Ovary removal aids women at high risk of cancer
WASHINGTON — For women who carry a notorious cancer gene, surgery to remove healthy ovaries is one of the most protective steps they can take. New research suggests some may benefit most from having the operation as young as 35.
Women who inherit either of two faulty BRCA genes are at much higher risk of developing breast and ovarian cancer than other women, and at younger ages. Actress Angelina Jolie generated headlines last year when she had her healthy breasts removed to reduce her cancer risk.
The study is the largest yet to show the power of preventive ovarian surgery for those women. The surgery not only lowers their chances of getting either ovarian or breast cancer. The study estimated it also can reduce women's risk of death before age 70 by 77 percent.
Ovarian cancer is particularly deadly, and there is no good way to detect it early like there is for breast cancer. So for years, doctors have advised BRCA carriers to have their ovaries removed between the ages of 35 and 40, or when women are finished having children.
The new study suggests the surgery, called an oophorectomy, should be timed differently for the different genes.
For women who carry the higher-risk BRCA1, the chance of having ovarian cancer rose from 1.5 percent at age 35 to 4 percent at age 40, said lead researcher Dr. Steven Narod of the University of Toronto. After that, the risk jumped to 14 percent by age 50.
In contrast, the researchers said carriers of the related BRCA2 gene could safely delay surgery into their 40s. The study found only one case in a woman younger than 50.
Ovarian surgery “is the cornerstone for cancer prevention,” declared Narod, whose team published the research in the Journal of Clinical Oncology. “The typical woman with a BRCA1 mutation will benefit to a large extent from an oophorectomy at age 35, and we want to make that a pretty standard recommendation.”
Future studies would have to verify the findings, and other specialists urged caution.
Waiting until age 40 for ovary removal, as many women with BRCA1 do today, makes a very small difference, stressed Dr. Claudine Isaacs, an oncologist and cancer risk specialist at Georgetown University's Lombardi Comprehensive Cancer Center, who wasn't involved in the new research.
The findings should not frighten women into acting sooner if they're not ready, agreed Dr. Susan Domchek of the University of Pennsylvania's Basser Research Center for BRCA, who also wasn't involved in the study.
Many women have babies during their late 30s, and ovary removal sends women into early menopause that can increase their risk of bone-thinning osteoporosis or heart disease later.
“Thirty-five isn't necessarily a magic number,” Domchek said. “If you are talking to a woman who hasn't yet finished having her kids, it's a completely reasonable thing to discuss the low risk of ovarian cancer by age 40 in the context of the other decisions that she's making in her life.”
But Domchek added: For BRCA1 carriers, “by age 40, I will be nagging you about this again.”
About 1.4 percent of women develop ovarian cancer at some point in life, but 39 percent of BRCA1 carriers do, and between 11 and 17 percent of BRCA2 carriers, according to the National Cancer Institute. Likewise, 12 percent of average women will develop breast cancer, but a BRCA mutation raises the risk four- to five-fold.
The new study included 5,787 BRCA carriers from Canada, the U.S. and parts of Europe. Researchers tracked their health for an average of 5½ years, and found 186 who eventually developed either ovarian cancer or related fallopian tube or peritoneal cancer. Ovary removal reduced cancer risk by 80 percent.
Interestingly, removing the ovaries can reduce the risk of breast cancer as well by affecting hormone levels in the body — and Narod found the surgery increased women's chances of survival even if they already had developed breast cancer.
Specialists say more than two-thirds of BRCA carriers undergo ovary removal at some point, compared with about a third who choose a preventive mastectomy. Insurance generally pays for the procedures.
Key to the ovary decision is having a doctor who knows how to treat the hot flashes and other menopause problems that can make women delay the surgery, said Georgetown genetic counselor Beth Peshkin.
Show commenting policy
TribLive commenting policy
You are solely responsible for your comments and by using TribLive.com you agree to our Terms of Service.
We moderate comments. Our goal is to provide substantive commentary for a general readership. By screening submissions, we provide a space where readers can share intelligent and informed commentary that enhances the quality of our news and information.
While most comments will be posted if they are on-topic and not abusive, moderating decisions are subjective. We will make them as carefully and consistently as we can. Because of the volume of reader comments, we cannot review individual moderation decisions with readers.
We value thoughtful comments representing a range of views that make their point quickly and politely. We make an effort to protect discussions from repeated comments either by the same reader or different readers.
We follow the same standards for taste as the daily newspaper. A few things we won't tolerate: personal attacks, obscenity, vulgarity, profanity (including expletives and letters followed by dashes), commercial promotion, impersonations, incoherence, proselytizing and SHOUTING. Don't include URLs to Web sites.
We do not edit comments. They are either approved or deleted. We reserve the right to edit a comment that is quoted or excerpted in an article. In this case, we may fix spelling and punctuation.
We welcome strong opinions and criticism of our work, but we don't want comments to become bogged down with discussions of our policies and we will moderate accordingly.
We appreciate it when readers and people quoted in articles or blog posts point out errors of fact or emphasis and will investigate all assertions. But these suggestions should be sent via e-mail. To avoid distracting other readers, we won't publish comments that suggest a correction. Instead, corrections will be made in a blog post or in an article.
- Ancient giant sea scorpion turns up
- 3 strikes convict freed in Mo.
- More Hillary emails have parts blocked, ruled classified
- Outrage greets wildlife officials’ plan to kill bear cub that approached hiker in Connecticut
- Authorities in Illinois hunt for 3 in officer’s slaying
- West Point law professor resigns amid remarks that critics of war on terror are ‘treasonous’
- CIA joins special ops in secret terrorist hunt in Syria
- Monsoon leaves Phoenix in the dark
- Defense Secretary Carter was closing Guantanamo prison being considered, ceding base to Cuba isn’t
- Kentucky clerk invokes ‘God’s authority,’ still refuses gay marriage licenses
- Ky. clerk defies courts on gay marriage