BRCA1 and BRCA2 mutation carriers can reduce their risk of ovarian, Fallopian and peritoneal cancer by 80% by removing both ovaries and tubes. This has not been the understanding to date, but recent data presented at ASCO confirms this staggering risk reduction of the related cancers. Furthermore, there is a 77% reduction in risk of death from all causes.
A research team at the University of Toronto looked at an international registry of 5,783 women who had BRCA1 or BRCA2 mutations. Over a median followup interval of 5.6 years there were 186 new ovarian, peritoneal or Fallopian tube cancer cases. Of these 68 died. Women who had NOT undergone a risk reducing bilateral removal of tubes and ovaries had 108 cancers develop. For BRCA1 carriers, the greatest risk of cancer was in the age range of 50-59 years of age. For those who harbored BRCA2 mutations, the greatest risk of cancer was between 60 and 69 years of age.
The data was strongly supportive of removing ovaries and tubes by age 35 if there is proven BRCA1 mutation and by the age of 40 or so when there is a BRCA2 mutation noted. Since there is no good way for screening, this is important information for those women in this situation. Prevention, including aggressive integrative methods, is important and may have some impact but it is not proven and the risk of death from this cancer is too high. Discuss this situation with your physician and choose wisely. Keep in mind that the average physician may not have information of this type available to them, nor may they understand cancer very well if they are not an oncologist. So, if necessary, get a second opinion. Prophylactic, or preventative, removal of the ovaries is a very low risk proposition for most women these days and is done on an outpatient basis in most cases with rapid recovery.
Finch AP J Clin Onc 2014
On the inside this is what the surgery looks like. It takes about 45 minutes, with most of the time being setup time. In other words, as surgery goes, it’s quick!
Should the uterus be removed along with the ovaries? Here are a few points to consider from the Memorial Sloan Kettering Cancer Center.
Finally a very blunt discussion about the issues and hard decisions regarding prophylactic (preventative) removal of breasts and ovaries in the face of a strong family history and/or BRCA mutation discovery. Angelina Jolie looked at both issues and decided to have surgeries on both fronts. The same may or may not be the right decision for you, but what is important is to speak with a qualified physician about this. It can literally be the difference between life and death.