Angelina Jolie, Menopause, Estrogen and Breast Cancer

Angelina Jolie, Menopause, Estrogen and Breast Cancer

In this post, I would like to share my thoughts on some important points related to Angelina Jolie, estrogen and breast cancer that are impactful yet have been largely overlooked by most of the coverage.

As you likely know, about two years ago Angelina Jolie, who has the BReast CAncer  (BRCA1) gene and a strong family history of cancer, had her breasts removed to lower her risk of breast cancer. Given her young age of 37,  this was a huge and difficult decision.

More recently, Ms. Jolie had additional surgery (NY Times Op-Ed March 24, 2015 A23) to remove her fallopian tubes and ovaries (her uterus was not removed) to lower her risk of ovarian cancer that her mother died from at age 56.   Again, this must have been a very difficult decision because surgically removing both ovaries threw her into what is medically called “surgical menopause.”

I applaud Angelina Jolie for her courageous and open discussion of her BRCA1 gene screening and the actions she took to lower her risk of breast and ovarian cancer. She has raised awareness for millions of women and given them the courage to openly discuss genetic testing.  I want to expand upon a  few points  that could make Ms. Jolie’s brave public disclosure even more impactful.

The first is fact that BRCA, particularly the BRCA2 gene mutation, is associated with an up to 22 times greater likelihood of developing pancreatic cancer. Pancreatic cancer is on the rise and likely to overtake colon cancer as the number two cause of death due to cancer by 2020. People with BRCA and in particular BRCA2 should have this discussion with their doctors.

The second point is that Angelina states she is taking estrogen. Because her ovaries were surgically removed, she is in early menopause. Her taking estrogen is a very important point to underscore because going into menopause before age 46 and not beginning estrogen is associated with up to a 70% increase risk of Alzheimer’s disease, a 23% increased risk of heart disease and potentially, an increased risk of breast cancer.  Very importantly, women with BRCA who choose to take estrogen do not appear at any increased risk of breast cancer than women with BRCA not taking estrogen. Taking estrogen will also help Ms. Jolie maintain her youthful looks.

The third point is that Ms. Jolie is using a progesterone secreting IUD. As a result, she can take estrogen without having to also take oral progesterone, which is otherwise required to protect her uterine lining from the risk of uterine cancer.  The take home message here is that women who are on estrogen and still have their uterus can talk with their doctor about the option of using a progesterone secreting IUD off label as a possible alternative to oral progesterone.

These three key points expand Ms. Jolie’s generous efforts to turn her challenges into life-saving wisdom for millions of women and also highlight that a woman is not defined by either menopause or her health condition.

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