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Women with BRCA1 Mutation Should Remove Ovaries by Age 35

Woman Laying Down with Eyes ClosedA BRCA1 gene mutation significantly increases the risk of breast and ovarian cancers in women. Now a large international study as published in the Journal of Clinical Oncology suggests that women with a BRCA1 gene mutation should undergo preventive surgery to remove the ovaries by the age of 35 because the risk of ovarian cancer continues to increase with age.

The general rate of ovarian cancer is 1.4 percent among all women. However, women with a BRCA1 gene mutation have a 39 percent risk of developing the disease. Approximately 70 percent of women with the genetic mutation opt for the surgical removal of the ovaries.

Because of the increased risk associated with the BRCA1 gene mutation, researchers led by Amy Finch and Dr. Steven Narod of Women’s College Hospital in Canada sought to estimate the reduction in risk of ovarian, fallopian tube, or peritoneal cancer in women with a BRCA mutation after oophorectomy, or removal of the ovaries.

Many doctors suggest that women with a BRCA mutation undergo an oophorectomy by age 35 or after the woman is done having children. However, until the present study, no research existed on the effect of age on a reduction in overall mortality risk associated with the removal of the ovaries in women with the genetic mutation.

Explains Finch, “Scientific evidence clearly shows removal of a woman’s ovaries and fallopian tubes is very effective in preventing both breast and ovarian cancer in women with a BRCA mutation. But the real question has been at what age these women should have the surgery to best diminish their chance of developing cancer.”

To determine the effects of age on the effectiveness of oophorectomy on women with a BRCA gene mutation, the researchers identified women with the mutation from an international registry. A total of 5,787 women completed questionnaires about reproductive history, surgical history including preventive ovary removal and mastectomy, and hormone use. The study began in 1995 and continued until 2011.

Of the total number of participants, 2,123 had opted for an oophorectomy prior to the start of the study, 1,390 underwent the surgery during the study, and 2,274 opted out of the surgery. A total of 186 women developed either ovarian, fallopian tube, or peritoneal cancer during the study. Of the 511 who died during the study, 333 died from breast cancer and 68 from ovarian, fallopian tube, or peritoneal cancers.

According to the study, the removal of the ovaries reduced the risk of ovarian cancer by 80 percent. However, women with a BRCA1 mutation who delayed surgery until the age of 40 increased the risks of ovarian cancer to four percent. Women who waited until the age of 50 increased the risk to 14.2 percent. Undergoing a preventive oophorectomy reduced the risk of death by 77 percent.

States Dr. Narod, “To me, waiting to have oophorectomy until after 35 is too much of a chance to take. These data are so striking that we believe prophylactic oophorectomy by age 35 should become a universal standard for women with BRCA1 mutations.”

Only women with a BRCA1 gene mutation should undergo an oophorectomy by age 35. Women with a BRCA2 gene mutation can safely wait until after age 40 because the risk of ovarian is not as high with the BRCA2 mutation.

Additional research is still needed on the long-term effects of the early removal of the ovaries. However, the procedure is safe and effective.

Another recent study concluded that women with hereditary breast cancer as a result of a BRCA gene mutation and who undergo a double mastectomy are less likely to die from the disease than women who undergo the procedure on only the affected breast.

References

Impact of Oophorectomy on Cancer Incidence and Mortality in Women With a BRCA1 or BRCA2 Mutation: http://jco.ascopubs.org/content/early/2014/02/24/JCO.2013.53.2820.abstract
Young Women with BRCA1 Mutation ‘Should Remove Ovaries Earlier’: http://www.medicalnewstoday.com/articles/273163.php

Image Credits

Woman Laying Down with Eyes Closed: http://www.freeimages.com/photo/1379644

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