Preventive surgery protects against breast, ovarian cancer in women carrying BRCA1, BRCA2 gene mutations

Women who have gene mutations that put them at high risk of ovarian and breast cancer can significantly reduce the risk of developing or dying from these cancers by having their healthy ovaries or breasts removed, according to a new study reported in the Sept. 1 issue of the Journal of the American Medical Association.

Creighton University's Hereditary Cancer Center was one of 22 clinical and research genetics centers in Europe and North America to be involved in the study of 2,482 women with inherited BRCA1 or BRCA2 gene mutations between 1974 and 2009.

Henry Lynch, M.D., director of the Hereditary Cancer Center and holder of the Charles F. and Mary C. Heider Endowed Chair in Cancer Research at Creighton, is one of the study's co-authors.

"These findings should help women with these mutations and their doctors select strategies to reduce a patient's chances of developing breast and gynecological cancers," Lynch said. "The bottom line is that lives can be saved. Clearly, these are compelling results, demonstrating that preventive surgery offers a significant level of protection against breast and ovarian cancer for women carrying the BRCA1 and BRCA2 gene mutations."

The study followed each of the women for about four years. During the study, women who had their ovaries and fallopian tubes removed (a procedure known as salpingo-oophorectomy) reduced their risk of dying from ovarian cancer by 79 percent and from breast cancer by 56 percent.

Other findings:
• None of the women who underwent preventive mastectomies developed breast cancer, however 7 percent of the women who declined surgery did.

• Only 1 percent of the women who had at least one ovary and fallopian tube removed developed ovarian cancer, compared to 6 percent of the women who declined this surgery.

• Salpingo-oophorectomy also reduced the chances of getting breast cancer; 11 percent of the women undergoing this surgery developed breast cancer, compared to 19 percent who did not have surgery.

A pioneer in the field of genetic cancer research, Lynch was among the first physicians internationally to identify the BRCA1 and BRCA2 gene mutations and to recommend prophylactic preventive surgery to reduce the risk of ovarian and breast cancer in women inheriting the mutations.

Lynch noted that many women who test positive for BRCA1 or BRCA2 mutations, particularly young women, are reluctant to have the preventive surgeries to reduce their risk of breast or ovarian cancer because of how it will affect their physical appearance or because they plan to have children.

These women need to be intensively monitored by their physicians and receive more frequent screenings, including mammograms. Preventive chemotherapy is another option, he said.

Women who have inherited mutations in the BRAC1 or BRCA2 genes have substantially elevated risks of breast cancer and ovarian cancer, with a lifetime risk of breast cancer of 56 percent to 84 percent. The estimated ovarian cancer risks range between 36 percent to 63 percent for BRCA1 mutation carriers and 10 percent to 27 percent for BRCA2 carriers.

While most breast cancer occurs in women, men can also develop the cancer.


Journal of the American Medical Association


The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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