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Study: Prophylactic surgeries protect women

Some women who test positive for genetic mutations that increase the risk for breast and ovarian cancers undergo surgery to protect themselves. But it's been unclear how much that really helps. A new study finds that these "prophylactic" operations do significantly decrease the risk for those cancers.

Susan Domchek of the University of Pennsylvania School of Medicine in Philadelphia and colleagues studied 2,482 women who tested positive for mutations in the BRCA1 and BRCA2 genes in Europe and North America between 1974 and 2008.

None of the women who underwent mastectomies developed breast cancer malignancies in the three years following their surgeries, the researchers reported in the Journal of the American Medical Association. In contrast, 7 percent of the women who did not get the surgery were diagnosed with breast cancer. Similarly, women who had their ovaries removed virtually eliminated their risk for ovarian cancer, the researchers reported.

In an editorial accompanying the study, Laura Esserman of the University of California, San Francisco, and Virginia Kaklamani of Northwestern University in Chicago said more research like the new study would be valuable to track the effectiveness of treatments that occur because of new tests.

By Rob Stein  |  August 31, 2010; 4:00 PM ET
Categories:  Cancer , Prevention , Women's Health  
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Comments

"women who had their ovaries removed virtually eliminated their risk for ovarian cancer"

"Virtually"?

Duh. That is like saying people who went to the guillotine "virtually" eliminate their risk of headaches.

Seriously though, amputating perfectly healthy organs just to prevent the possibility of those organs getting cancer sounds like a horrible idea.

Posted by: jeff20 | August 31, 2010 6:38 PM | Report abuse

jeff20, you DO understand that if a person gets cancer, removing the organ that is the primary site does not eliminate the possibility that the cancer will recur? In other words, it is still theoretically possible for women who have had their ovaries removed to grow ABNORMAL (cancerous) ovarian cells. That is what makes these results significant.

Posted by: carlaclaws | August 31, 2010 8:42 PM | Report abuse

If I keep getting skin cancers on my left hand, should I cut my hand off? This is absurd. There is an epidemic of C-sections, because physicians make more money with C-sections.

Coke and Pepsi with high fructose corn syrup is more dangerous than cocaine and heroin.

A majority of adults in California are obese or overweight, and more than 2 million have been diagnosed with diabetes.

In California, the total annual cost of diabetes is estimated to be $24 billion, with $17 billion spent on direct medical care and $7 billion on indirect costs associated with the disease. The cost of obesity to families, employers, the health care industry and the government is equally steep: $21 billion. If obesity and diabetes continue to affect more and more of the population, the associated costs will continue to grow.

Posted by: alance | August 31, 2010 9:43 PM | Report abuse

I'll be happy to answer almost any question on this topic.

To those asking the questions already?

if you're hand had melanoma.... then yes, amputate the hand... (depending on depth of invasion... nodal status...) that will kill you quickly.

If your healthy organ had a 95% chance of killing you in 20 years? then remove it, right?

It's all about decisions, rights, and resources.

We could not afford to remove all ovaries in these patients. It's not pragmatic.

However, if someone cannot sleep at night worrying.... their mom and sister died from ovarian cancer.... they can't get out of bed, don't brush their teeth...

I have removed ovaries in this type of patient... the recovery can be amazing...

Posted by: docwhocuts | September 1, 2010 8:02 AM | Report abuse

Read carefully: 7% of women who didn't get the surgery developed cancer between 1974 and 2008 -that's in 34 years,or assuming an even spread a risk of .2% per year, but none of the women who had the surgery developed cancer in the 3 years following their surgery.
Sounds significant, but scarcely compelling, considering that most of the cancers in either group would increase as the women aged.
I would like this study repeated with age-matched cohorts in an equal period of time.

Posted by: ladyxoc | September 1, 2010 11:45 AM | Report abuse

If there's no risk to removal, other than that which comes with any routine surgery, then I don't see a downside here. It's not like you need ovaries or breasts for a certain quality of life. If it were me with that genetic mutation, I'd go for removal in a New York minute.

Posted by: 7900rmc | September 1, 2010 2:17 PM | Report abuse

The point that alance and jeff20 (both presumably young, moderately ill-educated men) fail to understand is that for these women, NONE of their organs are perfectly healthy. We're not talking about the benign, slow growth types of ovarian cancer, we are talking about the fast growing, malignant, deadly variety with a strong corollation with specific genetic markers.

The women getting their ovaries removed all have a genetic marker that is indicative of a much higher chance of getting ovarian cancer. Their genetic code itself is unhealthy.

If you look at the ratio of detection to survival rates by stages of the disease; it a fairly severe inverse relationship. Early detection doesn't usually happen, and death rates soar with late detection.

This is a classic condition for the use of prophylactic surgery. The risks of complications, and the severity of complications for removal of the ovaries is significantly less than the risk of death from the cancer.

Posted by: mhoust | September 1, 2010 2:20 PM | Report abuse

Well, I have to politely but forcefully disagree with those opposed to and questioning of prophylatic surgeries. I tested positive for a BRCA 1 mutation last June (after reluctantly getting the test) My three sisters also tested positive. Within two months, one of my sisters was diagnosed with breast cancer.

At first, I wanted to pursue the "watchful waiting" approach and just get monitored more carefully. All of the existing tests that I had during the summer for ovarian cancer were negative. I finally had "prophylactic" surgery in September and fallopian tube cancer was discovered, fortunately at only Stage 2. The existing tests for ovarian cancer simply do not detect ovarian cancer until very advanced and hard-to-cure stages.

I underwent another surgery and then chemotherapy during the winter. Then had a prophylactic (and this time no cancer was discovered) mastectomy in May. I had an 87% chance of developing breast cancer with our specific mutation. I am now healthy, alive and will not wake up in three years with Stage 4 ovarian cancer.

My suggestion, don't pre-judge what you would or wouldn't do in these situations. In my situation, knowledge was power and taking action saved my life.

And, a few additional facts; many people think of this as the "breast cancer gene". It is not. It is the breast AND ovarian cancer gene. Secondly, we inherited the genetic mutation from my FATHER. His mother had died of breast cancer at the age of 33. All of my doctors and my sisters' doctors had always told us that the "father's side doesn't matter". FALSE.

If you have a history of early onset (pre-age 50) breast or ovarian cancer in your family, take this seriously and look into it. It might save your life.

Posted by: marti1 | September 2, 2010 8:31 PM | Report abuse

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