What to ask your doctor about Angelina's cancer surgery.

When Angelina Jolie writes about her personal health struggles in the New York Times, it makes a splash. In 2013, Jolie set off a media storm by writing about her double mastectomy and genetic predisposition for cancer, then wrote about a second surgery, this time to remove her ovaries and fallopian tubes, in 2015.

High drama, yes, but it’s hard not to admire her candour. Jolie writes that she is now in full menopause and using bio-identical estrogen patches and an IUD to replace the hormones she’s lost. That’s no small reveal for anyone, let alone an actress known for her vitality and sex appeal.

Jolie also added a note of caution, knowing that the "Jolie effect" is now a recognized factor in doctor-patient conversations and that her preventative surgeries are an extreme course of action.

"I did not do this solely because I carry the BRCA1 gene mutation, and I want other women to hear this. A positive BRCA test does not mean a leap to surgery," she writes.

On this point, Canadian doctors and cancer experts agree. High drama may be a good way to start a conversation but calm heads makes the soundest decisions.

A cancer doctor weighs in
Dr. Marcus Bernardini a surgical oncologist at Toronto’s Princess Margaret Cancer Centre at University Health Network told us there are a few things Canadian women should know in the wake of Jolie’s announcement:

1. There is actually no effective general screening for high-grade serious ovarian cancer and screening is not recommended.

2. Preventative surgery is recommended for high-risk women (those who carry the BRCA1 or BRCA2 mutation).

3. Jolie mentions a scenario in which only the fallopian tubes are removed (called a salpingectomy) for women who still hope to get pregnant. Dr. Bernardini calls this "an intriguing strategy," but for now the removal of the ovaries and fallopian tubes (a salpingo-oophorectomy) is the recommended course of action.

4. There are four questions Dr. Bernardini suggests discussing with your doctor if you have concerns raised by Angelina Jolie’s story:
- Am I at risk for ovarian cancer?
- Is there a history of ovarian cancer in my family?
- How does one find out if they are eligible for testing?
- I know there are different types of ovarian cancer, are all preventable in this way?

Family history is the starting point
Responding to the Jolie news this week, Gillian Bromfield, the director of Cancer Control Policy at the Canadian Cancer Society also pointed out that it’s important that people try to learn their family health history.

The group also has information for women with a known strong family history of breast and ovarian cancer, including information on genetic testing, and preventive strategies that may be available to them, she says.

"The decision to have a preventive surgery is a very personal one that a woman would make in consultation with her healthcare provider based on her medical history and her personal preferences," she says.

Here’s hoping Jolie’s candour leads to more information being shared – not more panic.

Read on for more information on menopause and genetic testing.