The Angelina Jolie factor & Ovarian Cancer: Risks, Genetics, epigenetics and nutrigenomics

We have all heard about the famous and beautiful actress Angelina Jolietmb_173x173_angelina-jolie-parenting-21may14-01 having taken the preventative steps of having her breasts, and now her ovaries surgically removed due to the presence of her cancer causing genetic roulette make up. She made this decision after careful consultation with her medical advisors, and after watching her mother die of the same genetic cancer.  She is such an admirable and gifted human being with otherwise an amazing genetic makeup.  It takes us aback with this news to appreciate that she really is, indeed, human.
Many of you readers may have formed an opinion about this. Some have voiced disappointment in the media hype with their pontificating on conspiracy theories. That is “she was manipulated by big pharma” or having surgery to improve the coffers of the Medical establishment etc. this quite frankly does not make sense. There is very little pharmacy associated with surgical healing compared to cancer chemotherapy. It’s actually a much more straightforward procedure. Even a complete ovariohysterectomy is only a few days in hospital.  I am sure that a woman of such high regarded stature would have had excellent medical advice and care. It is very likely that she will also partake of nutritional medicine, including herbs and  antioxidant therapies replete in omega 3 rich meals.  Integrative medical care in the United States is much more advanced than here in Australia, although we do have the Olivia Newton John Hospital opening in Victoria.  http://www.austin.org.au/cancer/
Others are saying that she was not given adequate informed holistic advice, otherwise why would she have surgery, especially if her organs were not shown to be cancerous. I think this too is unlikely.  Angelina and her family are well connected and intelligent people.
It’s more likely that the general public is less informed.
Having just returned from a visit with the senior professor in oncological gynecology, Professor Obermair http://www.obermair.info/inform…/gynaecological-cancer/… I think I can speak from the medically established  point of view given the latest research which puts some women (with the bad BRAC1&2)  somewhere between 30-80% certain to have ovarian cancer at some stage in their future if they carry a percentage, in total summation of genetic markers called SNP’s, that  produce the overall risk factor.
Ovarian cancer is insidious, and by the time it is diagnosed it is usually too late to save those precious mothers, wives and daughters. . It’s a difficult diagnosis to make, the signs and symptoms are not specific-and the cancer markers CA125 and HE4 are not 100% sensitive or specific. Therefore– speaking from the specialists:  it is simply an unacceptable risk if you have the strong SNP BRAC 1 and BRAC 2. End of discussion. Take it out, end of future risk.

As a veterinary surgeon who has performed thousands of ovariohysterectomies  and indeed some lifesaving surgeries, (pyometron, leiomyoma, adenocarcinoma) I can see their point.

I think it is most likely that Angelina had the best advice – she seems level headed and a smart cookie- and am confident it wasn’t about cosmetics. The public are probably not generally knowledgeable about the serum markers and DNA tests, as this is relatively new technology.  Given that her mother died a horrible death from this and that we are not privy to her exact BRCA figures, we are the uninformed. 

Because she is a public figure we can question her choice, but its likely that she did not have much choice from a statistic and genetic understanding. No doubt she will continue on with herbal, and nutritional supplementation, as did Olivia Newton John and all others. If Angelina had even a small cystic change on her ovaries, she would have been advised that there is no way to tell if this benign change could not become cancerous, and by the time it is “watched for change” it is often too late and peritoneal metastatases have spread. That is the dilemma in this diagnostic plan. You can read some more about it here:http://www.obermair.info/…/gynaecolo…/ovarian-cancer/…

Gynaecological Cancer Uterine Cancer In Australia, uterine cancer is the most common gynaecological cancer with more than 2000 women newly diagnosed every year. Typically it is a disease of postmenopausal women. Fibroids can become cancerous.  Ovarian cysts can become cancerous.

 I think the real point is that there is a lot more to understand about the intricacies now known regarding BRCA genes.

