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A new study shows that women who have a gene mutation called BRCA1 can greatly reduce their risk of deadly ovarian cancer if they have their ovaries removed while young. For many women, this can be a difficult and heart-wrenching choice beginning with asking the right questions. Here are some basics on how this research might affect you.
Watch Dr. Nancy Snyderman's Nightly News report here:
How can I find out if I have this mutation?
Step one is to talk to a doctor. They can use a tool called a risk calculator to help you figure out if you have a high enough risk to justify getting the test. Myriad Genetics, the company that made the first BRCA gene tests, has a risk calculator. The National Cancer Institute offers one here. You can find an outline of ovarian cancer risks at the Ovarian Cancer Alliance. And a group called Facing Our Risk Empowered also provides guidance.
My mom died from breast cancer – should I take out my ovaries?
Just because your mother had breast cancer doesn’t mean you’ll get it, and it doesn’t mean that you have this genetic mutation. Monday's findings only apply to women with BRCA1 mutations -- and those only account for a small percentage of breast cancer cases.
Having a close relative like a mother or sister does raise your risk of breast cancer, but it doesn’t mean you have a mutation. The U.S. Preventive Services Task Force recommends that only women with a strong family history consider getting a BRCA genetic test.
What if you have the cancer gene, but haven’t had kids yet?
This makes it a tough decision. An analysis of all the women in the study showed that the best protection was for women who removed their ovaries by the age of 35. That’s before some women have finished, or even started, a family. Women without ovaries cannot naturally conceive. There are some options, such as having your eggs frozen or, if you have a partner, having IVF and freezing the embryos, and then deciding whether to try to become pregnant without fallopian tubes or to have a surrogate gestate the embryo.
If I remove my ovaries, can I take hormone therapy to avoid hot flashes and other side effects?
No. Doctors remove ovaries in order to slash the body’s production of estrogen, the hormone that fuels most cases of breast cancer. Replacing the estrogen would be risky and might undo the protection provided.
Can you just exercise and eat right instead of removing your ovaries?
It is true that many cases of breast cancer are linked to poor diet and a lack of exercise. But that’s what’s called sporadic breast cancer -- the kind that isn't caused by an inherited gene mutation. So while most women can lower their risk of breast cancer by eating plenty of fresh fruits and vegetables and getting daily vigorous exercise, that's not the case for women with BRCA1 mutations. The mutation has destroyed the body’s ability to repair the damage that leads to tumors.
Why did the researchers suggest women with BRCA1 consider ovary removal?
They studied more than 5,000 women and compared women who chose to have their ovaries removed to women who did not, or who waited for a few years after finding out they had the mutation. Not very many of the women developed cancer -- just 186 of them got ovarian cancer or a related cancer over six years of follow up.
That was the good news.
But the women who had opted to have their ovaries removed were 80 percent less likely to be among those 186. And they also were 77 percent less likely to die of anything in the five to 16 years they were followed. Not only that, the researchers found 46 cases of ovarian, fallopian tube or peritoneal cancer in women who had their ovaries removed before they had developed any symptoms.