High Risk Women Often Opt to Surgically Remove
Breasts, Ovaries to Avoid Cancer
Older women much less likely to have a mastectomy,
but more likely to have their ovaries removed
Aug. 6, 2009 - Many women at high risk for breast
or ovarian cancer are choosing to undergo surgery as a precautionary
measure to decrease their cancer risk, according to a report in
Cancer Epidemiology, Biomarkers & Prevention, a journal of the
American Association for Cancer Research.
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"Women have their breasts or ovaries removed based
on their risk. It does not always happen immediately after counseling or
a genetic test result and can take more than seven years for patients to
decide to go forward with surgery," said lead researcher D. Gareth
Evans, M.D. Evans is a consultant in clinical genetics at the Genesis
Prevention Center, University Hospital of South Manchester NHS Trust and
a professor at the University of Manchester, United Kingdom.
Evans and colleagues assessed the increase in
risk-reduction surgery among women with breast cancer and evaluated the
impact of cancer risk, timing and age.
Rate of increase was measured among 211 women with
known unaffected BRCA1 or BRCA2 mutation carriers. BRCA1 and BRCA2 are
hereditary gene mutations that indicate an increased risk for developing
breast cancer.
Additionally, more than 3,500 women at greater than
25 percent lifetime risk of breast cancer without mutations also had a
documented increase in risk-reduction surgery.
Women who had a biopsy after undergoing risk
evaluation were twice as likely to choose a risk-reducing mastectomy.
Forty percent of the women who were mutation
carriers underwent bilateral risk-reducing mastectomy; 45 percent had
bilateral risk-reducing salpingo-oophorectomy (surgical removal of
ovaries).
These surgeries are widely used by carriers of
BRCA1 and BRCA2 gene mutations to reduce the risk for breast and ovarian
cancer.
Evaluated by gene type, bilateral risk-reducing
salpingo-oophorectomy was more common in women who were BRCA1 gene
carriers — 52 percent had the surgery compared with 28 percent of the
women who were BRCA2 gene carriers.
"We found that older women were much less likely to
have a mastectomy, but were more likely to have their ovaries removed,"
said Evans.
Most of the women, specifically those aged 35 to 45
years, opted for surgery within the first two years after the genetic
mutation test, but some did not make a decision until seven years later.
"This is a very interesting study. It fleshes out
some of what we know about adoption of risk reduction strategies in
high-risk women who have participated in a very comprehensive and well
thought-out genetic counseling, testing and management program," said
Claudine Isaacs, M.D., an associate professor of medicine and
co-director of the Fisher Center for Familial Cancer Research, Lombardi
Comprehensive Cancer Center at Georgetown University.
BRCA1 and BRCA2 mutation carriers have a very high
lifetime risk of cancer, and for BRCA1 carriers there are unfortunately
no clearly proven non-surgical prevention strategies, according to
Isaacs. These women face a 50 to 85 percent lifetime risk of breast
cancer, and mastectomy is currently the most effective prevention method
available.
The findings confirm the expectations that when a
woman has a biopsy, even if benign, most are more likely to opt for
risk-reduction surgery.
"Screening should be conducted at a place with
expertise in an effort to minimize false-positive results, which often
lead to biopsy. This will minimize the anxiety that comes along with
such a diagnosis. Patients should consult with an expert in advance and
stay in contact with them to see how the science may be changing over
time," she advised.
"This is an ongoing conversation that needs to be
addressed and individualized for each patient."
Likewise, Evans suggested that additional studies
are needed to help evaluate the communication efforts and methods
between doctors and/or counselors and women at risk for breast cancer.
Questions to be raised should include how is the communication method
occurring, are the doctors sympathetic and is there an ongoing dialogue?
"Careful risk counseling does appear to influence
women's decision for surgery although the effect is not immediate," the
researchers wrote.
The mission of the American Association for Cancer
Research is to prevent and cure cancer. Founded in 1907, AACR is the
world's oldest and largest professional organization dedicated to
advancing cancer research. The membership includes more than 28,000
basic, translational and clinical researchers; health care
professionals; and cancer survivors and advocates in the United States
and nearly 90 other countries.
http://www.aacr.org/
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Aug. 6, 2009 - Many women at high risk for breast
or ovarian cancer are choosing to undergo surgery as a precautionary
measure to decrease their cancer risk, according to a report in
Cancer Epidemiology, Biomarkers & Prevention, a journal of the
American Association for Cancer Research.