Surgery to Prevent Breast and Ovarian Cancer

Researchers have shown for the first time that women with mutations in BRCA1 and BRCA2 genes can reduce their risk of breast and ovarian cancers if they have surgery to remove their ovaries and fallopian tubes.

The study involved 173 women whose genetic tests showed mutations in the BRCA1 and BRCA2 genes. These mutations place women at higher risk for developing breast and ovarian cancer. The women received genetic counseling regarding their options, and chose a course of action. Of the group, 101 chose surgery to remove their ovaries and fallopian tubes (a procedure called salpingo-oophorectomy). The other 72 chose in-tensive screening: transvaginal ultrasound and a CA-125 blood test twice a year.

Compared to screening, surgery to remove the ovaries and fallopian tubes reduced the risk of breast and ovarian cancers by 75%.

After two years, three breast cancers and one peritoneal cancer were diagnosed in women who had preventive surgery. In the group of women who chose intensive screening, there were eight breast cancers, four ovarian cancers, and one peritoneal cancer.

Among the women who chose preventive surgery, doctors detected three unsuspected early-stage ovarian tumors during the operation. "This highlights the limitations of current screening tests for ovarian cancer," said Richard Barakat, MD, Chief of Gynecologic Oncology at MSKCC, and a co-author of the study.

Removing the ovaries may also reduce breast cancer risk by decreasing estrogen and halting or slowing breast cancers that depend on estrogen to grow.

The researchers will continue to follow the women in the study to evaluate the long-term effects of preventive surgery on cancer rates, on other health risks, and on overall survival. (Abstract #3)

What does this mean for patients?

Every woman with BRCA1 and BRCA2 mutations makes a highly individual decision with help from family, her doctors, and genetic counselors. These results are short-term, but suggest that women with these mutations may now have another option when making decisions.

"We now have prospective evidence to present to patients so that they can make informed decisions about their care," said lead investigator Kenneth Offit, MD, Chief of the Clinical Genetics Service at Memorial Sloan-Kettering Cancer Center. Women at high risk for breast and ovarian cancer should talk with their doctor.