Karolyn A. Gazella

The Healing Factor

Some Clarification For Angelina Jolie Pitt's Followers

Jolie Pitt missed a few great opportunities to talk about risk reduction.

Posted Mar 28, 2015

Twenty years ago today, I was operated on for ovarian cancer. Just two days earlier, I celebrated my 33rd birthday. My extended family is one of the largest known carriers of the mutated BRCA gene in North America. My sister had breast cancer, my brother had esophageal cancer, and our mom died of pancreatic cancer. I have many aunts and cousins who have heroically fought their battles against this horrible disease. My devastating personal connection with cancer motivated me to dedicate my career to providing support and information to cancer survivors. 

That’s why when it comes to cancer and I see a missed opportunity, I feel the need to respond.

I last wrote about Angelina Jolie Pitt when she publicized her decision to have a preventative mastectomy after learning that she is a carrier of the mutated BRCA gene. Now she’s in the news again for her decision to have her ovaries and fallopian tubes removed. Once again, I have no issue with the choice Jolie Pitt made about her own risks and her own body. I, do, however, have a problem with the lack of clarification provided surrounding key issues associated with risk reduction. The fact is, Jolie Pitt’s circumstances—like my own—are unique and not applicable to most women. BRCA mutations account for only about 5 to 10 percent of all breast cancers and are associated with about 15 percent of all ovarian cancers.

Based on her Op Ed, the factors that Jolie Pitt used to make her decision regarding the surgery included:

  • BRCA mutation
  • Family history
  • CA125 (which was normal)
  • Ultrasound (which was normal)
  • PET/CT scan (which was normal)
  • Elevated inflammatory markers

It appears as though increased inflammation was a key impetus to Jolie Pitt’s decision to prophylactically remove her ovaries. She wrote that she had several elevated inflammatory markers and that fact combined with her family history and genetic mutation caused her to choose surgery.

Clarifying Inflammation and CA125

For the past decade, much of my writing and speaking has been on the topic of inflammation. In fact, it is an integral part of the Five to Thrive Plan I created with Dr. Lise Alschuler. Chronic internal inflammation can now be linked to nearly every major illness, including cancer, diabetes, heart disease, Alzheimer’s, and countless others. We identify increased inflammation through a variety of markers, and when those markers are elevated (as in the case of Jolie Pitt), it is certainly worth further investigation.

These inflammatory marker tests are critical tools to use to get a picture of overall health and disease risk. It’s important to note, however, that there is no inflammatory marker that I’m aware of that has been proven to diagnose ovarian cancer or any other cancer for that matter. So it’s critical to clarify that inflammatory markers are just one piece of the puzzle and they could indicate a variety of issues. There are also numerous dietary and lifestyle strategies to reduce inflammation and normalize these markers.

Jolie Pitt also wrote that she has been monitoring her CA125, a blood biomarker linked to ovarian cancer. As she reports in her New York Times Op Ed piece, the CA125 test has a 50 to 75 percent chance of missing cancer. In fact, this test is not meant to be used to screen for cancer for the general public. It’s primarily used to monitor cancer progression during and after treatment. Many things can cause elevations in CA125, including normal processes like menstruation, which is why it is not typically used as a screening measure in most women. Only in rare, very high-risk cases, is CA125 used to screen for ovarian cancer, and even then, it is used as a part of a comprehensive plan that includes symptom monitoring, vaginal ultrasound, and annual exams.

Good for You Angelina!

This time, Jolie Pitt does mention doing things to naturally support and strengthen her immune system; however, she does not say what those things are. This is a huge area of empowerment and a missed opportunity. She should also be applauded for adding a naturopathic doctor to her medical team. Chances are that doctor has given her great advice about diet and lifestyle.

Jolie Pitt clearly states that she wants women to hear that there are options. “The most important thing is to learn about the options and choose what is right for you personally,” she writes, and that is worth repeating.

She ends with “knowledge is power.” I couldn’t agree more. Knowledge is the antidote to fear. As I mentioned, I have been researching and writing about cancer for more than two decades. Many decisions surrounding the cancer experience are made from a place of fear, which is understandable. However, fear is very disempowering. Gandhi reminded us, “The enemy is fear.” We may think the enemy is cancer, but it’s not. When we are paralyzed by fear, we lose clarity.

The fact is, there are reasons to feel empowered even if you are a woman who carries the BRCA mutation.

Revisiting BRCA

The emerging field of study known as epigenetics clearly shows us that our genes are not our destiny. We can, in fact, influence how our genes behave. Women who are BRCA-positive have a mutation in that cell repair gene. There is no way to fix that. It means that this BRCA repair gene will not be able to repair defective (cancerous) cells. However, this is not the only cell repair gene that we have. Epigenetic research shows us that we can shore up the other cell repair genes to help compensate for the defective BRCA gene.

A study from 2005 demonstrated that having normal body weight and avoiding obesity helped BRCA-positive women reduce their risk of developing breast cancer. A 2011 study showed the same, and a 2010 study demonstrated that BRCA carriers who were more physically active had a reduced risk of developing breast cancer. Other studies have demonstrated that women who carry the BRCA mutation but eat more fruits and vegetables will reduce their risk of developing breast cancer.

It’s likely that most women who carry the mutated BRCA gene are not even aware that they can reduce their risk through diet and lifestyle. That would have been a great, empowering message for Jolie Pitt to deliver along with her news.

No Easy Answers

It’s true that prophylactic surgeries can save lives. But even if a woman chooses to have these surgeries, it’s ill advised for her to think she is free and clear. Even Jolie Pitt admits that it’s not possible to remove all risk. We are all at risk of developing cancer no matter how many body parts we remove. Cancer is pervasive, and until we start truly focusing on comprehensive, proactive prevention through diet and lifestyle, we will continue to lose the battle against it.