Prophylactic Removal of Ovaries and Quality of Life in High-Risk Patients
According to research published in the Journal of Clinical Oncology, the majority of patients at high risk of developing ovarian cancer who undergo prophylactic surgical removal of the ovaries and fallopian tubes are happy with their decision and would recommend it to other women at high risk of developing the disease.
The ovaries are two small female organs that are located in the pelvis. They are responsible for the development and release of eggs each month. Ovarian cancer is the fourth leading cause of cancer death among women in the US.
Since ovarian cancer does not cause symptoms in its early stages and therefore, the majority of cases are not diagnosed until the cancer has spread. Unfortunately, cure rates remain dismal once the cancer has spread from the ovaries.
Patients at a high risk of developing ovarian cancer, either due to a strong family history or specific genetic mutations, may take the chance that if they are diagnosed, it will be at a curable stage or risk side effects from the surgical removal of the ovaries.
Inherited mutations in two genes-BRCA1 and BRCA2-have been found to greatly increase the lifetime risk of developing breast and ovarian cancer. Alterations in these genes can be passed down through either the mother’s or father’s side of the family. While it’s important to note that BRCA1 and BRCA2 alterations account for only a small proportion of all breast and ovarian cancers, some families may benefit from genetic testing.
Women with BRCA1 or BRCA2 mutations often choose to undergo radical preventive measures as their risk of developing ovarian and/or breast cancer is significantly higher than the general public. A bilateral prophylactic slapingo-oophorectomy (BPSO) is a surgical procedure in which both the ovaries are removed to prevent or drastically reduce the risk of developing either ovarian or breast cancer. Since breast cancer is often stimulated to grow by exposure to female hormones, and the ovaries produce a large portion of these hormones in the body, the removal of ovaries may also prevent the development of breast cancer.
A BPSO can reduce the risk of ovarian cancer by approximately 90% and the risk of breast cancer by approximately 50% among carriers of the BRCA1 or BRCA2 mutations. However, an association between survival advantage and a BPSO has not been confirmed.3
Researchers from 13 institutions in the U.S. and Europe analyzed data to evaluate rates of overall survival and cancer-specific survival among 666 women with BRCA1 or BRCA2 mutations. Overall and cancer-specific survival rates were compared between women who elected a prophylactic BPSO and those who did not elect the procedure.
Patients who elected BPSO had improved survival compared to those who did not undergo the surgery:
- Patients who underwent BPSO had significantly improved overall survival compared to those who did not elect to undergo BPSO.
- Patients who underwent BPSO had a significantly reduced risk of death from breast cancer compared to those who did not undergo the surgery.
- Patients who underwent BPSO had a significantly reduced risk of death from ovarian cancer compared to those who did not undergo the surgery.
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The researchers concluded that women with BRCA1 or BRCA2 mutations appear to achieve significant improvements in overall survival as well as cancer-specific survival if prophylactic BPSO is performed; this improved survival is compared to women within this group who do not undergo the surgery.
Other studies suggest that premenopausal women undergoing BPSO with no subsequent estrogen supplementation may have increased risk of mortality.4
It is important for every women to discuss their individual risks and benefits of all preventive or screening decisions with their physicians.1
Quality of Life After Oophorectomy
A multiple-institution study was recently conducted to evaluate the quality of life in 846 women who were considered to be at a high risk of developing ovarian cancer. Approximately half of the patients underwent a prophylactic salpino-oophorectomy (preventive surgical removal of the ovaries) while the other half underwent regular gynecologic screening for early detection of ovarian cancer.
Overall, patients who underwent preventive surgery reported a good quality of life:
- No significant difference in quality of life was reported between the two groups of patients.
- Patients who underwent surgery reported fewer worries about developing ovarian or breast cancer.
- Patients who underwent surgery reported a more favorable risk of the development of cancer.
- Patients who underwent screening had fewer endocrine (hormone-associated) problems and worse sexual functioning.
- 86% of patients who underwent surgery would choose it again.
- 63% of patients who underwent surgery would recommend it to a friend who is at a high risk of developing ovarian cancer.
The researchers concluded that quality of life does not appear to be significantly reduced in women at high risk of developing ovarian cancer who undergo the preventive surgical removal of her ovaries compared to women who undergo frequent gynecologic screening. However, these decisions are very personal, and women considered at high risk of developing ovarian cancer need to speak with their physician regarding their individual risks and benefits with each preventive or screening option.2
References:
- Domchek S, Friebel T, Neuhausen S, et al. Mortality After Bilateral Salpingo-Oophorectomy in BRCA1 and BRCA2 Mutation Carriers: a Prospective Cohort Study. The Lancet Oncology. 2006. Early on-line edition. DOI:10.1016/S1470-2045(06)70585-X
- Madalinska J, Hollenstein J, Bleiker E, et al. Quality-of-Life Effects of Prophylactic Salpingo-Oophorectomy Versus Gynecologic Screening Among Women at Increased Risk of Hereditary Ovarian Cancer. Journal of Clinical Oncology. 2005; 23: 6890–6898.
- Finch A, Beiner M, Lubinski J, et al. Salpingo-oophorectomy and the Risk of Ovarian, Fallopian Tube, and Peritoneal Cancers in Women with a BRCA1 or BRCA2 Mutation. Journal of the American Medical Association. 2006; 296:185-192.
- Rocca W, Grossardt B, Andrade M, et al. Survival Patterns after Oophoprectomy in Premenopausal Women: A Population-Based Cohort Study. Lancet Oncology. Early online publication September, 2006. DOI:10.1016/S1470-2045(06)70869-5.
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