Recently the Hollywood actress got her ovaries removed because of ovarian cancer risk. Experts explain more about this procedure
Almost a year ago, actress Angelina Jolie made a public revelation about having undergone a preventive mastectomy after being diagnosed with faulty BRCA1 gene. Recently, she made another public revelation of getting her ovaries and fallopian tubes removed because of her risk of ovarian cancer. Such bold revelations have got people talking about such taboo-like health topics. We asked experts about the procedure of removal of ovaries and fallopian tubes associated with ovarian cancer risk.
Gene testing
The BRCA1 and BRCA2 gene testing help determine the risk of breast and ovarian cancer, and is done in India too. “The BRCA1 gene is the more dominant one of the two, and if there’s a defect in it the chances of cancer occur from 20 to 25 per cent by the age of 50 and 40 to 45 per cent by the age of 70. In the case of defect in the BRCA2 gene, the chances of cancer are not very high, say 20 per cent by the age of 70,” opines Dr Hemant Tongaonkar, consultant uro-gynegology oncology surgeon, Hinduja Healthcare Surgical.
The BRCA1 and BRCA2 gene testing help determine the risk of breast and ovarian cancer, and is done in India too. “The BRCA1 gene is the more dominant one of the two, and if there’s a defect in it the chances of cancer occur from 20 to 25 per cent by the age of 50 and 40 to 45 per cent by the age of 70. In the case of defect in the BRCA2 gene, the chances of cancer are not very high, say 20 per cent by the age of 70,” opines Dr Hemant Tongaonkar, consultant uro-gynegology oncology surgeon, Hinduja Healthcare Surgical.
Cost factor
BRCA 1 and 2 testing is available in India. Estimated cost is `24,900. We have hereditary breast cancer panel which contains additional 14 genes along with BRCA1 and 2 which diagnose additional mutations responsible for causing breast cancer (cost `31,500) which may be missed otherwise if testing is restricted to BRCA1 and 2, informs Dr Nandita Palshetkar, head of IVF, Lilavati Hospital.
BRCA 1 and 2 testing is available in India. Estimated cost is `24,900. We have hereditary breast cancer panel which contains additional 14 genes along with BRCA1 and 2 which diagnose additional mutations responsible for causing breast cancer (cost `31,500) which may be missed otherwise if testing is restricted to BRCA1 and 2, informs Dr Nandita Palshetkar, head of IVF, Lilavati Hospital.
Who’s at risk?
Dr Tongaonkar says that if there are two to three members female members with a history of breast or ovarian cancer in the maternal side of the family, then it would be advisable for a woman to underdo BRCA1 and 2 testing. Also, these cancers are seen more among women who delay having their first child till late and those who don’t have children. Generally it’s menopausal and post-menopausal women who are detected with ovarian cancer but now even women in their 30s are having this issue.
Dr Tongaonkar says that if there are two to three members female members with a history of breast or ovarian cancer in the maternal side of the family, then it would be advisable for a woman to underdo BRCA1 and 2 testing. Also, these cancers are seen more among women who delay having their first child till late and those who don’t have children. Generally it’s menopausal and post-menopausal women who are detected with ovarian cancer but now even women in their 30s are having this issue.
Age group for ovarian cancer is decreasing
Dr Meghal J Sanghavi, consultant onco surgery, Wockhardt Hospital says, “The most common age group for diagnosing risk for ovarian cancer would ideally be a decade before the risk for developing ovarian cancer, which is between 30 to 50 years of age. For eg. if a mother has ovarian cancer diagnosed at the age of 53 years with a genetic mutation and so does her daughter have the same mutation, then the daughter’s risk of developing ovarian cancer would be a decade prior, which is about 43 years. Hence, screening for the gene should be done at an earlier age in the high risk groups.”
Dr Meghal J Sanghavi, consultant onco surgery, Wockhardt Hospital says, “The most common age group for diagnosing risk for ovarian cancer would ideally be a decade before the risk for developing ovarian cancer, which is between 30 to 50 years of age. For eg. if a mother has ovarian cancer diagnosed at the age of 53 years with a genetic mutation and so does her daughter have the same mutation, then the daughter’s risk of developing ovarian cancer would be a decade prior, which is about 43 years. Hence, screening for the gene should be done at an earlier age in the high risk groups.”
She adds that the age group for ovarian cancer is decreasing. Infact, the age group for all cancers is seen to be decreasing. The reasons being:
- Lifestlyle changes, stress which leads to hormonal imbalances.
- Obesity, inadvertant hormone therapies.
- As mentioned earlier the chances of developing ovarian cancer in a genetically positive background reduces by a decade.
- Lifestlyle changes, stress which leads to hormonal imbalances.
- Obesity, inadvertant hormone therapies.
