Risk-reduction surgery for ovarian cancer improves survival

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Preventive surgery improves survival for women who are at greater risk of developing ovarian cancer, and it may be helpful for women at risk of developing breast cancer due to genetics.

Women with a mutation in either of the two high-risk genes, known as BRCA1 and BRCA2, have an increased risk of dying from breast and/or ovarian cancer. Many such women, including high-profile celebrities such as Angelina Jolie, choose to undergo surgery to remove their healthy breasts, ovaries, or both before the disease affects them. However, few studies have looked at the possible benefits of these procedures across large groups of women.

The research team, from  Manchester Cancer Research Centre at The University of Manchester in the United Kingdom, looked at 691 women who had undergone genetic testing and were confirmed as carrying a mutation in either the BRCA1 or BRCA2 gene before they had developed cancer. The results were published recently in Breast Cancer Research and Treatment (2013; doi:10.1007/s10549-013-2765-x).

A little more than one-third of women in this study opted for preventive surgery. The researchers compared outcomes for those who chose to have risk-reducing surgery with those who did not.

"The research shows a major benefit from undergoing risk-reducing surgery, particularly removal of the ovaries and fallopian tubes, which reduces the risk of both ovarian cancer greatly and breast cancer by about half," said senior author Gareth Evans, MD, of The University of Manchester.

Women who had any form of risk-reducing surgery had increased survival compared with those deciding against such an operation. Life expectancy was almost normalized in those that underwent surgery but substantially reduced in those who did not. Further research is now needed to assess the possible advantage of a double mastectomy alone.

"In the past, some women have thought that MRI screening is so good that they don't need to have removal surgery, but our research has shown, despite intensive screening, quite a few of these women, particularly with the more aggressive BRCA1 gene, were dying and perhaps being lulled into a false sense of security by screening,” said Evans. "Following Angelina's announcement, there has been a three-fold increase in the number of women with a family history of breast and ovarian cancer coming forward asking about surgery. It really has raised the public awareness of this.”

Evans explained that decisions, particularly to have breast surgery, take a long time. He said that many people consider it for a number of years, and they may finally act if there has been another death in the family. He noted, “There is no doubt that the most effective method for a woman at risk is to have her ovaries removed, and we are pretty close to certain that removing breast tissue increases life expectancy, but more research is needed.”

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