Two years after her double mastectomy, Hollywood superstar Angelina Jolie has undergone another preventive operation to remove her ovaries and fallopian tubes.
The 39-year-old actress, who lost her mother, grandmother and aunt to cancer and carries a mutation in the BRCA1 gene, wrote in a piece to the New York Times that she was planning the surgery for some time.
The gene mutation gives Jolie an estimated 87 per cent risk of breast cancer and 50 per cent risk of ovarian cancer.
"I had been planning this for some time. It is a less complex surgery than the mastectomy, but its effects are more severe. It puts a woman into forced menopause.
"So I was readying myself physically and emotionally, discussing options with doctors, researching alternative medicine, and mapping my hormones for estrogen or progesterone replacement. But I felt I still had months to make the date," Jolie wrote.
The actress, who is married to Brad Pitt and raises three adopted and three biological children with him, said she decided to speed the process after getting a call from her doctor.
"Then two weeks ago I got a call from my doctor with blood-test results. 'Your CA-125 is normal,' he said. I breathed a sigh of relief. That test measures the amount of the protein CA-125 in the blood, and is used to monitor ovarian cancer. I have it every year because of my family history.
"But that wasn't all. He went on. 'There are a number of inflammatory markers that are elevated, and taken together they could be a sign of early cancer." I took a pause. 'CA-125 has a 50 to 75 per cent chance of missing ovarian cancer at early stages," he said. He wanted me to see the surgeon immediately to check my ovaries," Jolie added.
The actress said she went through a difficult time but assured herself that there was no reason that she would not see her children grow up or meet her grandchildren.
"I called my husband in France, who was on a plane, within hours. The beautiful thing about such moments in life is that there is so much clarity. You know what you live for and what matters. It is polarizing, and it is peaceful."
Jolie said she was happy to see that her "PET/CT scan looked clear, and the tumor test was negative".
"To my relief, I still had the option of removing my ovaries and fallopian tubes and I chose to do it," Jolie said while advising other women to go through various options and choose what is right for them.
The actress said removing her tubes and ovaries was the best option as her doctors indicated that she should have preventive surgery about a decade before the earliest onset of cancer in her female relatives. "My mother's ovarian cancer was diagnosed when she was 49. I'm 39."
Jolie, an actress, director and UN envoy, agreed that it was not possible to remove all risk and she remained prone to cancer but she will continue to work for her health.
Though she is expecting some physical changes due to the hormone replacements, Jolie said she was at ease about her future.
"I will look for natural ways to strengthen my immune system. I feel feminine, and grounded in the choices I am making for myself and my family. I know my children will never have to say, 'Mom died of ovarian cancer.