In women who have both breast cancer and the BRCA1 mutation, having surgery to remove the ovaries can significantly lower their risk of dying from the disease, suggests a new study published in the journal JAMA Oncology.
Women with BRCA1 or BRCA2 genetic mutations have up to a 70% risk of getting breast cancer and a high risk for ovarian cancer. Like actress Angelina Jolie, these women will often consider undergoing preventative surgeries to remove the breasts and ovaries to keep that risk at bay. Now, a new study shows that for women who already have cancer and have a BRCA1 mutation, surgery to remove ovaries—called oophorectomy—could lower the risk of dying of breast cancer by 62%.
Women with BRCA mutations who already have breast cancer will often consider also removing their ovaries to prevent ovarian cancer or secondary breast cancer. Hormones from the ovaries are thought to stimulate the breast tissue and contribute to breast cancer risk.
The study looked at 676 women with stage I or II breast cancer and a BRCA1 or BRCA2 mutation. They were observed for up to 20 years after their diagnosis. Among the women, 345 underwent oophorectomy and 331 women kept their ovaries. At 20 years, the overall survival rate was around 77%—and the women who opted to remove their ovaries had a 56% lower risk for breast cancer death than women who didn't. For women with the BRCA1 mutation, oophorectomy was associated with a 62% reduction in risk of death from breast cancer, but there was no significant association for women with the BRCA2 mutation. The study authors note that the number of women in the study with the BRCA2 mutation was also much lower than those who had BRCA1.
"The data presented here suggest that oophorectomy should be discussed with the patient shortly after diagnosis," the study authors write. "We recommend that the operation be performed in the first year of treatment to maximize the benefit."
Oophorectomy proved particularly beneficial for women with estrogen receptor–negative breast cancer. "It seems kind of counterintuitive," says Dr. Robert DeBernardo, a gynecology-oncology surgeon at Cleveland Clinic's Women's Health Institute (who was not involved in the research). "The ovaries make the estrogen, and if we take it out, we expect to see less estrogen positive breast cancers, but we see a benefit from estrogen negative cancers. That very well may be because the ovary doesn’t just make estrogen or progesterone. It may also make some other things that we have not recognized."
For women with BRCA mutations, DeBernardo says the study offers more insight into the risk and benefits of their surgical options. "All women with BRCA1 and BRCA2 mutations [will likely] see a specialist like myself to talk about the role of removing their ovaries and tubes," says DeBernardo. "Now we have something else to discuss to make it easier to make a decision."