The SNP pedia explains the genetics in some detail, and it turns out that “23 and me ” saliva test is actually not as accurate as one would hope. There are over 2 thousand genetic markers when considering the 2 BRCA types. For the cancer markers 1+2 SNPedia currently contains 1456 BRCA1 SNPs and 1497 BRCA2 SNPs. Some of the variations in these genes are linked to Breast cancer and ovarian cancer, and other variations are benign. (See also BRCA1 and BRCA2 for individual gene discussions and links).
Microarray platforms used by DTC genomics testing companies such as FamilyTree DNA and 23andMe usually test a subset of substantially less than 100 BRCA1 or BRCA2 SNPs, typically, the most common ones. This results in both false positives (which includes being found positive for a variation that’s benign) as well as false negatives (the person tested carries a bad mutation, but it won’t be found since it’s one of the many SNPs that aren’t actually tested.
Having just researched and gone over the “23 and me” genomics (you can read about testing yourself here: https://www.23andme.com/)   I think it is not as simple as black and white, “it is what it is” does not explain the complex interaction of multiple genes…that is people on the outside (not being privy to geneticists, medical teams and the individuals circumstances) and without that genetic map knowledge might lump everyone into yay or nay piles. Diet and preventative measures are helpful FOR SOME, but they have a poorer probability of cancer reversal for others. Its not as simple as “you have BRAC1 gene so you must chop off your breasts”. There are thousands of genes with several of them interacting to set off or disallow the telomerase/cancer restriction to occur. Its actually more like a calculus problem, with many arithmetic variations and its very complex. One can have a multiplying variation of cancer causing genes which factor into the equation. As we age and our telomeres contract (its inevitable really, none of us get out of this life alive in the end!) our natural killer cells and immune system struggles. If you have a few SNPs that code for cancer they may increase your risk with age to an unacceptable level.( http://www.snpedia.com/index.php/Rs1042838)  This predisposition may rear its ugly head at any time- its like a time bomb.. Surgical removal of the offending, out of control tissue is a realistic option and is likely life saving for some. Not everyone will need to do this procedure, but for those with the 80% risk factors its definitely something to consider. If the multiplying factors weigh in at say 10% the option is less straightforward and perhaps not something someone would want to do, as the surgeries are not without trauma and side effects. Its great to be optimistic and open minded, but not so open that your brains fall out. Nutritional  medicine and herbs have a place and Gerson diets, Budwig principle, http://www.budwigcenter.com/the-budwig-diet/#.VRT1nmeJhdg,  and essential oils can help and I encourage you all to review https://www.youtube.com/watch?v=LHKaVd_twIE
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The risk factors based on genetic testing may also be misleading.http://www.survive-and-thrive-cancer.com/angelinajoliemastectomy.aspx#.VTcdF5WlBFR It may well be that the risk of breast cancer being passed down through the generations is seldom due to true genetic inheritance but rather due to an ‘inheritance’ of similar non-constructive dietary habits, lifestyle ways and emotional patterns.
I advocate careful choices–>health, nutrigenomics, herbal medicine and Surgery if it is indicated. It does very little to support the patient to say that “they must have eaten too many toxins or didn’t take enough tumeric, or didn’t pray enough or eat enough salad” if they, in fact drew the short straw in the gene pool. As more of us become thoroughly educated about the genetic risk factors, we may be seeing a whole new method of cancer treatment- genetic manipulation and deletion of some of our nasty genes. There is already the possibility of adding the mitochondria from a third person into an embryo making a “three person zygote”. Hmmm, now that is an interesting concept. We likely will not achieve immortality, nor would we want that- where will everyone fit on the planet? 😉

So the point is the oncological checks for ovarian cancer are so far poor diagnostic and prognostic indicators , ultrasound does not diagnose (It can’t differentiate a benign cyst from malignancy) , the cancer markers are somewhat inaccurate (benign uterine fibroids also elevate CA125), and the genetic potential is the only marker that is relatively accurate in identifying risks. The diagnosis of ovarian cancer is best made by excising the suspect ovary- the complete ovary within a bag carefully, with no Fine Needle aspirate- it seeds the cells into the peritoneum. The surgery is tricky, but curative.   If you have been given a big bundle of bad genes its probably better out than in, but if you have only a minor “bad hand” you might want to think about it – rest and digest, but pay closer attention to monitoring. (Ultrasound and serum testing CA125 and HE4). Eat healthy take in daily antioxidants and antitumour diets.  Avoid processed meat (ham, salami) and eat a largely plant based, preferably organic diet.  Avoid simple sugars. Joanna Budwig diet of flax seed oil and cottage or quark cheese with your salads is likely beneficial.  See our facebook site for more!    https://www.facebook.com/Naturopathvet?fref=nf

Get your antioxidants in early in the day, and take large quantities!

Get your antioxidants early in the day, and take large quantities! Juice it up, but avoid simple sugars and choose green vegetables with each meal.  Ripe fruit provides enzymes for your body to digest. Have 1gm/kg body weight protein.

 

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2 thoughts on “The Angelina Jolie factor & Ovarian Cancer: Risks, Genetics, epigenetics and nutrigenomics

    • Thank you Genevieve, its great to have good feedback in the blogsphere! Ovarian cancer is such a difficult disease to diagnose accurately so it’s really important that naturopaths and doctors team together and pay attention to that niggley IBS signs etc. It seems laporoscope surgeries by an excellent team is important- also for ruling out endometriosis. Dr Andrew Orr gives some significantly helpful information on all of this.

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