27 February 2014

Who is recommended preventive ovariectomy?

Carriers of the "Jolie gene" were advised to hurry up with the removal of the ovaries

Copper news based on the materials of the American Society of Clinical Oncology:
Large Study Shows Preventive Ovarian Surgery in BRCA1 Mutation Carriers Should Be Performed Early for Greatest BenefitPreventive ovarian removal surgery (preventive ovariectomy) in carriers of oncogenic mutations in the BRCA1 and BRCA2 genes reduces the risk of developing malignant neoplasms by 80 percent and the risk of premature death by 77 percent, the authors of an international prospective study published in the Journal of Clinical Oncology (Finch et al., Impact of Oophorectomy on Cancer Incident and Mortality in Women With a BRCA1 or BRCA2 Mutation).

At the same time, carriers of a mutant copy of the BRCA1 oncogene (which has recently been called the "Jolie gene") should decide on this operation before the age of 35, since then the probability of cancer increases significantly, and for carriers of another oncogene, BRCA2, this age is not critical and they may not have surgery hurry up, experts say.

A team of researchers from Canada, USA, Poland, Norway, Austria, France and Italy led by Professor Steven Narod from the University of Toronto for 16 years, from 1995 to 2011, observed a group of almost six thousand women carriers of mutations in the BRCA genes. The study participants regularly filled out questionnaires, answering questions about their reproductive history, surgical interventions performed by them, including ovarietomy and mastectomy, taking hormonal drugs.

More than two thousand participants did not undergo preventive ovariectomy at all, about the same number had already performed such an operation by the beginning of the study, and the rest decided on it during the observation period. Within 5.6 years after the start of the study, 186 participants developed either peritoneal cancer or malignant neoplasms in the ovaries or fallopian tubes, 68 of them died for this reason.

The authors found that preventive ovariectomy reduces the risk of such cancer by 80 percent, while in carriers of the BRCA1 mutation, postponing surgery until the age of 40 increases the risk of ovarian cancer by 4 percent, and up to 50 years – by 14.2 percent. There was no similar effect on BRCA2 mutation carriers. For comparison, the average lifetime risk of ovarian cancer for all women, including those without BRCA mutations) is approximately 1.4 percent.

"I believe that postponing preventive ovariectomy for the age over 35 is too risky," the People said in this regard, whose words are quoted in a press release from the American Society of Clinical Oncology. – The data we have obtained irrefutably indicate that performing such an operation before the age of 35 should become a universal standard for carriers of the BRCA1 mutation. On the other hand, women with the BRCA2 mutation can safely postpone surgery until the age of 40 and older, since their risk of ovarian cancer is not so pronounced."

Narod and his colleagues also found that preventive ovariectomy reduces the risk of premature death by 77 percent in carriers of BRCA mutations, mainly by reducing the likelihood of ovarian cancer, fallopian tubes, abdominal cavity or mammary glands. Earlier, scientists found on the same group of participants that ovariectomy with BRCA1 mutation reduces the risk of breast cancer by 48 percent and the risk of death for this reason by 70 percent.

In the United States, approximately 70 percent of BRCA mutation carriers decide on preventive ovarian removal.

Recall that in early 2013, Hollywood actress Angelina Jolie, who is a carrier of a mutant copy of the BRCA1 gene, had a double preventive mastectomy due to the high risk of developing breast and ovarian cancer, which doctors determined to be 87 and 50 percent, respectively. It is believed that a mutation in the BRCA1 gene increases the risk of breast cancer by an average of five times (compared to normal), and the risk of ovarian cancer by 10-30 times. Slightly less likely to develop malignant tumors in women with mutations in the BRCA2 gene. Mutations in these genes are not too common – their carriers are approximately 5-10 percent of women suffering from breast cancer.

Portal "Eternal youth" http://vechnayamolodost.ru27.02.2014

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