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The whole world knows that Angelina Jolie had a double mastectomy to reduce her risk of breast cancer. But carriers of BRCA gene mutations are also at risk of ovarian cancer. Should Angelina have had her ovaries removed? Should other carriers?

Remember how the news of Angelina Jolie's double mastectomy took over what seemed like the whole internet for a while? The actress made the difficult but brave decision to have both her natural breasts removed, because she carries the BRCA1 gene that greatly increases the risk of breast cancer. 

She looks as beautiful as ever with reconstructed breasts and obviously had a fantastic medical team on her side.

Many other women who also carry the BRCA1 gene are still, however, weighing the pros and cons of having the surgery done.

Cancer is frightening, and people who know they carry BRCA1 may feel like they are living with a ticking time bomb.

Jolie and her partner Brad Pitt showed the world a new perspective on preemptive mastectomy, both by making Jolie's experience public and staying positive throughout. Brad Pitt said: "She could have stayed absolutely private about it and I don't think anyone would have been none the wiser with such good results. But it was really important to her to share the story and that others would understand it doesn't have to be a scary thing." 

"In fact, it can be an empowering thing, and something that makes you stronger and us stronger."

Indeed, if BRCA1 is a ticking time bomb, deciding to have it deactivated is very empowering. Jolie's doctors estimated that she had a shocking 87 percent risk of developing breast cancer, and her decision to undergo a double mastectomy and breast reconstruction surgery lowered that risk to less than five percent. 

But BRCA1 does more than increase a person's risk of breast cancer — it also leads to much worse odds for ovarian cancer. Ovarian cancer is what Jolie's mother, Marcheline Bertrand, died from after a decade-long struggle. 

Bilateral Oophorectomy — Another Preemptive Surgery For BRCA1 Carriers

Jolie wrote an op-ed for the New York Times to explain her decision back in May, and she says she often talks about her mom with her six kids. "I find myself trying to explain the illness that took her away from us," the actress wrote. "They have asked if the same could happen to me." She adds:

"I have always told them not to worry, but the truth is I carry a 'faulty' gene, BRCA1, which sharply increases my risk of developing breast cancer and ovarian cancer."
We know that Jolie reduced her risk of breast cancer very dramatically by opting for a double mastectomy, but she was also told she has a 50 percent chance of developing the cancer that took her mom away. Why did she not have a bilateral oophectomy, a surgery to remove both ovaries, then? She said she opted to have the mastectomy first as her "risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex".
 
After that statement, People magazine wrote that "her medical odyssey is not done. The mother of six is also planning to undergo surgery to remove her ovaries."
Their brief report was apparently triggered by Jolie's remark that she "started with the breasts", implying that more was to follow. It led to thousands of other reports and blog posts saying that Jolie was going to "have her ovaries removed next".
 
Perhaps so. But Jolie didn't actually say that. Her actions actually show something a little different — that she chose not to have a bilateral oophorectomy right now.
In fact, many doctors would have recommended that oophorectomy. Dr Steven Narod, a professor at the University of Toronto and director at the Women’s College Research Institute’s Familial Breast Cancer Research Unit, was one of them. Narod is the world's foremost researcher of BRCA gene mutations, and he found that an oophorectomy reduces death from breast and ovarian cancer by 70 percent in women carrying BRCA gene mutations. 
 
He told the Times Of Israel: “She didn’t ask me, but I would have recommended an oophorectomy as well.
I'll pose the question again. Why did Jolie not opt to have a bilateral oophorectomy when she chose to have a double mastectomy?  An oophorectomy removes the ovaries, so it sends a woman straight into a premature menopause. Losing the protective benefits of the female hormone estrogen, produced in the ovaries, can cause a whole host of potential health problems
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