A Bloomington physician is urging caution regarding a new study suggesting that surgically removing the ovaries of women who carry gene mutations that increase their chances of developing ovarian or breast cancer can not only reduce their risk of developing those cancers, but can prolong their lives.
“This study has caught a lot of national media attention because it’s the first one to ever show a survival advantage to doing this surgery,” said Dr.Benjamin Parsons, a medical oncologist and hematologist with IU Health Southern Indiana Physicians. “But it’s still a very individualized choice. A lot of women feel very strongly about not having parts of their bodies removed, and I can fully understand that.”
He said removing the ovaries and fallopian tubes induces menopause, which takes away a woman’s child-bearing potential.
“That’s why we prefer to wait until a woman is comfortable with the size of her family before discussing the possibility of removing her ovaries and fallopian tubes,” he said.
Women who inherit either of two faulty genes — BRCA1 or BRCA2 — are at much higher risk of developing breast and ovarian cancer than other women, and at younger ages. Actress Angelina Jolie generated headlines last year when she had her healthy breasts removed to reduce her cancer risk.
The new study, published in the Journal of Clinical Oncology, tracked the health of 5,787 BRCA carriers for an average of 51/2 years. It’s the largest study yet to show the power of preventive ovarian surgery for those women. It found the surgery not only lowered the women’s chances of getting either ovarian or breast cancer, but reduced their risk of death before age 70 by 77 percent.
Ovarian cancer is particularly deadly, and there is no good way to detect it early like there is for breast cancer. The symptoms — things like bloating, weight loss and abdominal pain — often don’t surface until the cancer has reached an advanced stage. So for years, doctors have offered the surgery to BRCA2 carriers beginning at age 35.
“The study did not find a single case of a woman with a BRCA2 mutation developing ovarian, fallopian tube or breast cancer before age 40,” Parsons said. “We now know it’s safe for those who have the BRCA2 mutation to wait until age 40 to have the ovary-removing surgery.”
He said he will continue to tell women with the BRCA1 gene mutation they can consider the surgery as early as age 35, or when they are no longer want to bear children.
Parsons said BRCA1 and BRCA2 gene mutations are relatively rare, and produce just 5 to 10 percent of all breast cancers and about 15 percent of all ovarian cancers.
“About 12 percent of women in the general population will develop breast cancer in their lifetime,” Parsons said. “But 55 to 65 percent of women who inherit a BRCA1 mutation and around 45 percent of women who inherit a BRCA2 mutation will develop breast cancer by age 70.”
He said that while 1.4 percent of women in the general population will get ovarian cancer during their lifetime, about 40 percent of women who inherit a BRCA1 gene mutation and 15 percent of women who inherit a BRCA2 mutation will develop ovarian cancer by age 70.
The genetic test
Several physicians in Bloomington, including Parsons, offer genetic testing for the BRCA1 or BRCA2 genes in their offices. It’s performed by taking a blood sample or saliva from inside the cheek. The cost can range from several hundred to several thousand dollars, but many insurance companies will cover the cost if you meet certain testing criteria — such as having a close relative who’s had breast or ovarian cancer at an early age.
“I would advise most patients who meet the criteria to first talk to a genetic counselor, so they can consider all the implications,” Parsons said. “If the test is positive, it may influence a person’s decision on marriage or on having children, because there is a 50 percent chance of passing the genetic mutation on to your children.”
Parsons said the Genetic Information Nondiscrimination Act of 2008 sayshealth insurance companies cannot discriminate against people who test positive for a BRCA gene mutation, but it allows life insurance companies to deny coverage to those who test positive.
“If you are going to have the genetic testing, I would advise getting life insurance prior to the test,” he said. “Another option is to protect your privacy by paying for the test out-of-pocket using a blinded patient identifier code rather than your real name.”
Parsons said that while a positive genetic test for BRCA1 or BRCA2 does increase the likelihood that a person will develop breast, ovarian or other cancers, it does not mean the person will definitely get cancer.
Surveys show that more than two-thirds of those who test positive for the BRCA gene mutation undergo ovary removal at some point, compared with about a third who choose a preventive mastectomy. Insurance generally pays for the both procedures.
