TUESDAY, Aug. 31 (HealthDay News) -- Women who carry genetic
mutations that boost their odds of breast and ovarian cancer can
live longer and reduce their cancer risk by having preventive
surgery, a new study suggests.
The surgery in question is drastic: removal of the breasts or
ovaries before any signs of cancer have arisen.
However, "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," said study senior author Dr. Timothy Rebbeck, a
professor of epidemiology at the University of Pennsylvania School
The findings are published in the Sept. 1 issue of the
Journal of the American Medical Association.
The 22-center 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 who carry these mutations have a lifetime risk of breast
cancer of anywhere between 56 percent to 84 percent, according to
the researchers, whereas 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's less than 2 percent.
Roughly 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) between 1974 and 2008, in order to proactively
lower their risk of cancer. The women were followed for an average
of about 3.5 years.
During the follow-up period, no breast cancer events occurred in
the women who underwent mastectomies, while 7 percent of the women
in the group who didn't undergo surgery were diagnosed with breast
In addition, women who had their ovaries removed lowered their
risk of ovarian and breast cancer, and also lived longer than women
who didn't have the surgery. For example, over 6 years of
follow-up, no ovarian cancer cases were seen among BRCA2 mutation
carriers who underwent salpingo-oophorectomy, compared with 3
percent of carriers who did not undergo the procedure, the
"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," said Rebbeck. "There really isn't anything else that can reduce a woman's risk by this much."
"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," said Dr. Virginia Kaklamani, co-author of an editorial that accompanied the study. "I see women all the time who get the genetic test only after they're diagnosed with cancer," said Kaklamani, who is director of translational breast cancer research at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, in Chicago.
Kaklamani added that she hoped the findings would encourage more
women to ask their primary care physicians whether they are
candidates for genetic counseling.
"This is a very important study because it gives us more information in order to counsel women at risk," said Dr. Daniel Silver, assistant professor of medicine at the Dana Farber Cancer Institute and Harvard Medical School. Silver added 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."
According to Rebbeck, doctors 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
haven't finished having children. He said the surgery today is
often done in an outpatient setting, with the use of laparoscopes,
which limits scarring and shortens a patient's recovery time.
Find out more about the BRCA1 and BRCA2 genes at the
U.S. National Cancer Institute.