concerned about their family history of cancer or who have been diagnosed themselves. By taking a medical history and family history, we can work out the patient’s cancer risk and advise them about cancer screening. If appropriate we will also offer genetic tests and advise on, risk reducing options, such as mastectomy.

Presence of this gene can also indicate a need for more robust treatment, should cancer develop. Vicki explains “Women without a BRCA1 mutation have more than a 90% chance of surviving stage one or stage two breast cancer, but for women with BRCA1-associated triple negative breast cancer that rate falls to 80% without chemotherapy. The good news is that with chemotherapy women with BRCA mutations have as good a chance of survival as other women.

Professor Wishart adds: “Whilst problematic genes cannot simply be avoided as many lifestyle factors can, knowledge of their presence can arm individuals against cancer risk by giving them clear courses of action – action that can save lives.”

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