Angelina Jolie and Risk Reduction Surgery

You may remember the story of Angelina Jolie's decision to have her breasts removed as she was a very high risk for breast cancer. Now, she's undergone further surgery to remove her tubes and ovaries.

From the NY Times:

“Prophylactic removal of ovaries and fallopian tubes is strongly recommended in women before age 40 in BRCA1 and BRCA2 mutation carriers,” said Dr. Susan Domchek, executive director of the University of Pennsylvania’s Basser Research Center, which specializes in BRCA mutations. “There is no effective screening for ovarian cancer and too many women with advanced stage ovarian cancer die of their disease.”

Writing for The New York Times’s Op-Ed page, Ms. Jolie Pitt, 39, said she had expected to have her ovaries and fallopian tubes removed, a procedure called a laparoscopic bilateral salpingo-oophorectomy, but that a cancer scare made her decide to undergo the procedure sooner. Her mother, aunt and grandmother died of cancer.

“To my relief, I still had the option of removing my ovaries and fallopian tubes and I chose to do it,” she wrote.

Two years ago, she ignited a worldwide discussion about options for women at high risk for breast cancer when she wrote that she had had both breasts removed because BRCA1, the same genetic mutation that prompted her surgery last week, increased her risk of breast cancer.

Allow me to clear up one misconception. This is not "Prophylactic Surgery" but rather Risk Reduction Surgery. Even following removal of the tubes and ovaries, there is a small residual risk of cancer inside the abdominal cavity, histologically identical to ovarian cancer.

For more info, you can go here.

When All Else Fails, Blame The Obstetrician

Now that the vaccine-autism link has been debunked again, Jenny McCarthy notwithstanding, everything but the kitchen sink is being put forth as potential causes of this affliction. The latest out of Duke finds a connection between autism and induction of labor.

... Overall, the likelihood of autism increased by 23% in association with induced or augmented labor as compared with children whose mothers had unassisted labor, Simon G. Gregory, PhD, of Duke University, and colleagues reported inJAMA Pediatrics.

Induction only, augmentation only, or the combination all were associated with significantly increased odds of autism. The magnitude of increased risk was similar to that associated with fetal distress, meconium, prematurity, and maternal diabetes, they said.

Curiously, this linkage seemed to hold predominantly for boys. The connection for females was more tenuous.

While this is certainly interesting, remember that association hardly proves cause and effect. Emily Willingham in Forbes gives this article a thorough review and notes some quite strange findings. For one thing, moms' having a college education increase the odds of her child attending special education. Yes, you read that right. Also, maternal smoking apparently decreases the risk of later autism diagnosis. So should we infer that women should drop out of school and commence smoking? Hardly.

While the dust settles around this study, remember that there have been numerous studies linking various genetic factors and autism, the latest trumpeted by the New York Times. Here's a thought - perhaps whatever genetic or epigenetic factor which may lead to autism spectrum may also predispose to a situation which subsequently require induction of labor. 

Remember that as Mark Twain ( often attributed to Benjamin Disraeli) said, there are "lies, damned lies, and statistics." I learned in high school that statistics are like bikinis - what they reveal is suggestive but what they conceal is vital.