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Gene Test, Preventive Surgery Save Women's Lives

Preventive Surgery Cuts Death Risk for Women With BRCA Cancer Genes
By
WebMD Health News
Reviewed by Laura J. Martin, MD

Aug. 31, 2010 -- Women who carry the BRCA1 or BRCA2 cancer genes cut their risk of death, breast cancer, and ovarian cancer by getting preventive surgery.

But to reduce their risk, women must make difficult choices:

  • They must decide whether to get tested for the BRCA mutations.
  • If BRCA positive, they must decide whether to undergo risk-reducing surgery to remove their ovaries and fallopian tubes.
  • If BRCA positive, they must decide whether to undergo risk-reducing surgery to remove their breasts.

Just a few months ago, 42-year-old Maxine Grossman, PhD, faced all these decisions. Her mother had died of breast cancer at age 55. A close cousin on her father's side was diagnosed with breast cancer at age 33. And Grossman has an Ashkenazi Jewish background, increasing her risk of carrying the BRCA gene.

These risk factors -- relatives on both sides of the family with early breast cancer and her heritage -- make Grossman a prime candidate for the BRCA gene test. But it was hard for her to decide to get the test -- and hard for her to face the next set of choices.

Now there's more information to help women like Grossman make these choices. It comes from a long-term study of nearly 2,500 BRCA-positive women studied at 22 medical centers in the U.S. and Europe by University of Pennsylvania researcher Timothy R. Rebbeck, PhD, and colleagues.

Only 10% of the BRCA-positive women in the study underwent preventive breast removal. Over three years of follow-up, none of them got breast cancer. Over the same period, 7% of BRCA-positive women who kept their breasts got breast cancer.

Only 38% of the BRCA-positive women in the study chose to have their ovaries and fallopian tubes removed. These women had a significantly lower risk of both breast and ovarian cancer than women who did not have the surgery.

They also reduced their risk of death. Among women who underwent the procedure, known as risk-reducing salpingo-oophorectomy or RRSO:

  • 3% died from any cause, vs. 10% of those who did not have the surgery.
  • 2% died of breast cancer, vs. 6% of those who did not have the surgery.
  • 0.4% died of ovarian cancer, vs. 3% of those who did not have the surgery.

"You can prevent a death from ovarian cancer by appropriate use of genetic testing and preventive surgery," Rebbeck tells WebMD. "That is a message that some women should get to save their lives."

The BRCA gene vastly increases a woman's cancer risk. Women with the BRCA1 or BRCA2 gene have a 56% to 84% lifetime risk of breast cancer. Lifetime risk of ovarian cancer increases by 36% to 63% for women with BRCA1 and by 10% to 27% for those with BRCA2.

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