Health experts hail Jolie decision
Angelina Jolie's decision to have her ovaries and fallopian tubes removed to lessen her chances of developing ovarian cancer has been hailed as "brave" by health experts.
The Hollywood star revealed that she underwent the preventative surgery last week, two years after having a double mastectomy.
The actress carries a mutation in the BRCA1 gene meaning she had a 50% chance of developing ovarian cancer, which killed her mother, Marcheline Bertrand, in 2007.
Jolie has been praised in the past for opening up discussions around women's health and sparked a doubling in referrals for genetic breast cancer tests in the UK last year, in what doctors dubbed the "Angelina effect".
Katherine Taylor, acting chief executive of Ovarian Cancer Action, said she expected the same thing to happen now and hoped it would make women become more aware of the symptoms of ovarian cancer.
More than half of women with ovarian cancer die within five years of diagnosis and those who are not diagnosed until a more advanced stage have a poorer survival rate.
The main reason it is such a big killer is because it is hard to detect in the early stages. The main symptoms are swelling in the abdomen, weight gain, bloating or irritable bowel-like symptoms.
Writing in The New York Times, Jolie said the decision was "not easy".
"In my case, the eastern and western doctors I met agreed that surgery to remove my tubes and ovaries was the best option, because, on top of the BRCA gene, three women in my family have died from cancer," she said.
"My doctors indicated I should have preventive surgery about a decade before the earliest onset of cancer in my female relatives.
"My mother's ovarian cancer was diagnosed when she was 49. I'm 39.
"It is not possible to remove all risk, and the fact is I remain prone to cancer.
"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'."
Jolie said she had been planning the surgery "for some time" and had been preparing herself "physically and emotionally" for the operation, which puts a woman into forced menopause.
However, the procedure became urgent two weeks ago when her annual blood test results showed she could be in the early stages of cancer.
Doctors have since since found "no signs of cancer in any of the tissues", she said.
Jolie said her husband, Brad Pitt, was on a plane within hours of the worrying blood test results.
"The beautiful thing about such moments in life is that there is so much clarity," she said. "You know what you live for and what matters. It is polarising, and it is peaceful."
She said she considered other options, advice from doctors and her own family history before choosing to have her ovaries and fallopian tubes removed.
"There is more than one way to deal with any health issue," she said.
"The most important thing is to learn about the options and choose what is right for you personally."
Chief executive of Target Ovarian Cancer, Annwen Jones, said: "Taking the decision to have your ovaries removed to reduce the risk of ovarian cancer is an incredibly difficult decision for any woman.
"This sort of preventative surgery has a very big impact both physically and emotionally, and so it is incredibly important that any woman considering this option takes time to discuss all of the advantages and disadvantages with both a counsellor and medical team.
"Angelina Jolie's decision to tell her story is very brave, and she plays a vital role in raising awareness of ovarian cancer and the BRCA gene mutation, which significantly increases the risk of ovarian cancer.
"It's so important for women and GPs to be aware of the symptoms of ovarian cancer - bloating, feeling full, needing to wee more and abdominal pain - as there is no proven screening programme."
Lester Barr, chairman of Genesis Breast Cancer Prevention, said: "Angelina Jolie's mastectomy in 2013 brought the subject of preventative surgery firmly into the spotlight. Following her announcement, our researchers found that the number of high-risk women in the UK enquiring about their own options more than doubled.
"Her story is proof that one high-profile case can do immense amounts for public awareness - hopefully we will see a similar increase in women at risk of developing familial ovarian cancer come forward for preventative treatments over the coming months."
Women have a much greater risk of developing breast and ovarian cancer if they inherit the mutation in the BRCA1 gene - like Jolie - or the BRCA2 gene.
Martin Ledwick, head information nurse at Cancer Research UK, said: "Angelina Jolie's brave decision to be open about her increased risk of breast and ovarian cancer helps to draw attention to the difficult decisions faced by women who have a BRCA gene fault.
"For these women, having their ovaries removed can significantly reduce their risk of developing ovarian cancer and has an added effect of helping to reduce the chances of getting breast cancer too.
"However, it is important to remember that only a relatively small proportion of breast and ovarian cancers are caused by one of these gene faults, so only a small number of women will be faced with this difficult choice."