Oscar-winning actress Angelina Jolie has revealed she has undergone more preventive surgery, having her ovaries and fallopian tubes removed in the hope of reducing her risk of cancer.
Writing in the New York Times, the filmmaker and philanthropist said that a recent blood test showed inflammatory markers that were elevated, which taken together could be a sign of early cancer.
The news came as a blow to the star, who has already had a double mastectomy.
She wrote: "I went through what I imagine thousands of other women have felt.
"I told myself to stay calm, to be strong, and that I had no reason to think I wouldn't live to see my children grow up and to meet my grandchildren."
Jolie, 39, revealed two years ago that she carries a defective BRCA1 gene that puts her at high risk of developing breast and ovarian cancer.
Her mother died of ovarian cancer, and her maternal grandmother also had ovarian cancer - strong evidence of an inherited, genetic risk that led the actress to have her healthy breasts removed in a bid to avoid the same fate.
She said that while having the gene mutation alone was not a reason to resort to surgery - other medical options were possible - her family history influenced her decision to have further surgery now.
Her decision to announce her double mastectomy publicly was praised as a courageous watershed moment in efforts to persuade women to get breast cancer screening early - and to raise awareness of the need for early detection.
The same sense of mission led her to write about her follow-up care.
"I wanted other women at risk to know about the options," she wrote.
"I promised to follow up with any information that could be useful, including about my next preventive surgery, the removal of my ovaries and fallopian tubes."
Jolie's article makes plain the anguish the results of the new blood tests brought. She said she immediately called her husband, the actor Brad Pitt, who flew home from France within hours.
"The beautiful thing about such moments in life is that there is so much clarity," she wrote.
"You know what you live for and what matters. It is polarising, and it is peaceful."