Women with an abnormal BRCA1 or BRCA2 gene have a much higher than average risk of both breast and ovarian cancer. One way to lower cancer risk is to remove both the breasts (prophylactic mastectomy) and the ovaries (prophylactic oophorectomy) before cancer is diagnosed. These prophylactic (protective) surgeries are usually done separately. The first is done and then the second is done months after you've recovered from the first.
In the small study reviewed here, doctors at the University of Texas M.D. Anderson Cancer Center report that 12 women with an abnormal BRCA1 or BRCA2 gene successfully and safely had prophylactic breast and ovary removal during one surgery. Most of the women (10) already had been diagnosed with breast cancer. Removing the breasts and ovaries during a single surgery was done to reduce the risk of:
Most of the women (10) also had breast reconstruction during the surgery.
The 12 women who had combined surgery didn't have any complications during surgery, but three of them had some complications related to the surgery while they recovered in the hospital. Because so much was done during the surgery, both the length of the surgery and recovery time in the hospital were a longer than if each surgery had been done separately.
The women were followed for about 7 years after surgery. Even though they had an abnormal BRCA1 or BRCA2 gene, none of the women developed a new cancer (breast or ovarian). Two of the 10 women previously diagnosed with breast cancer had the breast cancer come back somewhere else in their bodies. This means that the original breast cancer already had spread before they had surgery.
Doing two procedures during one trip to the operating room allows you to avoid a second surgery and hospitalization. It's too soon to say that combining prophylactic breast and ovarian removal is a good idea for most women, but this study shows that it can be done safely and deserves more study.
Stay tuned to breastcancer.org for the latest news about research findings that may lead to better ways to prevent, diagnose and treat breast cancer.
NEW YORK (Reuters Health) - Women who are carriers of BRCA1/2 gene mutations that put them high risk for cancer may opt to undergo mastectomy and ovary removal as a cancer prevention strategy. Now, a small study suggests it's possible to combine the two procedures into a single operation, without undue complications.
On average, the combined procedure took 9.3 hours to perform and patients were hospitalized for 5.4 days afterward, according to the report in the online journal BMC Cancer.
Women with BRCA1 or BRCA2 mutations are known to be at greatly increased risk of both breast and ovarian cancer, Dr. Funda Meric-Bernstam and colleagues point out. By 70 years of age, up to 85 percent of carriers will develop invasive breast cancer and up to 65 percent will develop invasive ovarian cancer, the team from the University of Texas M. D. Anderson Cancer Center in Houston notes.
Women with these mutations may choose to be intensively monitored for any sign of cancer, to take preventive measures with tamoxifen treatment, or to undergo preemptive removal of her breasts and ovaries. Although the last approach is more aggressive, research has shown it to be highly effective in preventing the associated cancers.
Typically, the mastectomy is performed first and the ovary surgery is performed months later during one of the breast reconstruction procedures that most patients elect to undergo.
The new findings, which are based on a review of 12 patients treated at the authors' center, suggest that mastectomy and ovary removal can be safely rolled into one operation. The average patient age was 43 years and 10 of the women had a prior breast cancer. Ten women also underwent bilateral breast reconstruction during the combined procedure.
None of the patients experienced any major complications during the operation. Afterward, however, there were three instances of problems related to the surgery that needed attention, and one case of pneumonia.
After an average of seven years, none of the patients developed a new cancer, but two had a recurrence at other sites in the body.
According to the authors, greater convenience for the patient is a key advantage with the combined procedure. Furthermore, doing both procedures at once reduces the theoretical risk that ovarian cancer will arise between staged procedures.
SOURCE: BMC Cancer, online April 14, 2008.
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