Medical Wisdom

For women with breast cancer gene, removing ovaries by 35 could be life saver

For women with cancer gene, removing ovaries by 35 could be life saver

A new cancer study reveals that women with a specific genetic abnormality could drastically decrease the risk of death by having their ovaries removed early in life.

The Journal of Clinical Oncology reports that women with the BRCA1 gene who have preventative surgery to remove their ovaries by age 35 reduce their risk of death by 77 percent. Women with the BRCA2 gene who wait until their 40s to have the procedure would get the same benefit.

 For those with BRCA 1 or 2, the risk for ovarian cancer increases from 1-in-70 to as high as 1-in-2.

Dr. Bruce Fine, a gynecologic oncologist at Medical City Dallas, says the recommendation for BRCA mutation carriers to remove their ovaries has been conventional wisdom for more than a decade, but this study is making news because of the declarative importance of age on survival.

About 1 in 800 people have Breast Cancer Susceptibility genes, which are classified as BRCA1 and BRCA2 mutations. They are both linked to increased incidences of breast and ovarian cancer.

According to Fine, the risk for ovarian cancer in the general population is about 1-in-70; for those with the BRCA 1 or 2 mutation, it’s anywhere from 1-in-5 to 1-in-2.

"It’s a huge deal for those small subset of patients, but for the general population, it probably isn’t applicable," Fine says of the recent research.

Another reason this medical research is turning heads across the country, Fine believes, is as simple as Angelina Jolie. The 37-year-old actress (and BRCA1 carrier) had a double-mastectomy in 2013. Jolie has also mentioned the possibility of having her ovaries removed.

 Dr. Bruce Fine of Medical City Dallas says this study is making news because of the declarative importance of age on survival.

"In the past, people of her notoriety would not have been so open about it; they would have kept it quiet," Fine says. "The doctors that deal with this were so happy to see Angelina Jolie be open about this and talk about her decision. She is doing exactly what we recommend."

As with any medical procedure, there are potential drawbacks associated with preventative ovarian surgery.

"The impact of early menopausal symptoms on quality of life is very hard to quantify," Fine says. "What may be unbearable for one person is not a problem for another. It's really a risk versus benefits issue."

One study said there was a big impact on cardiovascular disease by removing ovaries at an early age, but again you have to weigh the risk of not taking it out — and for those subgroups, it’s an extremely high risk."

Women who have a family history of breast or ovarian cancer as well as those of Ashkenazi Jewish descent are at increased risk for the BRCA mutation and are encouraged to get tested. According to Fine, most insurance companies will now cover testing for patients in high-risk subgroups. In another Hollywood connection, the 2012 movie Decoding Annie Parker recounts the saga of BRCA mutation discovery.

Fine says a BRCA mutation carrier getting her ovaries removed is akin to someone not smoking to prevent lung cancer. "It's a fairly good analogy, because although not smoking definitely reduces your risk, we do have patients who still get cancer."

Women with the BRCA mutation who have their ovaries removed will definitely not get ovarian cancer, but Fine says it doesn't eliminate the possibility of the patient later developing another type of cancer associated with the genetic abnormality.

Angelina Jolie May 2013
Angelina Jolie carries the BRCA1 gene. Angelina Jolie/Facebook
Helen Hunt in Decoding Annie Parker
In Decoding Annie Parker, Helen Hunt plays Mary Claire King, the doctor who discovered the BRCA1 gene. Courtesy of Dorado Media