Cancer Found in More Than 2% of High-Risk Women Who Have Ovaries Removed Preventively

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A study has found that 2.6% of women at high-risk for ovarian cancer because of genetics or family history who had their ovaries and fallopian tubes removed (called “salpingo-oophorectomy”) preventively had cancer that was found during ovary removal surgery.

The research was published in the Oct. 10, 2014 issue of the Journal of Clinical Oncology. Read the abstract of “Pathologic Findings at Risk-Reducing Salpingo-Oophorectomy: Primary Results From Gynecologic Oncology Group Trial GOG-0199.”

Everyone has BRCA1 (BReast CAncer gene one) and BRCA2 (BReast CAncer gene two) genes. The function of the BRCA genes is to repair cell damage and keep breast cells growing normally. But when these genes contain abnormalities or mutations that are passed from generation to generation, the genes don’t function normally and breast and ovarian cancer risk increase. Abnormal BRCA1 and BRCA2 genes may account for up to 10% of all breast cancers.

Women with an abnormal BRCA1 or BRCA2 gene:

  • have up to an 85% lifetime risk of developing breast cancer
  • have a much higher-than-average lifetime risk of ovarian cancer; estimates range from 15% to 60%

Women who know they have an abnormal BRCA1 or BRCA2 gene can take steps to reduce their risk. Removing the healthy ovaries (and breasts) -- called prophylactic surgery (“prophylactic” means “protective”) -- are very aggressive, irreversible risk-reduction options that some women with an abnormal BRCA1 or BRCA2 gene choose.

In this study, researchers wanted to better understand which women benefit the most from having their ovaries and fallopian tubes removed prophylactically.

The researchers looked at the records of 966 women at high risk for ovarian cancer who were age 30 or older who had prophylactic surgery to remove their ovaries and fallopian tubes. None of the women were having any symptoms of ovarian or breast cancer.

Before the prophylactic surgery, all the women also had cancer antigen 125 (CA-125) serum testing and transvaginal ultrasound.

A CA-125 test measures the amount of CA-125 in a person’s blood. CA-125 is a protein that is found in greater concentrations in cancer cells, particularly ovarian cancer cells.

A transvaginal ultrasound test creates images of the ovaries.

The women were all part of the Gynecologic Oncology Group (GOG) 0199 study, also called the National Ovarian Cancer Prevention and Early Detection Study.

More than half the women had an abnormal BRCA1 or BRCA2 gene:

  • 33% had an abnormal BRCA1 gene
  • 24% had an abnormal BRCA2 gene
  • 0.2% had both an abnormal BRCA1 gene and an abnormal BRCA2 gene
  • 42% didn’t have either abnormal BRCA gene

Overall, occult cancers were found in 25 women (2.6%) during the prophylactic surgery. Doctors call cancers that are found by chance during another procedure “occult.” Of these occult cancers:

  • 11 were ovarian cancers
  • 9 were tubal cancers
  • 5 were cancers in the lining of the abdominal cavity

The women with occult cancers included:

  • 4.6% of women with an abnormal BRCA1 gene
  • 3.5% of women with an abnormal BRCA2 gene
  • 0.5% of women with no abnormal BRCA gene

After analyzing the results, the researchers found that certain factors were linked to a higher risk of cancers being found during prophylactic removal of the ovaries and fallopian tubes, including:

  • being postmenopausal
  • having an abnormal BRCA1 or BRCA2 gene
  • abnormal CA-125 test results
  • abnormal transvaginal ultrasound results

No occult cancers were found in women who didn’t have an abnormal BRCA gene who had normal CA-125 and transvaginal ultrasound results. This suggests that these women would benefit less from prophylactic ovary and fallopian tube removal than women with an abnormal BRCA gene or women with abnormal CA-125 or transvaginal ultrasound results.

If you know you have an abnormal breast cancer gene, you may be considering taking steps to keep your risks of breast and ovarian cancer as low as they can be. There are many lifestyle choices you can make, including:

  • maintaining a healthy weight
  • exercising regularly
  • limiting alcohol
  • eating nutritious food
  • never smoking

You also may be considering preventive ovary and fallopian tube removal. This surgery can significantly reduce the risk of developing ovarian cancer -- and also reduce the risk of breast cancer when done before menopause -- but is a serious choice that can have a considerable effect on your life. The sudden loss of estrogen can cause a range of side effects, such as hot flashes, depression, difficulty sleeping, and lower sex drive. Estrogen loss may affect bone and heart health. Ovary removal also takes away your ability to have children.

Regardless of whether prophylactic ovary removal is involved, there are many factors to consider when deciding on a risk-reduction strategy. Take the time you need to talk to your doctor and family members about the different ways you can lower your risk.

For more information on BRCA1 and BRCA2 genes, as well as all the risk-lowering steps you can take if you have an abnormal version of one or both of these genes, visit the Breast Cancer Risk Factors: Genetics page in the Breastcancer.org Lower Your Risk section.


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