Perhaps you've heard: Actress Angelina Jolie published an essay yesterday about opting to surgically remove her Fallopian tubes and ovaries because of her elevated risk for ovarian cancer. It's a life-altering choice, as it drastically reduces her risk for cancer, but also puts her into an early menopause. From the public eye, it also feels like a momentous decision—removing entire organs that, in Jolie's case, aren't yet making one sick. Yet, as research shows, many women make the same choice, and they apparently fare fine afterwards.
It's important to note that Jolie's situation is rare. She has both a strong family history of breast and ovarian cancer and a mutation in a gene, called BRCA1, that raises people's risk for those cancers. Different combinations of these risk factors may make other women's situations different. Yet Jolie is not alone, either. Because screenings for ovarian cancer aren't proven to work well, doctors often recommend such surgery to higher-risk women. Many choose it. Psychologists have conducted a few surveys of people who were predisposed to ovarian cancer and chose to get their Fallopian tubes and ovaries removed.
Any one person's response to such a major surgery is unique. And even people who later report to researchers that they're leading an overall happy life still likely experience times of sickness, sadness, and pain. Nevertheless, it's reassuring to find that in studies, on average, women who choose surgery report the same quality of life as other women their age—despite the fact that many women report severe hormonal symptoms after their surgeries.
Because screenings for ovarian cancer aren't proven to work well, doctors often recommend such surgery to higher-risk women. Many choose it.
In one study of 846 Dutch women who were at elevated risk for ovarian cancer, those who chose surgery—44 percent—and those who chose to instead get frequent screenings both reported similar quality of life as other women in their age range. Those results are backed by another study, this one of 40 Canadian women who all chose surgery: Those women also had similar quality of life as anyone their age.
The biggest psychological benefit to surgery, across all the studies, was a heightened peace of mind. In the Dutch study, women who elected for surgery had fewer cancer worries than their counterparts who chose screenings. Oddly enough, the surgery-choosers even reported being less worried about their family members' risk of ovarian cancer, which suggests that their internal optimism had a wide-ranging effect on their overall outlook.
The most consistently reported drawback to surgery revolved around sexual symptoms, which came even to women who took hormone replacement therapy. Among the Canadian women, about half said they suffered from moderate to extreme sexual functioning symptoms—which the researchers didn't initially ask about, until the suggestion from some of the first women they surveyed.
So would those who got surgery recommend it to others? Here the answers are mixed, but still mostly positive. Among the volunteers in the Dutch study who chose surgery, 86 percent said they would do so again, and 63 percent said they would recommend it to a friend who had a family history of ovarian cancer. In the Canadian study, 49 percent of the women said they would make the same choice again, while 35 percent had no comment. Thirty percent of the Canadian women would recommend surgery to a friend, while the others said they would advise others to "be informed," "take control or responsibility," and "take time to make a decision." Three percent wouldn't recommend the procedure.
Making decisions about medical procedures—and how to potentially avoid an early death—is hard. Judging from a few of the comments to Jolie's essay, some people will think that major surgery isn't the right choice. But those who end up making the same decision seem to do well, with a quality of life on par with anyone else. "I feel at ease with whatever will come, not because I am strong but because this is a part of life," Jolie writes. Many who have walked the same path likely agree.