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Angelina Jolie has just announced she has removed her ovaries and fallopian tubes to "prevent cancer," following her decision last year to remove her breasts for the same reason. Is this medically justified, sane behavior?
With Angelina Jolie's recent announcement that she had her ovaries and fallopian tubes removed because of both a BRCA 'gene defect' and a history of breast and ovarian cancer in her family, the idea that genes play a dominant role in determining biological destiny and cancer risk is proliferating in the mainstream media and popular consciousness uncontrollably like a cancer.
Back in 2014, in a New York Times Op-Ed titled, "My Medical Choice," Angelina Jolie explained why she chose to have a double mastectomy, recounting what her doctors told her was the extreme health risk associated with her BRCA1 'gene mutation':
"My doctors estimated that I had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer, although the risk is different in the case of each."
At first glance, these estimates are frightening. Who, given such a bleak prognosis, wouldn't also feel compelled towards aggressive intervention when doing nothing (watchful waiting) would result in a 50% increased risk of developing the most lethal gynecological cancer known to exist. 
But where do these numbers come from? How did her caretakers arrive with any certainty at this figure?
The reality is that the average woman's lifetime risk of ovarian cancer is exceedingly small, with the overall risk of developing ovarian cancer by 65 years of age being 0.8 percent and the lifetime risk 1.8 percent. For those with a first-degree relative developing ovarian cancer, as is the case for Jolie, the risk estimates show increases to 4.4 and 9.4 percent, respectively.
It is also important to realize that lifetime ovarian cancer risk does not exist in a vacuum. Considering that it is not cancer (at any site) but heart disease that is the #1 killer of women, focusing on ovarian cancer risk as the primary threat to health is myopic at best, faulty reasoning with deadly consequences at worse. If Jolie had chose to go without radical surgical intervention, it is statistically more likely she would have died from heart-related death than cancer of any kind. The reality is that the lifetime risk of heart disease related death in women is in top position at 23.5%, according to CDC statistics, versus cancer which takes #2 position at 22.1%. And within cancer related deaths in women, breast, lung, colorectal cancer, uterine, thyroid, non-Hodgkin's lymphoma and melanomas are top on the list, with ovarian cancer in the 8th in position.
Given this context, how Angelina's doctors can justify expressing the relative risk of 50% in a way that colloquially comes off as absolute risk, is a mystery. But even if her prognosticators are accurate at reading the 'tea leaves' of her genome and family history, their attempts at predicting the future reflect a profound misunderstanding of the ovarian cancer statistics as a whole, and the nature of cancer itself.
Ovarian Cancer: Misunderstood and An Epidemic of Overdiagnosis
First, ovarian cancer is highly overdiagnosed, i.e. a labeling of "disease" that will never cause symptoms or death during a patient's lifetime. In other words, ovarian 'cancer' is being diagnosed in women whose ovarian abnormalities would never cause harm to them, and certainly never cause death before other more likely causes intervene!
According to a JAMA retrospective study of ovarian cancer screening, five times more women without ovarian cancer end up having surgery than those with ovarian cancer. These are women who were told they had cancer and ended up having their ovaries removed – including subjecting themselves to other extremely toxic 'treatments' such as radiation and chemotherapy- because they put unfailing trust in their doctors and a medical system that claims to know far more about their bodies than they do.
Not only does this overdiagnosis/overtreatment statistic represent an egregious assault upon women's physical and psychospiritual health, with unimaginable suffering as a consequence, but these false-positives inflate the ovarian cancer statistics, making it all the more likely to overestimate the prevalence and risk of ovarian cancer to the average woman in general.
One of the fundamental reasons for ovarian cancer overdiagnosis is that the natural history of ovarian cancer, and age-associated non-cancerous ovarian changes that may be mistakenly interpreted as life-threatening cancers, has not yet been worked out. We are too busy diagnosing 'early stage' lesions and cutting, burning and poisoning these 'abnormalities' to know what they are.
In the same way that so-called early stage breast cancers like ductal carcinoma in situ (DCIS), which for 30 years were treated as life-threatening and malignant – leading to 1.3 million US women having their breasts unnecessarily removed and their bodies treated with radiation and chemotherapy – were mistakenly classified as 'cancer,' non-malignant abnormalities of the ovaries that develop as women age are only now being understood as also benign and therefore better left untreated.
differ significantly from ovarian carcinomas with regard to percentile distribution of tumor histotypes, lower FIGO stage, excellent overall prognosis, younger age distribution, higher infertility rate, and a lower frequency of BRCA mutations."
[Note: while borderline tumors are related to a lower frequency of BRCA mutations, they nonetheless, inflate the statistics so that anyone, BRCA mutation or not, is subject to greater pressure to opt for ovarian removal]
Evidence for the non-malignancy of borderline ovarian tumors (BOTs) is reflected in the 5-year survival rate post-treatment, which is 95%–97% . This is on the same order magnitude as DCIS, which is as high as a 10-year survival rate of 96%-98%. Why so high a survival rate? Because the women diagnosed with the condition and subsequently treated are not surviving 'cancer,' rather, unnecessary surgery, treatment and the psychological traumas that follow the process.
The reality is that modern medicine just doesn't know what BOTs are:
"Borderline ovarian tumors represent a wide spectrum of tumors with different biological potential and uncertain malignant potential. No precise prognostic or predictive markers exist to clearly distinguish between tumors of purely benign behavior and those with risk of malignant transformation into carcinomas. Therefore, the oncologic safety must be always balanced again less radical treatment."
The primary justification today for preemptive ovary and fallopian tube removal -- salpingo-oophorectomy -- is the notion that hereditary determines risk. Family history, for instance, is considered the primary factor in determining whether a woman will end up with ovarian cancer. In other words, if your mother had ovarian cancer, it is believed you will be far more likely to end up with it as well.
The BRCA genes – BRCA1 and BRCA2 -- have been identified as the primary 'cause' for this familial association, in an unsophisticated nod to genetic determinism that has been the prevailing theory for over half a decade. But the reality is that if your mother had been diagnosed with ovarian cancer (perhaps falsely), you are more likely to share a similar set of environmental exposures, dietary incompatibilities and emotional patterns that feed into physiological/immunological factors directly related to ovarian cancer risk. These women are also much more likely to seek out medical surveillance for the condition, and are therefore much more susceptible to overdiagnosis and overtreatment yourself, repeating the vicious cycle of iatrogenesis. This is generally not considered when family history related ovarian cancer risk is calculated. And this has everything to do with the medical establishment not coming clean as to its increasingly obvious mistakes.