It’s not an easy thing to talk about, especially for women.
However, with recent attention surrounding actress Angelina Jolie’s decision to have her ovaries removed (after previously undergoing a double mastectomy) in order to lower her risk of cancer, we were curious. What should we know — aside from cultural commentary and social media conjecture — about these very real, very serious illnesses? Who should have these surgeries? Who is truly at risk, and what can we do about it?
We took our questions to Bright Pink, the nation’s only non-profit organization focused on prevention and early detection of breast and ovarian cancer in young women. There, the organization’s Chief Medical Officer, Dr. Deborah Lindner, graciously filled us in. Now, we want to do the same.
Read on below to learn more about how to talk to your doctor (and yourself) about breast and ovarian cancer, as well as the different prevention methods available.
Darling Magazine: Are breast and ovarian cancers on the rise in the United States?
Dr. Lindner: No, they actually remained essentially the same. The SEER data shows the incidence and mortality have decreased by about 1% per year over the last decade.
DM: What age groups are the most susceptible?
Dr. Lindner: Breast cancer will affect one in eight women at some point in their lifetime. It’s the leading cancer diagnosis among women and is the leading cause of cancer death in women ages 15 to 54. 1 in 67 women will develop ovarian cancer in their lifetime. While far less common than breast cancer, ovarian cancer is often called “the silent killer,” because its symptoms can be very difficult to detect. As a result, only about 19% of cases are caught before the cancer spreads. And 2/3 of those diagnosed will die from their disease.
In the general population, most breast and ovarian cancers occur after 50, but in BRCA carriers they striker younger and more aggressively.
DM: At what age should women start talking to their doctor about being checked for these kinds of cancers?
Dr. Lindner: The conversation should start early, in the 20’s and 30’s so there is time to investigate the family history and determine whether she is at increased risk and in need of genetic testing. Additionally, your risk accumulates over your lifetime. So the earlier you can begin practicing breast and ovarian self-awareness and risk-reducing behaviors the better.
As for screening, every woman should receive a clinical breast exam and pelvic exam at their annual physical. Note that a pap smear checks for cervical cancer, not ovarian cancer. But during the pelvic exam, your doctor will feel your ovaries. Additionally, national recommendations are for women of average risk to begin annual mammograms at 40. Women who have a family history of breast cancer should begin mammograms 10 years earlier than the age of their first-degree relative’s diagnosis. So, for example, if your mom was diagnosed with breast cancer at 47, you should begin mammograms at 37.
Women who have a family history of breast cancer should begin mammograms 10 years earlier than the age of their first-degree relative’s diagnosis.
DM: How treatable are they if found?
Dr. Lindner: When caught early, the five year survival rate for breast and ovarian cancer is greater than 92%. So it’s all about early detection. Breast cancer can be successfully treated in many patients if it is caught early. Ovarian cancer is more difficult to detect at an early stage and is therefore more often fatal. Even after aggressive treatment. 2/3rd of women diagnosed with ovarian cancer will die as a result.
DM: Angelina Jolie has seemingly taken extreme measures to guard herself against breast and ovarian cancer. How do these surgeries lower the risk of the disease?
Dr. Lindner: For someone at such high risk, these surgeries are not extreme measures, they are recommended by medical experts as the best way to bring the risk of cancer to a reasonable and safe level. Additionally, some women at high risk opt for chemoprevention, the use of medications to prevent, suppress or reverse cancer.
DM: Are they recommended for all women?
Dr. Lindner: No. Not unless the patient is at elevated risk due to a genetic syndrome. There are different risk-reduction recommendations for women at each of the 3 levels of risk, average, increased, and high. This is why it is so important to Assess Your Risk so you know where you fall and so you can follow the appropriate recommendations. Visit Bright Pink’s page on risk reduction to learn more.
DM: As a woman who has also undergone the removal of her ovaries, what factors did you weigh in considering your options?
Dr. Lindner: Many! The lifetime risk of cancer, the significance of the risk reduction by doing surgery, the fact that surveillance does not reduce the risk of cancer, my desire to avoid having to go through chemotherapy and it’s effects, my desire to be alive for my children, the potential side effects of surgery, including cosmetic effects and potential health risks and surgical risks.
This is why it is so important to Assess Your Risk so you know where you fall and so you can follow the appropriate recommendations.
DM: What convinced you to have the surgery, and what would you say to a woman who is currently considering it?
Dr. Lindner: This is a personal decision, one that no one else can make for you and that you must come to terms with prior to undergoing surgery. It is important to be able to feel completely confident in your choices, your surgical team and yourself. I weighed the above factors and made the right decision for me.
DM: What are some other ways a woman can reduce her risk without having surgery?
Dr. Lindner: There are easy things we can all do to lower our risk, starting with leading a healthy lifestyle.
For breast cancer, decreasing alcohol intake, not smoking, keeping a healthy body weight with exercise and a balanced diet, adequate vitamin D levels, and breast feeding are all recommended to reduce risk. For a patient at an increased risk, tamoxifen or raloxifene can reduce the risk by 50% if taken for 5 years.
For ovarian cancer, becoming pregnant earlier, more times, and breast feeding can minimize ovulation, which decreases cell turnover and thereby decreases risk. Oral contraceptive pills also can decrease the risk of ovarian cancer by nearly half, and their protective effect increases with the number of years they are taken.
DM: What should women know about the BRCA1 gene, and who should be tested for it?
Dr. Lindner: Genes like BRCA1 and BRCA2 (for breast cancer genes 1 and 2) normally stop breast and ovarian cells from growing and dividing uncontrolled. When an error occurs, or there is a mutation, it can increase the chances of cancer developing. We all have two copies of each gene. As long as at least one BRCA1 and one BRCA2 gene works normally, your risk for cancer won’t be raised; the two copies of each gene act as backups for each other. However, if both copies are damaged, your body loses a tool for stopping cancer cells from growing.
Images via Laura Greige