A study suggests that women with an abnormal BRCA1 gene diagnosed with breast cancer are more likely to survive if they have their ovaries and fallopian tubes removed (doctors call this procedure bilateral salpingo-oophorectomy). The procedure didn’t seem to help women with an abnormal BRCA2 gene.
Still, another study suggests that women who have their ovaries and fallopian tubes removed have lower quality of life, including problems with sleep, thinking and remembering, hot flashes, and sexual function.
Both studies were presented at the 2014 American Society of Clinical Oncology Annual Meeting on June 3, 2014. Read the abstracts of:
- “The impact of oophorectomy on survival after breast cancer in BRCA1 and BRCA2 mutation carriers.”
- "Quality of life in BRCA1 and BRCA2 mutation carriers (B1/2) following risk-reducing salpingo-oophorectomy (RRSO)."
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 a BRCA1 or BRCA2 genetic mutation:
- have up to a 72% lifetime risk of developing breast cancer
- have a much higher-than-average lifetime risk of ovarian cancer; estimates range from 17% to 44%
Women who know they have an abnormal BRCA1 or BRCA2 gene can take steps to reduce their risk. Removing the healthy breasts and ovaries and fallopian tubes -- called prophylactic surgery (“prophylactic” means “protective”) -- are very aggressive, irreversible risk-reduction options that some women with an abnormal BRCA1 or BRCA2 gene choose. You probably heard about Angelina Jolie’s decision to have a preventive double mastectomy because she learned that she had an abnormal BRCA1 gene. While protective surgery may be a good option for a number of women, it’s not right for every woman.
While it has been known that removing the ovaries and fallopian tubes reduces the risk of ovarian cancer as well as the risk of a second, new cancer in women with an abnormal BRCA1 or BRCA2 gene, it hasn’t been clear if the protective surgery improved survival in women who were diagnosed with breast cancer.
In the first study, the researchers looked at the records of 676 women who had an abnormal BRCA1 or BRCA2 gene who had been diagnosed with stage I or stage II breast cancer:
- 407 of the women had their ovaries and fallopian tubes removed after being diagnosed with breast cancer
The women were all between 24 and 65 years old and were followed for up to 20 years after being diagnosed.
Overall, women who had their ovaries and fallopian tubes removed were 37% less likely to die from breast cancer than women who didn’t have the protective surgery.
But this benefit was mostly seen in women with an abnormal BRCA1 gene: women with an abnormal BRCA1 gene who had their ovaries and fallopian tubes removed were 48% less likely to die from breast cancer compared to women who didn’t have the procedure. This difference was significant, which means it was due to the protective surgery and not just because of chance.
At 10 years, survival rates for women with an abnormal BRCA1 gene were:
- 89.2% for women who had their ovaries and fallopian tubes removed
- 63.9% for women who didn’t have the protective surgery
When the researchers looked at survival differences between women with an abnormal BRCA2 gene who had their ovaries and fallopian tubes removed and women with an abnormal BRCA2 gene who didn’t have the protective surgery, they found that women who had the protective surgery were 19% less likely to die from breast cancer than women who didn’t have the protective surgery. But this difference WASN’T significant, which means it could have been due to chance and not because of the surgery. This is why the researchers concluded that women with an abnormal BRCA1 gene benefited more from having their ovaries and fallopian tubes removed than women with an abnormal BRCA2 gene.
As this study strongly suggests, women who have an abnormal BRCA1 gene benefit from having their ovaries and fallopian tubes removed. But the procedure also has risks. Premenopausal women go immediately into menopause, which increases the risk of osteoporosis, hot flashes/night sweats, vaginal dryness and irritation, and a lower sex drive.
In the study looking at the quality of life of women with an abnormal BRCA1 or BRCA2 gene who had their ovaries and fallopian tubes removed, the researchers surveyed 637 women:
- all the women had an abnormal BRCA1 or BRCA2 gene
- all had had their ovaries and fallopian tubes removed; half were younger than 45 when they had the procedure and half were older than 45
- 43% had been diagnosed with cancer
- 87% of these women had been diagnosed with breast cancer
- 60% of the women diagnosed with breast cancer had been treated with chemotherapy
- 27% were using hormone replacement therapy (HRT)
The researchers asked the women about:
- their ability to think and remember (doctors call this cognitive function)
- menopausal symptoms
- sexual function
The results showed that:
- 14% of the women said they had high blood pressure
- 32% said they had osteopenia or osteoporosis (osteopenia is a low normal bone density score and means you have a higher risk of osteoporosis)
- 38% said they were depressed
The researchers found that many of the women had below normal scores for many of the quality of life indicators they asked about:
- 60% had poor cognitive function
- 57% had troubling hot flashes or night sweats
- 73% had poor sexual function
- 61% had poor sleep
- 56% were stressed
- 16% were anxious
- 15% were depressed
The younger the women were when they had their ovaries and fallopian tubes removed, the more likely they were to have sleep, stress, anxiety, and depression problems, as well as troubling hot flashes and night sweats.
If you know you have an abnormal breast cancer gene, especially an abnormal BRCA1 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.
Editor’s Note: This article was updated on Jan. 24, 2019, with updated information on cancer risk associated with BRCA mutations.
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