Prophylactic oophorectomy cuts Ca risk 75% in BRCA mutation carriers

Women at increased risk for breast and ovarian cancer due to BRCA1 and BRCA2 gene mutations can decrease that risk by 75 percent through prophylactic oophorectomy, according to results of the first prospective follow-up study to evaluate the effects of the procedure. Previous case-control studies have suggested that risk-reducing salpingo-oophorectomy is associated with a decreased incidence of both breast and ovarian cancer in BRCA mutation carriers, but this is the first prospective series to do so. Of 101 women who had BRCA mutations and underwent surgery, which included removal of the fallopian tubes and ovaries, three developed breast cancer, and one developed primary peritoneal cancer in the two years following the surgery.

Additionally, three unsuspected cases of the early-stage ovarian cancer were detected in the group of patients who underwent surgery, highlighting the unadequacy of current ovarian cancer screening methods. Of 72 who chose to undergo intensive surveillance rather than the surgery, eight developed breast cancer, four developed ovarian cancer, and one developed peritoneal cancer during follow-up. Intensive surveillance included transvaginal ultrasound and a CA-125 blood test twice per year, according to the study, which was published in May 2002.

Ovarian cancer-free survival and overall cancer-free survival (ovarian and breast cancer) were significantly greater in the surgery group, with a hazard ratio of 0.25 for overall cancer-free survival. If findings of a 75 percent reduction in cancer risk in patients persist with longer follow-up, they could have substantial impact on the management of women with BRCA mutations. The surgery could be performed after childbearing; the median age of the study participants was 45 years.