A Message About Today’s News Concerning Ovarian Cancer and Angelina Jolie

03/24/2015

I am writing to you from Orlando where the American Institute of Ultrasound in Medicine (AIUM) is having its annual meeting. I am the current president of this 10,000-member society and as most of you know I wrote the second book ever on transvaginal ultrasound and the first book on gynecological ultrasound.

Today’s news about Angelina Jolie’s decision to remove her ovaries necessitates that once again I send you, my patients, an email blast.

Some important facts; first Angelina Jolie carries the BRCA gene and that is why she had double mastectomies. In addition hers is the BRCA1 gene, which tends to cause high-grade ovarian tumors and tends to be premenopausal. The BRCA2 gene is less likely to be high grade and more likely to occur post menopausal. In addition less than 10% of ovarian cancers are related to this genetic mutation. Still, ovarian cancer tends to be a very lethal disease. In the “real world”, 82% of ovarian cancer presents as stage III or IV. The University of Kentucky ovarian cancer-screening program however found just the opposite. By annual transvaginal ultrasound screening, they picked up 82% of ovarian tumors at stage I or II, which is the exact opposite of the rest of the population. Recently a screening program in Britain, also using annual ultrasound screening, picked up ovarian cancer at an earlier stage. Still, they reported on nine women who came in less than one year after a negative ultrasound screen with a belly full of ovarian cancer—yet all nine were between 6–13 months since their negative screen. What does that tell us? If you are going to screen 12 months may be too long an interval. That is why for many years I have suggested seeing patients at six-month intervals, not for Pap tests but for vaginal sonograms. My personal motto has always been “over surveillance, under treat”

As usual if you have any concerns or questions don’t hesitate to call.