BRCA Mutations and Cancer Prophylaxis: Finding Courage Through One Woman's Bravery

News in Context |
March 26, 2015

BRCA Mutations and Cancer Prophylaxis: Finding Courage Through One Woman's Bravery

  1. Andrew M. Kaunitz, MD

Angelina Jolie Pitt recently chronicled her salpingo-oophorectomy and subsequent initiation of hormone therapy.

  1. Andrew M. Kaunitz, MD

In a March 24, 2015, New York Times op-ed piece, 39-year-old filmmaker Angelina Jolie Pitt described her recent laparoscopic bilateral salpingo-oophorectomy and subsequent initiation of hormone therapy. A BRCA1 mutation carrier, Jolie Pitt lost her mother and grandmother to ovarian cancer and her aunt to breast cancer.

Many premenopausal BRCA mutation carriers defer risk-reducing gynecologic surgery because they dread the menopausal symptoms that inevitably follow loss of ovarian function. Understandably, such women — many of whom have seen their relatives battle breast cancer — worry that they cannot safely use hormone replacement therapy (a concern shared by many clinicians). Contrary to conventional wisdom, however, evidence shows that BRCA mutation carriers with intact breasts can safely use hormone therapy for at least several years (J Natl Cancer Inst 2008; 100:1361). In women who have undergone risk-reducing bilateral mastectomy, hormone therapy is associated with even fewer safety concerns.

Comment

In May 2013, Jolie Pitt underwent risk-reducing bilateral mastectomy. Her bravery in publicizing her decision to proceed with risk-reducing breast surgery encouraged many women with high-risk family histories to seek out genetic counseling and testing. Now, Jolie Pitt's courage in sharing her story of risk-reducing gynecologic surgery should reassure mutation carriers that fear of severe menopausal symptoms need not deter them from making such lifesaving decisions.

Editor Disclosures at Time of Publication

  • Disclosures for Andrew M. Kaunitz, MD at time of publication Consultant / Advisory board Actavis plc; Bayer AG; Merck; Teva Pharmaceutical Industries Limited; UpToDate Royalties UpToDate Grant / Research support Trimel Pharmaceuticals Corp; TherapeuticsMD; NIH Editorial boards Contraception; Menopause; Contraceptive Technology Update; OBG Management; Medscape OB/GYN & Women’s Health Leadership positions in professional societies North American Menopause Society (Secretary)

Citation(s):

Reader Comments (3)

DIANA KLEBANOW Other, Other, formerly Dept. of Political Science, Long Island University

I wrote about my prophylactic oophorectomy. in "Shaking Off the Shadow of Ovarian Cancer." It was published in the July 2007 issue of USA TODAY MAGAZINE.
Non-famous patients can also choose to inform the public.
Diana Klebanow, Ph.D.

J JOSHI MD Physician, Oncology, GERMANTOWN, TN

The results regarding hormone therapy use in postmenopausal BRCA1 mutation carriers provide some evidence for safety but are insufficient to reliably inform routine clinical practice,” the editorialists of your ref paper write.

I think there is a U PEN study that is more affirmative (ASCO Abstract #1501: 2011- Is hormone replacement therapy (HRT) following risk-reducing salpingo-oophorectomy (RRSO) in BRCA1 (B1)- and BRCA2 (B2)-mutation carriers associated with an increased risk of breast cancer?

Victor Kantariya Physician, Family Medicine/General Practice

An alternative to surgery there are other options. In terms of breast cancer: chemoprevention with Tamoxifen or an aromatase inhibitors. But these drugs increased risk of womb cancer. Nitro-bisphonates , a progesterone IUD inserted in the uterus linked to lower Endometrial Cancer. In terms of ovarian cancer :use of the oral contraceptive pill reduce the risk for ovarian cancer by 50%.Choose Wisely. Victor Kantariya MD

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