Sexual & Reproductive Health Matters - SRHmatters.org

(Health.com) — Women who have gene mutations that increase the risk of breast and ovarian cancer can substantially reduce their chances of developing — and dying from — those cancers if they have their breasts or ovaries removed preemptively, according to a new study.

The study, which appears in the Journal of the American Medical Association, confirms that preventive mastectomy and ovary removal can slash the risk of cancer in women carrying the BRCA-1 or BRCA-2 gene mutations, and it suggests that surgery is more effective than rigorous screening at preventing future cancer.

Researchers at 22 cancer centers in the U.S. and Europe followed nearly 2,500 women with BRCA gene mutations for about four years. None of the women who underwent preventive mastectomy developed breast cancer during the study, whereas 7 percent of the women who opted against the surgery did. (The women who did not have surgery were put on an intensive screening schedule.)

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Meanwhile, just 1 percent of women who had at least one ovary and fallopian tube removed (a procedure known as salpingo-oophorectomy) got ovarian cancer, compared with 6 percent of women who didn’t have the surgery. The rate of breast-cancer diagnosis was also lower in women who underwent salpingo-oophorectomy (11 percent) than in those who did not (19 percent).

In addition, the women who had an ovary and fallopian tube removed cut their risk of dying from ovarian and breast cancer by 79 percent and 56 percent, respectively.

The findings confirm “an incredibly important endpoint,” says Claudine Issacs, M.D., one of the study researchers and the medical director of cancer assessment and risk evaluation at Georgetown Lombardi Comprehensive Cancer Center, in Washington, D.C.

“If you have this preventive surgery, it not only decreases the risk of disease but also significantly decreases the risk of death, which is [the] most important thing you’re trying to do.”

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Between 56 percent and 84 percent of women with a BRCA mutation will develop breast cancer in their lifetime, while 36 percent to 63 percent of women with the BRCA-1 mutation and 10 percent to 27 percent of women with the BRCA-2 mutation will develop ovarian cancer, according to estimates cited in the study.

Women who test positive for the BRCA-1 or BRCA-2 mutations generally have three options for managing their risk: body-altering surgery, preventive chemotherapy, or a stepped-up screening regimen that includes frequent mammograms. (Screening techniques are less effective for ovarian cancer than for breast cancer, and doctors usually advocate salpingo-oophorectomy if a woman has completed her family.)

Whether — and when — to have preventive surgery can be a gut-wrenching decision for many women, since surgery can impact both how they look (in the case of mastectomy) and their ability to have a family, says Rob Watson, M.D., assistant professor of surgery at the Texas A&M Health Science Center College of Medicine, in Round Rock.

Source: http://edition.cnn.com/2010/HEALTH/08/31/health.breast.ovary.removal/index.html