- As mentioned earlier the chances of developing ovarian cancer in a genetically positive background reduces by a decade.
Removal of ovaries and fallopian tubes sufficient?
What if a woman decides to go the Angelina Jolie way? Is the removal of fallopian tubes and ovaries sufficient or the uterus needs to be removed too? Gynaecologist Dr Suman Bijlani explains that for prevention of ovarian cancer, removal of ovaries and fallopian tubes is sufficient. However, if the woman has completed her family and has any other uterine problem which warrants removal, she may decide to have the uterus removed at the same sitting.
What if a woman decides to go the Angelina Jolie way? Is the removal of fallopian tubes and ovaries sufficient or the uterus needs to be removed too? Gynaecologist Dr Suman Bijlani explains that for prevention of ovarian cancer, removal of ovaries and fallopian tubes is sufficient. However, if the woman has completed her family and has any other uterine problem which warrants removal, she may decide to have the uterus removed at the same sitting.
Is it recommended?
Dr Palshetkar says that uterus and ovaries are removed for variety of reasons like heavy bleeding, fibroids, endometriosis and cancer. Removal of ovary and uterus for hereditary risk of cancer is entirely a patient’s decision taken after consultation with a qualified doctor after careful consideration of factors like severity of risk, family history and age of the patient, etc.
Dr Palshetkar says that uterus and ovaries are removed for variety of reasons like heavy bleeding, fibroids, endometriosis and cancer. Removal of ovary and uterus for hereditary risk of cancer is entirely a patient’s decision taken after consultation with a qualified doctor after careful consideration of factors like severity of risk, family history and age of the patient, etc.
Will phantom pain occur?
Phantom pain varies from person to person and only a few people experience it. It may be related to normal healing process after surgery and is significantly reduced after a few months.
Phantom pain varies from person to person and only a few people experience it. It may be related to normal healing process after surgery and is significantly reduced after a few months.
Cost factor
The cost of surgery for removal of ovaries and fallopian tubes would vary depending on the hospital, city and class (general ward or special room). It may range from about `25,000 to `1.5 lakh depending on the above factors.
The cost of surgery for removal of ovaries and fallopian tubes would vary depending on the hospital, city and class (general ward or special room). It may range from about `25,000 to `1.5 lakh depending on the above factors.
Effects of menopause
Removal of the ovaries before menopause causes a sudden drop in the female hormone oestrogen in the body. This is known as surgical menopause. Women undergoing surgical menopause may experience hot flashes, mood swings, vaginal dryness and reduced sexual drive and have a higher chance of developing thinning of bones (osteoporosis) and coronary heart disease. Most of these symptoms can be managed effectively with appropriate treatment. However, women who have their ovaries removed, especially at a younger age may face a higher risk of dying from hip fracture or coronary heart disease, explains Dr Bijalni.
Removal of the ovaries before menopause causes a sudden drop in the female hormone oestrogen in the body. This is known as surgical menopause. Women undergoing surgical menopause may experience hot flashes, mood swings, vaginal dryness and reduced sexual drive and have a higher chance of developing thinning of bones (osteoporosis) and coronary heart disease. Most of these symptoms can be managed effectively with appropriate treatment. However, women who have their ovaries removed, especially at a younger age may face a higher risk of dying from hip fracture or coronary heart disease, explains Dr Bijalni.
Will Angelina drive the stigma away?
Will a global female icon like Angelina Jolie talking about her personal health issue openly, make the stigma go away? Dr Bijlani says that medically, removal of ovaries causes loss of the feminine hormone (which may be replaced by hormonal replacement therapy). “‘Feminity’ is a concept, I believe. To each woman, it has its own meaning. Collectively, society does tend to associate menstruation and uterus with feminity. It takes a strong role model like Angelina to prove to the world that a woman can be woman enough without breasts and ovaries! This is certainly a step towards dispelling the stigma and myth associated with ‘loss of feminity.’”
Will a global female icon like Angelina Jolie talking about her personal health issue openly, make the stigma go away? Dr Bijlani says that medically, removal of ovaries causes loss of the feminine hormone (which may be replaced by hormonal replacement therapy). “‘Feminity’ is a concept, I believe. To each woman, it has its own meaning. Collectively, society does tend to associate menstruation and uterus with feminity. It takes a strong role model like Angelina to prove to the world that a woman can be woman enough without breasts and ovaries! This is certainly a step towards dispelling the stigma and myth associated with ‘loss of feminity.’”
Dr Sanghvi says that awareness created by openly discussing the facts about how these preventive surgeries can save lives in high risk women who have undergone genetic testing like Angelina will help society accept and realise that it’s no longer a stigma but is the need of the hour.
The above is from DNA
No comments:
Post a Comment