Angelina Jolie, the actress and unofficial ambassador for children's rights, has written that two years after she voluntarily underwent a double mastectomy because of her family history of cancer, she had her ovaries and fallopian tubes removed as well.
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In a personal essay in The New York Times on Tuesday, Jolie reiterated that she was prompted to have the mastectomy because she carried a mutation in the BRCA1 gene.
That mutation gave her an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer. Jolie lost her mother, a grandmother and an aunt to cancer.
The gene mutation that Jolie says prompted her decision to have a preventative double mastectomy is one of three genetic mutations known as Ashkenazi Jewish mutations.
This means they are common among Jews of Eastern European descent and increase the risk of developing breast cancer among women who carry them.
Israel has the world's largest concentration of Ashkenazi Jewish women and has emerged as an international research center for BRCA mutations.
Jolie said that she also had been regularly monitored for ovarian cancer with tests for the protein CA-125 in her blood.
While a recent test was normal, she said, a number of what the doctor called "inflammatory markers" were higher than they should have been and taken together might have signaled early cancer.
An examination of her ovaries showed them to be cancer-free, but her risks were such that she chose the surgery.
Jolie wrote that the procedure to remove her ovaries and fallopian tubes forced her into menopause and prevented her from having more children.
She said she feels "at ease with whatever will come, not because I am strong but because this is a part of life. It is nothing to be feared."
Surgery is not the only option for women who are found to have the mutation in the BRCA1 gene, she said.
She urged women to inquire with health professionals.
She herself spoke with doctors, surgeons and naturopaths, practitioners of both western and eastern medicine, before she made the decision regarding her ovaries and tubes.
"It is not easy to make these decisions," Jolie concluded. "But it is possible to take control and tackle head-on any health issue. You can seek advice, learn about the options and make choices that are right for you. Knowledge is power."