About one in 400 women carries gene mutations that put her at higher risk for developing breast and ovarian cancers. Now a new study finds women dramatically reduced their chances of getting the diseases and of death when they opt for mastectomies or removal of the ovaries before they show any signs of cancer.
The multi-center study found that women with the mutated genes BRCA1 and 2 who had a prophylactic mastectomy reduced their risk of breast cancer almost 100 percent.
Those who had surgery to remove their ovaries—oophorectomy—reduced their risk for ovarian cancer 70 to 80 percent and their risk for breast cancer 50 percent. The study was published Sept. 1 in the Journal of the American Medical Association.
Although previous studies have shown removing the breasts and ovaries reduces the risk of cancer, this is the largest study of its kind and the first to show a survival benefit from the surgeries.
But Donald Lannin, M.D., director of the Yale-New Haven Breast Center, says older women may not benefit as much from the surgeries as younger women.
"Younger women will get more benefit because they have more years ahead of them. It's not clear that surgery is the best option for, say, a 70-year-old woman, especially if she has other issues such as heart disease. Her surgery risk is higher, so it wouldn't make sense," Lannin says. "Also, it's not clear if the ovary removal's beneficial effect is as big in postmenopausal women."
This pivotal study shows for the first time that removing the ovaries of women with the mutated genes helps them live longer, says Virginia Kaklamani, M.D., associate professor in the department of medicine at Northwestern University. Since ovarian cancer is hard to diagnose before it is too late, ovary removal significantly lowers that chance, says Kaklamani, who wrote an accompanying editorial in JAMA but was not involved in the research. She added that the study hadn't gone on long enough to judge whether the mastectomies prolonged lives.
The study results do not mean the subjects' risk for all cancers are reduced. However, says Timothy Rebbeck, professor of epidemiology at the University of Pennsylvania School of Medicine and one of the lead authors of the study, "ovary removal also removes hormones, so in theory, cancers influenced by hormones—endometrial, melanoma, colon—may be reduced as well."
Rebbeck says women with the following risk factors should consider getting tested and discuss their options with a genetic counselor:
- Strong family history of breast or ovarian cancer, especially early-onset (age 40 or under).
- Personal history of early-onset breast cancer.
- Ashkenazi (Eastern European) Jewish descent.
Beth Levine is a freelance writer who lives in Stamford, Conn.