A large study conducted by researchers from Canada, Italy, Australia, Norway, Poland, and the United States, suggests that women genetically predisposed to breast and ovarian cancers could reduce the risk of developing the disease by up to 80 percent, should they have their ovaries removed prior to the age of 35.
Impact of Oophorectomy on Cancer Incidence and Mortality in Women With a BRCA1 or BRCA2 Mutation, published in the Journal of Clinical Oncology, recommends that carriers of the aggressive BRCA1 gene mutation have prophylactic oophorectomies - or pre-emptive removal of the ovaries - before the age of 35. Carriers of the BRCA2 gene could viably wait until the age of 40 before undergoing an oophorectomy, as the risk of developing ovarian tumors is somewhat reduced. "To me, waiting to have oophorectomy until after 35 is too much of a chance to take," said the study's lead author, Steven Narod, MD, professor of medicine at the University of Toronto in Canada. "These data are so striking that we believe prophylactic oophorectomy by age 35 should become a universal standard for women with BRCA1 mutations."
While previous studies have shown that prophylactic oophorectomies reduce the risk of developing such cancers, Dr. Narod's study breaks new ground, demonstrating a clear reduction in mortality rates. Further, women with the BRCA1 mutation have a heightened chance of developing the disease. Ovarian cancer affects a relatively minute 1.4 percent of women, though of that number, 39 percent carry the mutated gene. Breast cancer, which develops in around 12 percent of women, is similarly linked - 55 to 65 percent of sufferers have the mutation.
The study was conducted over a period of 16 years, with Dr. Narod and his team monitoring 5,787 women with BRCA mutations. Of these participants, 2,123 women had already undergone oophorectomies at the commencement of the study, 2,274 chose not have oophorectomies, and 1,390 had oophorectomies throughout the follow-up period - on average, 5.6 years. 511 women died during the course of the study, comprised of 333 breast cancer deaths, and 68 from ovarian, fallopian tube, or peritoneal cancers. The remaining participants died of other causes. The researchers found that oophorectomy reduced the overall risk of death by 77 percent, and reduced the risk of death by ovarian cancer by 80 percent.
The findings have been lauded by the medical community. "These results could make a real difference for women with BRCA mutations, who face tough decisions about whether and when to undergo a prophylactic oophorectomy. For women with BRCA1 mutations, these results suggest that surgery should be performed as soon as it is practical," said Don Dizon, MD, and ASCO Cancer Communications Committee member. "Importantly, for women who will be undergoing this surgery early in life, it's reassuring to see that it carries long-lasting benefits, substantially reducing ovarian cancer risk as well as total mortality risk."
Of course, women with the BRCA mutations have several other factors to consider as well. Removal of the ovaries is a major surgery, and effectively terminates the possibilty of bearing children.
