Many women who are considered high-risk for breast cancer also have a much higher-than-average risk of developing ovarian cancer. To determine whether you’re also at risk for ovarian cancer, talk to your doctor about seeing a genetic counselor (a health professional specially trained to provide information and advice about inherited conditions). If after meeting with a counselor you are found to be at high risk for developing breast and ovarian cancer, you may want to explore different strategies for reducing your risk.
Although prophylactic ovary removal can significantly reduce the risk of developing ovarian cancer — and also reduce the risk of breast cancer when done before menopause — this surgery is a serious choice that can have a considerable impact on your life. The sudden loss of estrogen can cause a range of side effects, such as hot flashes, depression, difficulty sleeping, and lessened 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.
You may wish to consider prophylactic ovary removal if there is evidence that breast and/or ovarian cancer run in your family. You and your doctor may decide prophylactic ovary removal is an option for you if:
- You’ve tested positive for the BRCA1 or BRCA2 gene mutations, which can increase the risk of breast and ovarian cancer. If you test positive for either of these mutations, the National Comprehensive Cancer Network guidelines recommend removal of ovaries and fallopian tubes between age 35 and 40 and as soon as you are finished having children. Women with BRCA2 mutations who have had risk-reducing mastectomy can delay removal of ovaries and fallopian tubes until age 40-45 if they choose; ovarian cancer in women who test positive for a BRCA2 mutation usually happens 8-10 years later than it would in women who test positive for a BRCA1 mutation. Women carrying BRCA2 mutations who have not had a bilateral mastectomy should have their ovaries removed by age 40 to get the breast cancer risk-reducing benefit that ovary removal offers.
- You have first-degree relatives who had breast and/or ovarian cancer: Your mother, sister, and/or daughter had breast cancer, ovarian cancer, or both, especially before age 50.
- You have a family history of ovarian cancer in two or more relatives, or you have one relative diagnosed before age 50. The more closely they are related to you, the more likely it is you could be at increased risk.
- You have a personal history of early breast cancer, diagnosed in your 20s, 30s, or 40s, or before you have gone through menopause. Research suggests you also may be at increased risk of developing ovarian cancer and/or breast cancer recurrence.
Prophylactic ovary removal also may be an option for you if:
You want to lower your risk of breast cancer without causing major visible changes to the body, as prophylactic mastectomy can. If you have a BRCA2 mutation, research shows that ovary removal before menopause can greatly reduce breast cancer risk. The ovaries often can be removed through small incisions in the pelvic area. This approach minimizes scarring and makes ovary removal a less invasive and shorter procedure than mastectomy is.
If mastectomy is followed by breast reconstruction, there will be a series of follow-up surgeries to complete the reconstruction. With ovary removal, no follow-up surgeries are typically needed. However, there are other strategies for reducing breast cancer risk that you should discuss with your doctor.
- You are more anxious about ovarian cancer than breast cancer. There are no good screening tools for ovarian cancer yet, as there are for breast cancer. It is very difficult to detect ovarian cancer early, which lessens the likelihood of starting treatment while the cancer is still at an early stage. Ovarian cancer is likely a greater concern for you if: (1) it runs in your family and/or (2) you have the BRCA1 or BRCA2 mutation.
- You do not want to take hormonal therapy to reduce your risk of getting breast cancer, or of developing breast cancer again if you have already been diagnosed. To reduce breast cancer risk, some undiagnosed women take hormonal therapy medicines that block estrogen's effects or lower the amount of estrogen in the body, such as tamoxifen, Evista (chemical name: raloxifene), Aromasin (chemical name: exemestane), or Arimidex (chemical name: anastrozole). To reduce the risk of the cancer coming back, women who have been diagnosed may take one of those four medicines or another type of hormonal therapy. Talk to your doctor and a genetic counselor about which mutation you have. If you have a high likelihood of developing estrogen-receptor-positive breast cancer but you don’t want to take hormonal therapy, prophylactic ovary removal could be an option.
You have had breast cancer and do not want to take medications that temporarily suppress estrogen production by the ovaries. Medications such as Zoladex (chemical name: goserelin) and Lupron (chemical name: leuprolide), which are given by injection, can temporarily shut down the ovaries’ production of estrogen. In effect, this “starves” any remaining breast cancer cells of the estrogen they need to grow. If you are premenopausal and have had an estrogen-receptor-positive breast cancer, your doctor may recommend these medications to lower the risk of recurrence. These medications put you into menopause while you are taking them. You and your doctor will work together to determine how long you should take them.
If you do not want to take estrogen-suppressing medications — perhaps because of the inconvenience or the cost — you might consider prophylactic ovary removal. Since surgery removes your body’s source of estrogen permanently, the reduction in the risk of breast cancer recurrence is permanent as well. However, remember that you will be put into menopause permanently, too.