Following her 2008 diagnosis of breast cancer, Christina Applegate decided to get a double mastectomy. Nine years later, she revealed that she has taken another major step toward cancer prevention and had her ovaries and fallopian tubes removed as well.
Speaking exclusively to Today.com, Applegate said that her cousin died of ovarian cancer in 2008, which led to the realization that she could prevent that from happening to her too.
“That’s how I’ve taken control of everything,” she said in the interview. “It’s a relief. That’s one thing off the table.”
Applegate went on to say, “if you’re BRCA positive, it’s highly possible you’ll develop cancer in your lifetime,” and suggested eating organic foods and trying to reduce stress in your life as other ways to help take control of your health.
Aware that not everyone can afford BRCA tests, Applegate founded Right Action for Women, which assists at-risk women who may otherwise be unable to pay for MRI screenings and BRCA testing.
“We’re at this place where we need to sit down and figure out the future of what it is that we’re doing and get into more of the BRCA tests for women,” Applegate told Today.com. “That’s a huge cost for a lot of people who don’t have perfect insurance. If you do know you have the gene, it gives you an empowerment about your lifestyle.”
Women, like Applegate, with a family history of ovarian cancer may have an increased risk of getting ovarian cancer, says Dr. Marc Winter, an OB-GYN at MemorialCare Saddleback Medical Center in Laguna Hills, Calif.
"We know that genetics can play a significant role in risk, and that women who carry the BRACA gene are at a very high risk – between 30 and 80 percent depending on the gene type and individual risk factors," he adds.
Surgery for women with family history of breast or ovarian cancer who have not been identified as BRCA-positive is more controversial and handled on an individual basis, according to Dr. Leslie Randall, a gynecological oncologist at MemorialCare Saddleback Medical Center in Laguna Hills, Calif.
For those who may not test positive for the BRCA gene, if a woman has a first degree relative (meaning a mother or sister) with ovarian cancer, her life risk increases from about 1.4 percent to five percent, Winters says, and with a five percent risk "it makes statistical sense to remove ovaries and fallopian tubes."
Regarding prevention of breast cancer, women with estrogen receptor positive breast cancer who are pre-menopausal have a reduced risk of breast cancer recurrence with removal of tubes and ovaries, though there are non-surgical means of suppressing the ovaries until menopause occurs naturally, Randall notes.
Unfortunately, Winter explains, testing for at-risk women – specifically, the blood test for tumor markers like CA 125 and pelvic ultrasound – is not reliable in picking up early cancers. As a result, the only intervention that has been shown to reduce the long-term risk in these patients is a prophylactic surgery, which is the removal of an organ or gland (in this case, the ovaries and fallopian tubes) that show no signs of cancer, in an attempt to prevent cancer.
While there are always risks to surgery, Winters explains, they are very small compared to the risk of developing cancer in BRCA carriers: The risk of major complications with hysterectomy is approximately one percent, compared to their 40 to 80 percent risk of developing cancer.
"In my experience," Winter says, "women are relived after surgery that their risk of developing ovarian cancer is not something that will keep them up at night."
The minimum procedure is removal of both tubes and ovaries, but some women choose to remove the uterus as well if other factors are present, such as need for tamoxifen for breast cancer, abnormal pap smears or periods, Randall says. The surgery is typically done laparoscopically, and is low-risk in most cases.
"The worst side effect is menopause which can lead to hot flushes, night sweats, vaginal dryness, sexual dysfunction, premature heart disease and osteoporosis," Randall says.
Menopause can be complicated to manage in women who have or who are at risk for breast cancer, and therefore, must be handled on an individualized basis. As a result, Randall notes, the short term procedural risks pale in comparison to the long term health and quality of life implications.
Meanwhile, the elective removal of ovaries as a preventative measure is not new. In fact, the procedure was previously very common during a routine hysterectomy. The idea behind this is that as long as doctors were in the area and the patient was having major surgery and would no longer have a uterus, they also wouldn’t need their ovaries, so they might as well be removed to prevent risk of ovarian cancer. However, that standard of care has been changing, and now, doctors only recommend removing the ovaries during a hysterectomy if there is a family history of ovarian cancer.
We wish Applegate all the best and continued health.
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