Removing Ovaries Helps With BRCA1-Related Breast Cancer

Women diagnosed with BRCA1-related breast cancer, significantly reduced their risk of death by having their ovaries removed, a recent study in JAMA Oncology found. When the ovaries are removed within two years of diagnosis, that risk drops even lower.

Background and Goals

Errors, or mutations, in the BRCA1 or BRCA2 genes greatly increase a person’s lifetime risk of developing breast cancer, as well as ovarian, prostate and certain other cancers. For breast cancer, the lifetime risk can be up to 70 percent. BRCA1 and 2 mutations also raise a person’s risk of getting a second breast cancer after they’ve been diagnosed with a first breast cancer.

Research has shown that women who have a BRCA mutation but do not have breast cancer can prevent both breast and ovarian cancer by having their ovaries and fallopian tubes removed. Doctors often advise women with a mutation who have not yet been diagnosed with breast cancer to have this surgery, called salpingo-oophorectomy, after age 35 and when they no longer want to become pregnant.

For this study, the researchers wanted to see if salpingo-oophorectomy would help women who are already diagnosed with breast cancer and have a BRCA mutation.

Design

Using records from cancer genetics clinics, the researchers found families with at least one member with a BRCA mutation and at least one diagnosis of invasive breast cancer. Any woman in the family diagnosed with stage I or stage II breast cancer between 1975 and 2008 was eligible for the study, whether they knew had a BRCA mutation or not. All women were diagnosed before age 65.

Women were excluded if:

• They knew they did not have a BRCA mutation, through past genetic testing
• They had their ovaries removed before diagnosis

Results

The study included 676 women with breast cancer from 493 different families. Most – 90 percent – had a BRCA1 or BRCA2 mutation. The BRCA status of the others was unknown.

After diagnosis,

• 345 women had their ovaries removed
• 331 did not, or had oophorectomy after being diagnosed with ovarian cancer or breast cancer recurrence

Overall the study found:

• oophorectomy reduced death related to breast cancer by 56 percent
  • There was a 65 percent reduction in death from all causes
• Removing the ovaries reduced breast cancer death by 62 percent in women with BRCA1 mutations
• Removing the ovaries did not reduce breast cancer death for those with BRCA2 mutations but the numbers were small
• The surgery benefitted women diagnosed after age 50 as well as those diagnosed before

Risk was further reduced if oophorectomy was performed within 2 years of breast cancer diagnosis.

Limitations

Because this study looked back over 33 years, newer therapies may minimize some of the benefit seen with oophorectomy. In addition, the women all had stage I or II breast cancer; findings might be different for those with stage III or IV disease.

What This Means For You

If you have a BRCA mutation, it is generally recommended that you have oophorectomy to lower the risk of ovarian cancer. This study suggests that this surgery may also reduce breast cancer-related death. “The data reported here are compelling,” noted the editor of the journal that published the study. She and the researchers believe healthcare providers should discuss the surgery with women shortly after diagnosis.

Talk with your healthcare provider about your personal or family history that could be hereditary breast cancer, to see if you should undergo genetic testing.

You may have concerns about the fertility and menopausal effects of having your ovaries removed, especially if you want to have children after treatment. Talk with your oncologist. Ask for a referral to a fertility specialist, to learn about fertility preservation options to take before surgery.

Even if you have finished treatment, you may want to talk with your provider about whether oophorectomy could further lower your future risk.

Metcalfe, K, Lynch, HT, Foulkes, WD, et al. Effect of Oophorectomy on Survival After Breast Cancer in BRCA1 and BRCA2 Mutation Carriers. JAMA Oncology 2015; doi: 10.1001/jamaoncol.2015.0658

This article was supported by the Grant or Cooperative Agreement Number 1 U58 DP005403, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.