Should Women with the BRCA Gene Remove Their Ovaries? A New Study May Change the Way We Think.
February 25, 2014
An interesting article appears in the current issue of the Journal of Clinical Oncology and it just might change some of the decisions we make for patients with genetic links to some cancers.
What Do We Know About BRCA Genes?
Over the past few years we’ve been learning more and more about the significance of the BRCA genes.
In general, we’ve known for years that some cancers, especially breast and ovarian cancers, have some familial predisposition.
Some patients come to my office and know of a distant relative with breast cancer. Others talk of breast cancers in their mother, sister and multiple aunts…and it clearly makes you wonder of some strong pattern.
The discovery of the BRCA genes (Breast Cancer Susceptibility Genes) have provided an identifiable link for some of these patients, somewhat defining this predisposition. This isn’t to say that every patient with a pattern of breast or ovarian cancer in their family has these genes, but we have learned the opposite…that those with these genes have a much higher risk for these cancers. This information is so significant that many people who are found to test positive for these genes elect to undergo prophylactic mastectomies to avoid their high cancer risk.
Angelina Jolie is a recent ‘high-profile’ example and, because reconstructive options are so good today, such decisions are much easier to make.
It is important to note that even though the gene is named as a Breast Cancer marker, it is a significant marker for ovarian cancer as well. The connection between the ovaries and breast cancer has been known for years as many breast cancers are sensitive to estrogen, a hormone produced by the ovaries.
In fact, years ago breast cancer patients frequently had their ovaries removed to reduce estrogens that could stimulate breast cancers. Today we use drugs like Tamoxifen that block estrogen and give a similar effect.
Benefits Go Beyond Prevention
This recent article takes things one step further.
It looks at 5800 patients who are BRCA1 and/or BRCA2 positive and followed them over time.
It found that in patients who had their ovaries removed while they were young had much better results.
The real important point of the article was that the improved results were not just limited to reducing the risk of ovarian cancer.
The study showed that there was an overall reduction in mortality and that’s the striking piece of this.
The results of the study show that, in patients who are BRCA1 Positive, there is a significant reason to have the ovaries removed before age 35!
Not just to reduce the risk of eventually getting Ovarian Cancer, but there is also a survival benefit! Patients who are BRCA2 Positive likely do not need to be as aggressive.
Do You Have Questions About How this Affects You?
I am happy to answer questions for any patients regarding this new information and how it may affect them. It is important that you consider this information if you are known to carry the BRCA gene.
This also underscores the importance of getting tested for the gene if you have apparent risk factors. Feel free to contact me or Dr. Sahgal with any questions.