Writing in the New York Times on Tuesday, actress Angelina Jolie Pitt shared the details of her decision to have her ovaries and fallopian tubes removed and described her experience undergoing the procedure.

The column comes two years after the well-known celebrity wrote about her double mastectomy procedure in the same newspaper.

In the 2013 op-ed, Jolie—whose mother, aunt, and grandmother all died of cancer—explained her decision to undergo a double prophylactic mastectomy after discovering she had the BRCA1 gene, which increases the average person's risk of developing cancer by 65%. In Jolie's case, doctors estimated she had an 87% risk of developing breast cancer and a 50% risk of developing ovarian cancer.

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Jolie wrote, "Once I knew that this was my reality, I decided to be proactive and to minimize the risk as much as I could."

She wrote in the Times that she "started with the breasts" because they posed the highest cancer risk. Months later, she told reporters that she had not ruled out the possibility of having further surgery to reduce her risk of ovarian cancer.

Jolie's announcement sparked a national debate about breast cancer prevention and mastectomies. Some doctors worried that Jolie's "disclosure could be misinterpreted by other women, fueling the trend toward mastectomies that are not medically necessary for many early-stage breast cancers," according to the Times.

More broadly, Jolie was commended for her willingness to discuss a difficult decision. Tens of years ago, "it would not have been the norm for someone of Angelina's stature to come out and talk about having this disease, having preventive surgery like this," said Nancy Brinker, the founder of Susan G. Komen for the Cure, adding, "It's a real testimony to her and to the journey we've all gone on in the last 30 years."

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Writing in the Times, Jolie explains how a cancer scare prompted her to make a decision to proceed with the preventive surgery, a procedure she had planning to undergo for some time.

Every year, Jolie gets a blood test to monitor her CA-125 protein levels because of her family history. Although her CA-125 levels were normal, her doctor was worried about elevated inflammatory markets and sent her to get an ultrasound and further testing.

She writes, "The day of the results came. The PET/CT scan looked clear, and the tumor test was negative. I was full of happiness, although the radioactive tracer meant I couldn't hug my children. There was still a chance of early stage cancer, but that was minor compared with a full-blown tumor. To my relief, I still had the option of removing my ovaries and fallopian tubes and I chose to do it."

She notes that ovary removals may not be right for every woman genetically predisposed to cancer. She writes, "I did not do this solely because I carry the BRCA1 gene mutation, and I want other women to hear this. A positive BRCA test does not mean a leap to surgery. I have spoken to many doctors, surgeons, and naturopaths." She adds, "The most important thing is to learn about the options and choose what is right for you personally."

Last week, Jolie underwent a laparoscopic bilateral salpingo-oophorectomy. "It is a less complex surgery than the mastectomy, but its effects are more severe," she writes, explaining, "It puts a woman into forced menopause."

During the procedure, doctors found a small benign tumor on one ovary, but no indication of cancer in the tissue.

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Jolie writes, "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.'"

She concludes, "It is not easy to make these decisions. But it is possible to take control and tackle head-on any health issue. You can seek advice, learn about the options, and make choices that are right for you. Knowledge is power" (Jolie Pitt, New York Times, 3/24).