Prophylactic Removal of Ovaries Improves Survival in BRCA1 or BRCA2 Carriers
According to a recent early online article published in The Lancet Oncology, women who have mutations within the BRCA1 or BRCA2 genes have significantly improved survival if they undergo prophylactic surgery to remove their 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.
Researchers from 13 institutions in the U.S. and Europe recently 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.
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. However, it is important for every women to discuss the individual risks and benefits of all preventive or screening decisions with their physicians.
Reference: 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
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