Angelina Jolie’s Ovaries

JolieOf course you’ve heard that actor/director Angelina Jolie went public this week with an op-ed piece in The New York Times about her decision to undergo a double mastectomy in the wake of finding out that she is positive for the BRCA1 genetic mutation, which dramatically increases her risk of developing breast and ovarian cancer.

The news has generated a staggering amount of media attention, with bloggers and medical experts and pundits of all stripes weighing in on Jolie’s decision. The overwhelming reaction to the news seems to be one of support and admiration for a highly public figure who’s been forthright enough to go public with a very personal story in the hopes of raising awareness about BRCA and women’s options in the face of it, and confident enough to assert that her surgery (which included breast reconstruction) will not in any way detract from her success in the film industry, her role as a parent to six children, or—let’s face it—her status as a contemporary icon of female sexuality and beauty.

There has been been, rightly, a sizable amount of grumbling about inequalities in health care coverage: The genetic test for BRCA alone costs in the range of $4,000, which puts it far beyond affordable for the average citizen, especially those without health insurance to cover the test. Prophylactic mastectomy and reconstruction cost many times that, arguably making these procedures the purview of the 1 percent. The discussion has also brought to light that a private company, Myriad Genetics, holds the patents to the BRCA1 and BRCA2 genetic mutations and can therefore exclusively dictate the testing options (and price) for women who potentially have the gene, as well as research into it. (A case before the U.S. Supreme Court is challenging these patents, with a decision expected in June.)

What I haven’t seen, however, in my admittedly inexhaustive review of the reactions to Jolie’s disclosure, is much in the way of discussion about another surgery the actor/director alludes to: oophorectomy, or the (preventive) surgical removal of her ovaries. Jolie notes that she has a 50 percent chance of developing ovarian cancer. “I started with my breasts,” she says, “as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex.”

It would seem that Jolie is planning to have her ovaries removed at some point, in a procedure that, while less medically complicated than her breast surgery, is—in my opinion at least—equally, if not more, significant.

And my question is this: In the event that Angelina Jolie has her ovaries (and likely her uterus) removed, will we care as much as we do about her breasts?

Oophorectomy, while not as readily “visible” as mastectomy, is a radical procedure, thrusting women into immediate surgical menopause. In addition to the obvious negation of fertility, the sudden and dramatic change in hormone levels can have several side effects, including changes to sex drive and function, metabolism, mood, bone density and muscle mass, and cognitive function. The surgery and its potential effects are a big deal—but we wouldn’t know that by the amount of ink and bandwidth devoted to it in relation to Jolie.

Maybe that’s because Jolie’s oophorectomy is only a hazy future event, while her breast surgery is here and now. Maybe it’s because her risk of breast cancer is higher than ovarian cancer.

But I’m not so sure. I think that our focus on Jolie’s breasts as opposed to her ovaries speaks volumes about the ways in which we continue to overvalue the external when it comes to women’s bodies. Put simply, the world is so interested in Angelina Jolie’s breasts because they’re pretty to look at and pleasing to men. (Full disclosure: They are also pleasing to me and, I’m sure to many other women, gay or straight.) Angie Jolie is cutting off her boobs? How brave! Don’t worry, though—she’ll still be as sexy as ever due the miracles of reconstructive surgery! She’ll even get to keep her nipples!

But ovaries? No one sees those. You can’t touch those. You can’t “enhance” (much less restore) them surgically, or click on a button to increase their size the way gamers do with Lara Croft in Tomb Raider (Jolie portrayed the busty Croft her in the 2001 feature film; rumor has it that several Internet “patches” have been designed to remove the character’s clothing in the game). Tucked away inside her body, or removed surgically, Angelina Jolie’s ovaries are about as appealing as her gallbladder.

But ovaries are a crucial part to women’s reproductive, sexual and overall health. With no reliable test to detect it, ovarian cancer is often discovered too late and can be deadly. If and when Angelina Jolie undergoes prophylactic oophorectomy, she may feel no different (or even better) afterwards, and I hope that’s the case. On the other hand, the surgery poses the risk of several significant side effects.

