BRCA1 / BRCA2 

Prophylactic ovary removal and BRCA1 or BRCA2

Women who are deemed high risk for being diagnosed with breast cancer such as those who possess BRCA1 or BRCA2 gene mutations, are also considered to be high risk for developing ovarian cancer. Therefore women who have tested positive for the BRCA1 or BRCA2 gene mutations are encouraged to have their ovaries prophylactically removed and thus be put in Surgical Menopause.

 

Ovary removal in women with BRCA1 and BRCA2 can lower the risk of ovarian cancer by 70 to over 90 percent. The National Comprehensive Cancer Network (NCCN) recommends that women with BRCA1 or BRCA2 gene mutations, in order to mitigate their risk of developing breast and ovarian cancers have their ovaries and fallopian tubes removed between the ages of 35 and 40 years old or as soon as they are finished having their family. Women with BRCA2 mutations who have had a double mastectomy can safely put off the removal of ovaries and fallopian tubes until the age 40-45. Ovarian cancer for those women who have tested positive for a BRCA2 mutation typically occurs 8-10 years later than it would in women who test positive for a BRCA1 mutation.

 

While prophylactic ovary removal and thus putting a woman into Surgical Menopause can lessen the risk of breast cancer if done prior to natural menopause as well as significantly reduce the probability of developing ovarian cancer, this surgery should not be considered lightly. This surgical option should be fully discussed and explored with both your genetic counselor and oncologist.

 

Surgical Menopause may be the only means to reduce health risks for women with BRCA1 or BRCA2, but the condition itself of being in Surgical Menopause presents its own health risks and complications. The sudden loss of hormones commonly leaves women with a wide range of side effects such as depression, hot flashes, memory loss, low/no sex drive, vaginal atrophy and dryness, insomnia, fatigue, and it also affects heart, brain and bone health.

 

Additionally if you possess the BRCA2 gene mutation, which tend to have cancers that are estrogen receptor-positive, you will likely not be a candidate for taking HRT (Hormone Replacement Therapy), which is the only medical treatment available for managing the unwanted effects women have in Surgical Menopause. Therefore, women with BRCA2 often have a much harder road ahead of them in terms of coping with the more severe symptoms and side effects brought on by ovary removal.

 

Ovarian Cancer and BRCA1 or BRCA2

 

Testing positive for BRCA1 or BRCA2 gene mutations increases a woman’s chance of being diagnosed with ovarian cancer.  According to the National Cancer Institute women in the general population have less than a 2% risk of being diagnosed with ovarian cancer, but for women with BRCA1 that increases to a 35-70% risk, and a 10-30% risk for those with BRCA2.

 

Although, as one can see, the risk is significantly more for those with BRCA1 or BRCA2 gene mutations than those who are non carriers, it is important to keep in mind that this does not translate to a worse long term prognosis. In fact, one study done by the National Cancer Institute discovered that 10 years following ovarian cancer diagnosis, the survival for BRCA1/2 carriers was about the same as for non-carriers. A big reason for this may be that BRCA1/2-related ovarian cancers appear to have a better response to chemotherapy than other ovarian cancers.

 

 

Genetic Testing

 

Genetic testing is the first line of defense in finding out if your breast or ovarian cancer or family history of breast or ovarian cancer is caused by a genetic gene mutation.

 

In the majority of cases genetic testing is first done with the person who has been diagnosed with cancer. The test is done through either a blood or saliva test. If no mutation is found, the cancer was not because of a BRCA1 or BRCA2 mutation and therefore other family members need not be tested.

 

If the test results indicate you are BRCA1 or BRCA2 positive, other family members should be tested as they are at greater risk. Even when BRCA1 or BRCA2 gene mutation is present, it is not 100% certain that all family members possess the mutation. You have a 50% chance of inheriting the gene as you inherit half your genetics from your mother and half from your father.

 

Genetic testing for BRCA1 or BRCA2 is a good idea if you have the following indicators:

  •  Your mother, grandmother, sister, aunts or daughter has had breast or ovarian cancer prior to the age of 45.

  •  A personal history of breast, ovarian cancer prior to the age of 45

  • You have a personal history of triple negative breast cancer diagnosed by age 60 or younger

  •  A family history of male breast cancer

  •  You possess Ashkenazi Jewish heritage and a personal history of breast or pancreatic cancer

Ongoing Care

 

Whether or not you opt to have your ovaries surgically removed because of BRCA1 or BRCA2 diagnosis, we strongly recommend that you employ the advice of a genetic counselor along with an oncologist to make the best possible decisions regarding your health. It is also important to note that a genetic counselor will be the best person to advise you as to whether or not you are a good candidate for Hormone Replacement Therapy (HRT).

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