I am not married to Brad Pitt, I have never given a speech at the UN and I tend not to travel by private jet. But Angelina Jolie and I, it turns out, have two major things in common. We are both 39, and we both have a gene mutation, which gives us an elevated risk of breast and ovarian cancers.
Jolie underwent a preventative double mastectomy and reconstruction in 2013, and today revealed that she has elected to have further surgery to remove her ovaries and her fallopian tubes, following a check-up two weeks ago. Writing in the New York Times, Jolie, who has a BRCA1 mutation, says she has an estimated 87% risk of breast cancer and 50% risk of ovarian cancer.
I have a BRCA2 mutation, which, I was told, means that my lifetime risk of developing ovarian cancer is up to 25%. Lower than Jolie, yes, but considered high. Up to a one in four chance. My breast cancer risk is a moot point, as I was diagnosed with the disease in 2011 and have since, like Jolie, had a double mastectomy and a reconstruction, although unlike her this took four years and involved five separate surgeries. I have only just had my nipples tattooed on. Not that I am complaining about the NHS (although the food is terrible), but it was not a simple or a straightforward procedure.
In fact, there are many things about Jolie’s decision that are not so straightforward for me. Jolie and Pitt have six children, including three biological children. I have no children, and am single. Electing to remove my own ovaries and fallopian tubes will mean that I will never be able to have biological children.
I saw a specialist in 2012, who explained to me that having surgery by the time I was 42 would be optimal. Tick tock. The surgery induces menopause – a whole decade, at least, early. And because my breast tumours were oestrogen positive, I am not a candidate for HRT to help relieve any of the horrible symptoms that will invariably accompany this.
In the meantime, there is screening. It consists of a blood test for a tumour marker, CA125, and an ultrasound scan of the pelvis. When I was offered it in 2012, there was no clear evidence to suggest it was beneficial. A study, the United Kingdom familial ovarian cancer screening study, had recently closed, and was due to report in 2013. As such, screening was self-funded, at £330 a year. Not a huge amount – but annoying. Everything is terrible, and it will cost you money. I had the screening once or twice, nothing showed up. I put it to the back of my mind. Or rather, I tried to. Because, unfortunately, information like this isn’t easily banished.
Jolie has been praised for her bravery by Katherine Taylor, the acting chief executive of Ovarian Cancer Action. But what about the millions of us for whom the decision is not quite so simple? The thought that I probably should get my ovaries removed is, to me, a kind of dreadful admin, like a really overdue bill. Something extremely unpleasant that I know I need to address, but that I really don’t wish to think about.
My choice right now is to either accept I will never have a child and have the surgery, or cross my fingers and hope for two things: firstly that I don’t develop ovarian cancer, and secondly that I meet someone and have a child with them. Quickly. This hardly seems ideal, or particularly likely.
When I saw the news this morning my first emotion was annoyance. Jolie says it is “possible to take control and tackle head-on any health issue”. I’m not sure that she’s right. But as I read her piece, being irritated with her seemed somewhat ridiculous. I looked up the results of the ovarian screening study, for one thing. It concluded that screening more frequent than annually, with prompt surgical intervention if needed, “seems to offer a better chance of early-stage detection”. Not exactly cut and dried, but possibly better than nothing. So why haven’t I been screened in more than two years? I have no idea really, apart from, well, procrastination. Every day a new reason to feel frightened and guilty.
Jolie makes clear that by sharing her story she wants to help and empower other women. And she has the grace to says she feels “deeply” for the childless, saying: “Their situation is far harder than mine.” Yes, Angelina, it really is.