Women who have gene mutations that increase the risk of breast and
ovarian cancer can substantially reduce their chances of developing –
and dying from — those cancers if they have their breasts or ovaries
removed preemptively, according to a new study.

The study, which
appears in the Journal of the American Medical Association, confirms
that preventive mastectomy and ovary removal can slash the risk of
cancer in women carrying the BRCA-1 or BRCA-2 gene mutations, and it
suggests that surgery is more effective than rigorous screening at
preventing future cancer.

Researchers at 22 cancer centers in the
U.S. and Europe followed nearly 2,500 women with BRCA gene mutations
for about four years. None of the women who underwent preventive
mastectomy developed breast cancer during the study, whereas 7 percent
of the women who opted against the surgery did. (The women who did not
have surgery were put on an intensive screening schedule.)

Meanwhile, just 1 percent of women who had at least one ovary and
fallopian tube removed (a procedure known as salpingo-oophorectomy) got
ovarian cancer, compared with 6 percent of women who didn’t have the
surgery. The rate of breast-cancer diagnosis was also lower in women who
underwent salpingo-oophorectomy (11 percent) than in those who did not
(19 percent).

In addition, the women who had an ovary and
fallopian tube removed cut their risk of dying from ovarian and breast
cancer by 79 percent and 56 percent, respectively.

The findings
confirm “an incredibly important endpoint,” says Claudine Issacs, M.D.,
one of the study researchers and the medical director of cancer
assessment and risk evaluation at Georgetown Lombardi Comprehensive
Cancer Center, in Washington, D.C.

“If you have this preventive
surgery, it not only decreases the risk of disease but also
significantly decreases the risk of death, which is [the] most important
thing you’re trying to do.”

Between 56 percent and 84 percent of women with a BRCA mutation will
develop breast cancer in their lifetime, while 36 percent to 63 percent
of women with the BRCA-1 mutation and 10 percent to 27 percent of women
with the BRCA-2 mutation will develop ovarian cancer, according to
estimates cited in the study.

Women who test positive for the
BRCA-1 or BRCA-2 mutations generally have three options for managing
their risk: body-altering surgery, preventive chemotherapy, or a
stepped-up screening regimen that includes frequent mammograms.
(Screening techniques are less effective for ovarian cancer than for
breast cancer, and doctors usually advocate salpingo-oophorectomy if a
woman has completed her family.)

Whether — and when — to have
preventive surgery can be a gut-wrenching decision for many women, since
surgery can impact both how they look (in the case of mastectomy) and
their ability to have a family, says Rob Watson, M.D., assistant
professor of surgery at the Texas A&M Health Science Center College
of Medicine, in Round Rock.

Some women facing this decision “are very young, and the timing can
have a significant effect on body image and reproductive status,” Watson
says. “We’re trying to help them understand what age is going to be
best for them in relation to family planning and body image and some of
the other goals they want to achieve.”

Women with a BRCA gene
mutation are often reluctant to have preventive surgery, despite its
proven ability to reduce risk. Just 10 percent of the women in the study
– who were as young as 20 — opted for preventive mastectomy, while 38
percent decided to remove one or both of their ovaries and fallopian
tubes.

Salpingo-oophorectomy reduced the risk of ovarian cancer regardless
of which BRCA mutation a woman had, or whether she had been had breast
cancer. The procedure also reduced the risk of breast cancer — but only
in women in whom cancer had never been diagnosed before.

“For
women to get maximum benefit from oophorectomy in terms of breast-cancer
risk, they should have it done prior to the first diagnosis of breast
cancer,” Watson says.

Three percent of the women who underwent
salpingo-oophorectomy died of any cause (including cancer) during the
study, versus 10 percent of the women who did not have the surgery. The
rates of fatal ovarian and breast cancer were lower in women who had the
surgery.

“Oophorectomy and mastectomy may be the best and most
effective way to reduce their risk,” says Len Lichtenfeld, M.D., deputy
chief medical officer of the American Cancer Society, who was not
involved in the new research.

Women
who are considering whether to have these surgeries should keep in mind
that surgical techniques are more sophisticated and less invasive today
than they were 10 or 15 years ago, Lichtenfeld adds.

“We have considerably improved surgical approaches, especially in terms of breast reconstruction,” he says