Women at High Cancer Risk May Benefit from Preventive Surgery

Women who have genetic mutations that increase their odds of breast and ovarian cancer may live longer and reduce their cancer risk by having preventive surgery, a new study suggests.

The surgery requires removal of the breasts or ovaries before any signs of cancer have arisen.

"What our findings show is that women who choose to have these surgeries will reduce their risk of dying of breast or ovarian cancer by about 70 to 80 percent, which is pretty profound," says study author Dr. Timothy Rebbeck, at the University of Pennsylvania.

The findings are reported in the Journal of the American Medical Association (JAMA).

Study Gives Definitive Answers

The 22-center clinical trial, one of the largest of its kind, studied nearly 2,500 women who were found to have inherited mutations in the BRCA1 or BRCA2 genes.

Women with the mutations have a lifetime risk of breast cancer of 56 percent to 84 percent. The risk for ovarian cancer ranges from 36 percent to 63 percent for BRCA1 mutation carriers, and 10 percent to 27 percent for BRCA2 mutation carriers.

By contrast, the lifetime risk of breast cancer among women generally is about 12 percent, and for ovarian cancer, it is less than 2 percent.

About half of the women in the study had undergone either mastectomies (surgery to remove their breasts) or salpingo-oophorectomies (surgery to remove the ovaries and fallopian tubes) to proactively lower their risk of cancer.

The women were followed for an average of about three and one-half years.

During the follow-up period, no breast cancer events occurred in the women who had mastectomies, while 7 percent of the women in the group who did not undergo surgery were diagnosed with breast cancer.

In addition, women who had their ovaries removed lowered their risk of ovarian and breast cancer, and also lived longer than women who did not have the surgery.

For example, over six years of follow-up, no ovarian cancer cases were seen among BRCA2 mutation carriers who had a salpingo-oophorectomy, compared with 3 percent of carriers who did not have the procedure, the researchers report.

"One of the main messages of our study is that salpingo-oophorectomy should be part of any management plan for any woman who is found to have these genetic mutations," says Dr. Rebbeck. "There really isn't anything else that can reduce a woman's risk by this much."

He says that physicians usually recommend that women who test positive for the genes have their ovaries removed at around age 35, but are okay with putting it off until age 40 if they have not finished having children.

Experts Agree the Information Helps Women Decide

Dr. Virginia Kaklamani, co-author of an editorial that accompanied the study, says, "These findings really emphasize how important it is for all women with a family history of early breast or ovarian cancer to undergo genetic testing.

"I see women all the time who get the genetic test only after they're diagnosed with cancer," says Dr. Kaklamani, at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University in Chicago.

She adds that the findings should encourage more women to ask their primary care physicians whether they are candidates for genetic counseling.

Dr. Daniel Silver, at the Dana Farber Cancer Institute in Boston, says, "This is a very important study because it gives us more information in order to counsel women at risk." He adds that women who are found to carry one of these genetic mutations face "a very complex set of considerations, so the more hard facts you can give them, the better."

Always consult your physician or other healthcare provider for more information.