Cancer gene carriers cut risk with ovarian surgery
NEW YORK (Reuters Health) - Women who carry a gene mutation that increases their risk of breast cancer appear to be able to lower their risk of breast and gynecologic cancers by undergoing the removal of their ovaries, results of a 10-year follow-up study show.
Dr. Fatima Laki and colleagues at the Institut Curie in Paris analyzed the survival rates of 89 women with BRCA1 and/or BRCA2 mutations who has their ovaries removed, a procedure also referred to as salpingo-oophorectomy, between 1994 and 2004 at their institution.
The women were an average of 51 years old when they underwent salpingo-oophorectomy.
A family history of breast or ovarian cancer was determined in 88 of the 89 women and 73 had a personal history of breast cancer.
There were 4 deaths among the 89 women in the study. Three died from breast cancer and 1 from pancreatic cancer.
Previously undetected ovarian and fallopian tube cancers were found in 4 women at the time of surgery. Before surgery, these women had normal ultrasound scans and levels of the tumor marker CA125.
Two of the 4 women remain disease-free. One had a recurrence after 4 years. One died of breast cancer 12 months after salpingo-oophorectomy.
Breast cancer developed in 3 of the 16 women without a personal history of the disease. Of the women with a previous history of breast cancer, 14 had a recurrence in the same or opposite breast and 8 had their cancer spread to other organs.
The results of the 10-year study are published in the medical journal Cancer.
The Institut Curie team concludes a larger study with a longer follow-up is needed "to more precisely evaluate the benefits of this procedure."
Other studies have shown that prophylactic salpingo-oophorectomy lowers the risk of a first breast cancer or breast cancer recurrence by 50 percent and has the greatest benefit among women younger than 40 years of age.
"This study shows that prophylactic salpingo-oophorectomy remains an important option for women at risk of hereditary breast or gynecologic cancer," Laki's group continues.
They add, however, that women need to know their BRA1/2 mutation status to increase the rate of salpingo-oophorectomy BRCA1/2 mutation carriers who have not yet developed breast or ovarian cancer.
SOURCE: Cancer, May 1, 2007.
What breastcancer.org says about this article…
Cancer gene carriers cut risk with ovarian surgery
About 5% to 10% of all breast cancers happen in women with inherited abnormal BRCA1 and BRCA2 genes.
The average woman (without an inherited breast cancer gene abnormality) in the United States has about a 12% risk of developing breast cancer over a 90-year life span.
In contrast, women who have an abnormal BRCA1 or BRCA2 gene have up to an 85% risk of developing breast cancer by age 70. Women with BRCA1 and BRCA2 abnormalities also are at increased risk of developing ovarian cancer. The lifetime risk is about 55% for women with BRCA1 mutations and about 25% for women with BRCA2 mutations.
Women who have an abnormal BRCA1 or BRCA2 gene and want to be as aggressive as possible in reducing their risk of breast (and ovarian) cancer may consider surgery to remove their ovaries and fallopian tubes. This surgery is called salpingo-oophorectomy.
The study reviewed here followed 89 women with either an abnormal BRCA1 or BRCA2 gene who chose to have their ovaries removed. Like earlier research, this study showed that removing the ovaries reduced the women's risk of breast cancer. However, earlier research showed that salpingo-oophorectomy had the greatest benefit in women younger than 40. This study showed that salpingo-oophorectomy had benefits for women who were about 51 at the time of surgery.
Of the 89 women in the study, 73 women ALREADY HAD BEEN TREATED for breast cancer before their ovaries were removed. During the 10-year follow-up period after surgery, about 70% had no new breast cancers. The other 30% had the cancer come back in the same or the opposite breast (14 women) or had the cancer spread beyond the breast (8 women).
Sixteen of the 89 women in the study DID NOT HAVE BREAST CANCER BEFORE they decided to have their ovaries removed. Three of them, or about 19%, developed breast cancer during the 10-year follow-up period. But the other 13 (about 81%) did not.Four of the 89 women died during the 10-year follow-up period, three from breast cancer and one from pancreatic cancer. Four of the women had early signs of cancer in their ovaries or fallopian tubes when they were removed.
If you know you have an abnormal BRCA1 or BRCA2 gene, you need practical guidelines and information.
- Develop an aggressive breast cancer screening plan. You and your doctor should develop a special plan of breast cancer screening, including more frequent screenings starting at an early age and possibly using other techniques (such as MRI scans) beyond routine mammograms. And monitoring for ovarian cancer is a must as well.
- Modify your lifestyle. There are many diet, exercise, and lifestyle changes that every woman, including those with genetic abnormalities, can take to lower her risk.
- Consider all the options for reducing your risk and create a plan that's right for YOU. Hormonal treatments, mastectomy, and removing the ovaries are all possible options to lower your risk. Together, you and your doctor can plan the approach that’s right for you. Certain family planning choices also may help lower your risk, including having children at a relatively early age (but only if you're ready to become a parent, of course).
To learn more, visit the breastcancer.org Genetics and Breast Cancer Risk section.
