by Pat Kramer
Women who face an inherited, high risk of ovarian cancer now have some much-needed confidence when deciding how best to protect their health, thanks to a research team that includes City of Hope scientists.
Surgical removal of the ovaries and fallopian tubes, called salpingo-oophorectomy, can reduce the chance of ovarian and related cancers by as much as 80 percent in women at high risk for the malignancies, according to the team’s findings, which were recently reported in the Journal of the American Medical Association.
Many women who carry mutations in genes called BRCA1 and BRCA2 eventually develop breast and ovarian cancer, so physicians have offered them mastectomy and salpingo-oophorectomy as preventive options. Researchers, though, have done few substantial studies to discover just how effective these procedures are in preventing cancer; this study is the largest so far.
“BRCA1 and BRCA2 are the most common causes of hereditary breast and ovarian cancer. If a woman carries a BRCA mutation, her breast cancer risk is 50 to 80 percent, often at an early age of onset, and her ovarian cancer risk is 15 to 60 percent over her lifetime,” said Jeffrey Weitzel, M.D., director of City of Hope’s Department of Clinical Cancer Genetics and one of the study authors. He has spent more than a decade studying BRCA1 and BRCA2.
From 1992 to 2003, a consortium of international researchers, including Weitzel, studied 1,828 women with an abnormal BRCA1 and BRCA2 gene. They compared women who had salpingo-oophorectomy to those who did not.
Over time, the researchers found that women who underwent the preventive surgery were significantly less likely to develop cancers of the ovaries and fallopian tubes.
Researchers recommended in the July 12 study that women undergo the procedure after finishing childbearing or by age 35 to get the most benefit. Through laparoscopy, Weitzel said, this surgery can be done with only an overnight hospital stay and about a two-week recovery.
When given the facts and risks of not having surgery, he said, most carriers of mutated BRCA choose oophorectomy. “By and large, we have not seen a significant change in the quality of life after the salpingo-oophorectomy, as compared to studies looking at the after effects of a mastectomy,” he said.
However, Weitzel said, women still face residual risk of peritoneal cancer after surgery. “At this point, there’s nothing we can do about that,” said Weitzel. “When we counsel women, we tell them that with the salpingo-oophorectomy, there is still a modest risk for primary peritoneal cancer.”
Weitzel established the registry for genetic cancer risk assessment at City of Hope when he arrived in 1996. His Clinical Cancer Genetics research team focuses on understanding the needs of people at high cancer risk — including everything from how surgery and medication alter disease risk to how to preserve quality of life for cancer patients.
While it has been more than a decade since researchers identified the BRCA genes and first understood the role they play in cancer risk, Weitzel said, more work is still needed to ensure that this genetic information is used responsibly and in the right circumstances, and to find ways to reduce risk without surgery.
For more information about cancer screening and prevention, please call Weitzel in the Department of Clinical Cancer Genetics: 626-256-HOPE, ext. 64324.