ovarian cancer : Prophylactic oophorectomy

Prophylactic oophorectomy significantly reduces your odds of developing cancer if you're at high risk — up to 50 percent for breast cancer and 95 percent for ovarian cancer. Weigh the pros and cons of this surgical prevention to determine whether it's an option for you.
Your doctor has determined that you carry a mutation in breast cancer gene BRCA1 or BRCA2. A mutation to either of these genes significantly increases your risk of breast and ovarian cancer. Your heart freezes at the thought of preventive mastectomy — the surgical removal of your breasts to prevent breast cancer. Do other preventive care options exist?

Yes, in fact, they do. One is called preventive (prophylactic) oophorectomy — the surgical removal of your ovaries. Although the procedure is usually performed to reduce your risk of ovarian cancer, if performed before you reach menopause it also reduces your risk of breast cancer.

But the surgery isn't for everyone. Before considering such a severe approach to breast and ovarian cancer prevention, talk with a genetic counselor to assess your risk. From there, weigh the pros and cons of the surgery and understand the implications that the surgery will have for you.
do. One is called preventive (prophylactic) oophorectomy — the surgical removal of your ovaries. Although the procedure is usually performed to reduce your risk of ovarian cancer, if performed before you reach menopause it also reduces your risk of breast cancer.

But the surgery isn't for everyone. Before considering such a severe approach to breast and ovarian cancer prevention, talk with a genetic counselor to assess your risk. From there, weigh the pros and cons of the surgery and understand the implications that the surgery will have for you.

What is preventive oophorectomy, and what does it have to do with breast cancer?
Oophorectomy refers to the surgical removal of your ovaries. Removing your ovaries greatly reduces the amount of circulating estrogen in your body. This can halt or slow breast cancers that depend on estrogen to grow.

How much of an impact can this have on your risk of breast and ovarian cancer? A significant one. Prophylactic oophorectomy reduces your risk of breast cancer by about 50 percent if you're premenopausal, and it reduces your risk of ovarian cancer by up to 95 percent — no matter what your menopausal status.

Oophorectomy vs. mastectomy
You might think that preventive mastectomy would be the best way to lower your risk of breast cancer. And the procedure does reduce your risk of breast cancer to a much greater extent than does prophylactic oophorectomy. However, you might choose prophylactic oophorectomy over mastectomy because oophorectomy protects against both breast and ovarian cancer, rather than just breast cancer. Having a BRCA1 or BRCA2 gene mutation puts you at risk of both diseases.

You might also opt for prophylactic oophorectomy because ovarian cancer is much more difficult than is breast cancer to detect and treat at an early stage. Preventive mastectomy by itself offers no protection against ovarian cancer.

Oophorectomy also may seem appealing if you're concerned about how you'll look if you have your breasts removed. The downside, though, is that you'll experience premature menopause.

You attain the greatest risk reduction for ovarian and breast cancer by having both procedures.

Who is prophylactic oophorectomy recommended for?
Prophylactic oophorectomy is usually recommended if you're at increased risk of breast cancer and ovarian cancer due to an inherited mutation in the BRCA1 or BRCA2 genes — two genes linked to breast cancer, ovarian cancer and other cancers. High-risk women age 35 and older who have completed their families are the best candidates for this surgery.

If you have a BRCA1 or BRCA2 gene alteration, your risk of ovarian cancer is much higher than it is for the general population — and your risk of breast cancer is even higher. But because ovarian cancer is much more difficult to detect at an early stage than is breast cancer, it's more likely to be deadly.

Because BRCA1 carriers are at risk of developing ovarian cancer at an earlier age than are BRCA2 carriers, they usually have the procedure at an earlier age — between ages 35 and 40. Carriers of a BRCA2 alteration can usually delay the procedure until age 45. In either case, you may be able to postpone having prophylactic oophorectomy until you've finished having children.

Prophylactic oophorectomy may also be recommended if you have a strong family history of breast cancer and ovarian cancer but no known genetic alteration. It might also be recommended if you have a strong likelihood of carrying the gene mutation based on your family history but choose not to proceed with genetic testing.

Assessing your cancer risk
Whether or not prophylactic oophorectomy is your best choice hinges upon your risk of developing breast or ovarian cancer. Your level of risk depends on your personal medical history, your family history and your genes.

You might be considered at high risk of breast and ovarian cancer and a candidate for prophylactic oophorectomy if you have a known mutation in the BRCA1 or BRCA2 genes. You might also be a candidate if you have certain combinations of the following risk factors:

A personal history of breast cancer diagnosed before menopause
A known mutation of the breast cancer genes — BRCA1 or BRCA2 — in your family
A first-degree relative, such as your mother, sister or daughter, with onset of breast cancer before age 50
A family member diagnosed with ovarian cancer before age 50
A family history of ovarian cancer in two or more relatives
A male family member with breast cancer
Ashkenazi Jewish ancestry
If one or more of these factors apply to you, consider making an appointment with a genetic counselor. A genetic counselor can chart your family history, provide an assessment of your cancer risk based on your family history and discuss with you the merits of genetic testing in your particular situation. The genetic counselor will help you understand your individual risk to aid in your decisions about prophylactic surgery. You may also want to meet with a breast health specialist and gynecologic surgeon to discuss other options.


by U.S. National Library of Medicine,