If and when she decides to have the surgery, and if and when she writes about it, let’s hope we care as much as Angelina Jolie’s ovaries we do about her breasts. Because they’re no less an important part of her.

Susan Goldberg is a writer, editor, and blogger based in Thunder Bay, Ontario. She was tested for the BRCA1 mutation after her own mother, a carrier, died after several battles with both breast and ovarian cancer, and created a 2006 radio documentary about the process. You can read more at www.mamanongrata.com.

Photo from Flickr user Gage Skidmore under license from Creative Commons 2.0

Comments

  1. Theresa says:

    Very well said!
    I would add that it’s not just the well-known BRCA1 and 2 mutations, but the actual genes themselves that are patented. So we all, bizarrely, contain within ourselves the “intellectual property” of Myriad and other companies that hold such gene patents. They make tests more expensive, and keep doctors from freely gathering and exchanging information about new mutations. Certainly a company has a right to patent a test and a method of risk analysis, but I hope the Supreme Court will put an end to these impossibly vague and broad patents on genes.

  2. Best wishes to her. She is brave.

  3. Joan Crowley says:

    Angelina Jolie is 38, and she already has 6 (I think) children. Removal of ovaries in an 18 year old would mean giving up childbirth, and that would be very difficult. In someone who has already finished child bearing, ovaries and uterus are much less of an issue, beyond the instant menopause effect. Her breasts, of course, are part of her daily presentation of self, as they are for any woman. Her beauty is a major component of her career, like it or not. I do not see that the two decisions are equivalent.

    The patenting of the genes is a separate issue, and one that needs to be dealt with soon. New advances in genetics has potential for both great benefit in preserving health, and great profit for well-positioned companies.

  4. Even if Jolie talks about having having her ovaries removed and the effects it can have on a women I don’t think it will get much media coverage. It won’t be because the media doesn’t want to cover it but I have found when it comes to surgical or natural menopause ,there is a large percentage of women who have a strong denial about what’s happening.

  5. If it helps someone it helps, but I was sort of jaded when i heard it. Yes, Hollywood, a land built by/on men looking at womens’ boobs. Duh, and as someone who really may be anorexic (Jolie), maybe it was a no brainer to cut just a bit more fat off her body. That’s what I honestly thought. But if it helps a woman somewhere, why not. Awareness is a big step to fixing anything.

  6. Jackie Robb says:

    I don’t want to sound cranky, but I felt I needed to respond to the poster who said “overies and uterus are much less of an issue, beyond the instant menopause.” Um… beyond instant menopause? As someone in natural menopause, (and a rather uncomfortable one at that) I think it’s something that deserves a little more than an aside or a “beyond.” In addition, the idea that the overies and uterus are just a pair of child-bearing organs is incorrect — the uterus provides structural support to the pelvis and bladder, and the ovaries provide hormones that benefit women in many ways, both health-wise and sexuality-wise.

    I wish MS and other media outlets would actually talk a little more about menopause — it’s a fact of life for every woman, and although some have fewer symptoms than others (and hats off to those with none!), it can be a difficult period in a woman’s life.

  7. Amanda Campbell says:

    As someone who has had my childbearing abilities removed (not because of ovarian cancer, but due to very severe endometriosis) I have to say that it can be a very emotionally painful experience. Even if you know it’s for the best and have made peace with the decision. Having the ability to bear children doesn’t make you a woman, but society sees childbearing as a part of your femininity. While your breasts can be reconstructed, and you can obviously have children other ways than from your own body there still seems to be a stigma associated with women who cannot carry children. That will be a big part of the reason no one talks about it if Angelina Jolie has a secondary operation.

  8. Thank you for this great piece. I had been struggling with the way this information was glossed over.

    As hormonal birth control like the pill suppresses ovarian function and seems to have the same range of side effects as mentioned here – is it all that different to removal of the ovaries?

