Surgery May Prevent Breast & Ovarian Cancers in Women with BRCA Mutations

Memorial Sloan-Kettering Cancer Center
Wednesday, 22 May 2002

While it is true that detecting cancer at its earliest stages offers patients the best chance for cure, preventing it altogether is ideal. New evidence shows that surgery may be the most effective way to prevent breast and ovarian cancers in women who are most likely to develop these diseases.

Women with abnormalities in the BRCA1 and BRCA2 genes are at substantially increased risk for both breast and ovarian cancers compared to the general population. Many of these women consider having surgery to remove their ovaries and fallopian tubes, a procedure known as salpingo-oophorectomy, as a way to reduce their risk of developing cancer.

In the first prospective study addressing this issue, researchers at Memorial Sloan-Kettering Cancer Center suggest that oophorectomy offers women at the highest hereditary risk a three-fold decrease in the likelihood that they will develop breast or ovarian cancer. The research will be published in the May 23 issue of The New England Journal of Medicine.

"Our results illustrate the potential value of salpingo-oophorectomy in preventing subsequent cancer in women with BRCA mutations," said Kenneth Offit, MD, Chief of the Clinical Genetics Service at Memorial Sloan-Kettering and senior author of the study.

Recently, a team at Memorial Sloan-Kettering demonstrated that the combination of intense screening and risk-reducing surgery after genetic testing could detect breast and ovarian cancers at an early stage. While these data were encouraging, they did not address the ultimate goal of prevention of breast and ovarian cancers.

The current study included 170 women who had not previously had their ovaries removed and who were identified as having mutations in the BRCA1 or BRCA2 gene after genetic testing at Memorial Sloan-Kettering. The participants received uniform counseling regarding the risks and benefits of both intensive ovarian cancer screening (with vaginal ultrasound and a blood test for a serum marker called CA125) and risk-reducing oophorectomy.

In the 72 women who elected surveillance, eight breast and five ovarian cancers were identified over an average two years of follow-up. In the 98 women who chose to undergo oophorectomy, three breast cancers and one peritoneal cancer (a cancer similar to ovarian cancer that arises in the abdominal wall) was detected during the same period of follow-up. Overall, oophorectomy was associated with a 75 percent decreased risk of subsequent breast and ovarian cancer.

"Previously, recommendations for oophorectomy were based primarily on expert opinion. We now have hard data to present to our patients so that they are able to make better informed decisions," said Noah Kauff, MD, a gynecologist and geneticist at Memorial Sloan-Kettering and lead author of the study.

Most patients in the study underwent removal of the ovaries and fallopian tubes without removal of the uterus. This allowed surgeons to perform the procedure using a minimally invasive surgical approach called laparoscopic oophorectomy.

"The fact that the majority of these procedures can be performed using a laparoscopic approach in which most patients can be discharged home the day of the surgery clearly adds to the potential benefit of the procedure," said Richard Barakat, MD, Chief of the Gynecology Service at Memorial Sloan-Kettering and co-author of the report.

Although the study shows that ovarian and breast cancers may be prevented by oophorectomy, the authors caution that the follow-up period, with a mean of 24 months, is short and the long-term outcome of women who undergo oophorectomy is not yet known.

"Because the removal of the ovaries may have a substantial impact on other health risks and quality of life, further research is needed to determine who is the best candidate and what is the best timing for this procedure," said Dr. Offit.

The research was conducted by a multi-disciplinary team of medical oncologists, genetic counselors, surgeons, and other scientists specializing in cancer genetics at Memorial Sloan-Kettering including Jaya Satagopan, PhD, Lauren Scheuer, MS, Mark Robson, MD, Mercedes Castiel, MD, Khedouja Nafa, PhD, Martee Hensley MD, MSc, Clifford Hudis, MD, Nathan Ellis, PhD, Jeff Boyd, PhD, Patrick Borgen MD, and Larry Norton, MD.

Memorial Sloan-Kettering Cancer Center is the world's oldest and largest institution devoted to prevention, patient care, research, and education in cancer. Our scientists and clinicians generate innovative approaches to better understand, diagnose, and treat cancer. Our specialists are leaders in biomedical research and in translating the latest research to advance the standard of cancer care worldwide.

For more information, or to contact Memorial Sloan-Kettering Cancer Center, see their website at: www.mskcc.org