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Preventive Surgery Fights Ovarian Cancer

Gynecological Surgeries May Prevent Ovarian Cancer in Women at Risk
By
WebMD Health News

July 16, 2003 -- For women at high risk of ovarian cancer, preventive surgery to remove the ovaries may substantially reduce the risk of developing ovarian cancer and a similar disease called peritoneal carcinoma.

A new study shows preventive gynecological surgery can reduce the risk of these cancers by 30%-90%, depending on the type of surgery.

Ovarian cancer is one of the deadliest cancers that strike women, but there are few screening options or preventive measures for women at risk for this type of cancer, such as those with a family history of the disease.

Peritoneal carcinoma occurs in the abdomen and is similar to ovarian cancer in symptoms, spread, and treatment, but it can grow in the absence of ovaries.

Surgery Reduces Ovarian Cancer Risk

In this study, published in the Journal of the National Cancer Institute, researchers looked at the history of gynecological surgeries, such as removal of the ovaries, hysterectomy (removal of the uterus), and tubal ligation among a group of Israeli women with ovarian cancers and compared them to women without such surgeries.

Compared with women without gynecological surgery, the study showed there was an overall estimated 40% reduction in ovarian cancer risk among women who had any type of gynecological surgery.

Women who had both ovaries removed had an estimated 90% lower risk of ovarian cancers than others, and women who had surgeries that involved removal of some ovarian tissue had an estimated 50% reduction in risk.

Researchers found this reduction in ovarian cancer risk was even greater among women with a mutation in the breast cancer genes BRCA1 and BRCA2, which is thought to increase the risk of ovarian cancer.

Among these women, surgery that specifically involved removal of ovarian tissue was associated with an estimated 66% reduction in ovarian cancer risk. Surgeries that did not involve removal of ovarian tissue, such as those involving the uterus or fallopian tubes, were associated with a 33% reduction in risk among women with this genetic risk factor.

These reductions in ovarian cancer risk were regardless of the age at which the women had the surgery or whether the procedure was performed before or after menopause.

Difficult Decision

Researchers say it's not exactly clear how these surgeries reduce the risk of ovarian cancers, but they may work by reducing the number of times a woman ovulates. But few nonsurgical options to reduce ovarian cancer risk are available to high-risk women.

"[Removal of both ovaries] may remove most of the risk, other surgeries that remove ovarian tissue may halve the risk, and hysterectomy and tubal ligation may modestly reduce the risk," write researcher Joni L. Rutter, PhD, of the National Cancer Institute and colleagues.

"Clinical decisions for ovarian cancer risk reduction in BRCA mutation carriers will necessarily involve the balancing of potential benefits and harms for each individual women faced with this difficult decision."

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