  9. Lisa Leger says:

    Good point Holly Grigg-Spall – ovaries are being suppressed right and left by hormonal drugs but at least there is the hope of them functioning again once women quit using birth control pills.

    Has anyone else speculated that Jolie might have been contemplating having some work done on her breasts anyway (not such an uncommon thing for a movie star after a few kids) and that her surgeons might have proposed the option of just replacing the whole works with implants in light of her genetic risk rather than fiddling around with lifting or augmenting or whatever alternative might have been under consideration. This course of events would make the decision more pragmatic than heroic, but no less radical and upsetting.

  10. Thank you for this more balanced view! You’re absolutely “dead on” in that no one seems to care about that which cannot be seen. However, the effects can be quite visible as I know from experience since having my sex organs unnecessarily removed (for a benign ovarian cyst). My appearance (skin, hair, figure) changed dramatically.

    I’ve been disappointed with the lack of mention by other media about the medically documented health and quality of life issues caused by ovary removal (correct terminology is “castration” but you won’t see that word in most media). If men’s healthy gonads were being removed, the authorities would step in and put an end to it.

    Hysterectomy and oophorectomy are destructive surgeries yet have been grossly overused for over a century. Despite a 2000 study in which ACOG determined 76% of hysterectomies to not meet their criteria, the medical-industrial complex keeps coming up with more ways to justify removal of women’s sex organs – laparoscopy and robotics for a shorter surgical recovery, removing healthy ovaries to reduce cancer risk even in women without a family history, BRCA testing to reduce cancer risk, etc. Ablation is considered an alternative to hysterectomy yet studies show that in the long-term it can lead to hysterectomy due to problems caused by the ongoing attempts of the uterus to build the lining in response to the hormonal messages from the ovaries.

    All women need to do their homework and understand that MOST hysterectomies and oophorectomies are unnecessary. Only about 2% are done for cancer. And this isn’t just about having unnecessary surgery. These surgeries are damaging to our overall health and quality of life and are a huge burden on our health care system.

  11. Let me start off by saying that I too have the BRCA1 mutation. I am adopted and only found out the information two years ago when I found my Birth Mother. I was 47 at the time. After consulting with seven Doctors including a Genetics Counselor, I made the decision to have my ovaries removed. Yes, it may have been easier for me because I was a bit beyond child bearing years, but as EVERY Physician stated to me… “Ovarian cancer is very difficult to detect & most often once it’s found it’s already in a late stage.” So…I made the decision to have my ovaries & tubes removed, but kept my uterus. One of my concerns about having the oophorectomy was going into instant menopause and a higher occurrence of osteoporosis (which I already have in my left hip). One of my Physicians is a specialist in Bio-identical pellet therapy and because BRCA1 is not an estrogen receptive cancer, I was given the OK by my Breast Specialist and other Physicians to go ahead with bio-identical hormone replacement. Note: BIO-IDENTICAL is the key word here. The pellets are inserted into my hip every four months and I must say that I feel like I am 30 years old again. I am still, however, contemplating the double mastectomy knowing that screenings for breast cancer are much better. It seems as though some of these posts are lacking in information about the high cancer risks and devastating effects of ovarian & breast cancer with this particular gene mutation. Any mother who wants to be around to be there for her children would do what she has to. Of course, it’s a personal decision either way. For those who are complaining about menopause…it is a fact of life, but there are sooo many ways to make the transition better if you just take the time to learn and ask the right questions.

  12. April Carlson says:

    http://www.naturalnews.com/040349_Angelina_Jolie_breast_cancer_surgery.html
    And make sure to listen to the video.
    How sad it is that women are duped into irrational fear by the very people (their oncologists) who are supposed to advise them and help protect their health? Epigenetics is the study of gene expression or supression. The BRCA gene controls tumor growth and it’s expression can be controlled through proper diet, elimination of toxins in the body, stress reduction and avoidance of radiation (that’s right, no mammograms.) Why do their doctors not tell them how to prevent cancer? Follow the money trail………….Now that’s a fact of life.

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