It’s well known that women whose families have a history of breast and ovarian cancer are at higher risk of developing those diseases, but what’s not so clear is what can be done to improve care for these patients. Researchers from the Mayo Clinic Cancer Center took a deep look at the latest studies to help determine the best way to assess the risk for breast and ovarian cancer, the effectiveness of surgery to reduce risk and alternative approaches to prevent cancer.
“Many of the studies we discuss were published recently, so we are taking advantage of the increased knowledge of the types of cancers that these women develop and the ages at which they occur, to suggest how we can change our thinking around their management,” Dr. Lynn Hartmann, oncologist at Mayo Clinic and lead author of the article, said in a statement. “It is part of medicine today to try to individualize recommendations whenever possible.”
Women can reduce their susceptibility to these cancers by undergoing a mastectomy or having their Fallopian tubes removed, but those procedures carry certain risks of their own. A bilateral prophylactic mastectomy, for example, can potentially lead to bleeding or infection and, according to the National Cancer Institute, it can dramatically affect a woman’s psychological well-being due to the changes in body image and the loss of normal breast function.
Historically, most of the research is focused on whether those procedures can prevent cancer and to what extent, but now there is an emerging shift toward better understanding the psychological consequences of the procedures. New studies suggest that most women are pleased with the choices they made, but more research is still needed to determine how clinicians can help them deliberate their options in the most effective way.
Women who have BRCA1 and BRCA2 mutations are usually grouped into a “BRCA1/2” category, but the researchers cautioned that the likelihood of developing certain cancers can be significantly varied across those groups.
Women with BRCA1 mutations have a 67 percent average risk of breast cancer and 45 percent risk of ovarian cancer by the time they turn 80 years old, whereas women with BRCA2 mutations have a comparable risk of breast cancer (66 percent) but only a 12 percent likelihood of developing ovarian cancer.
According to the researchers, breast cancer patients with BRCA1 mutations are frequently considered to have high-grade and estrogen-receptor-negative tumors, whereas women with BRCA2 mutations are for the most part estrogen-receptor-positive. Since certain medications that reduce risk are only available for women with estrogen-receptor-positive disease, grouping the two mutation types into a single category may limit the preventative options available to BRCA2 women.
When it comes to ovarian cancer, it usually develops sooner and with greater frequency among women with the BRCA1 mutation. The current guidelines recommend that women with BRCA1 and BRCA2 mutations who are finished having children should have their ovaries and Fallopian tubes removed between 35 and 40 years of age, but women with BRCA2 mutations might be able to delay that until they are 45 years of age since they only have a 1 percent risk of ovarian cancer by 50.
The researchers — who published their article today in the New England Journal of Medicine — are calling for more studies that investigate how women decide on the best treatment as well as studies that evaluate the short- and long-term psycho-social and clinical impact that surgery, taking risk-reducing medication, and surveillance can have on women.
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