Many women submit to unnecessary ovary removal reports new study
Women who carry the BRCA1 or BRCA2 gene mutations are at increased risk for ovarian cancer. Some of these women undergo removal of their ovaries and fallopian tubes (salpingo-ophorectomy) to reduce the risk of ovarian cancer. The American Congress of Obstetricians and Gynecologists (ACOG) recommends that if women who are carriers of these genes choose to have their ovaries removed, it should be done after they have completed childbearing and are near 40 years of age. However, some women who are not BRCA carriers are undergoing a salpingo-oophorectomy. Researchers affiliated with the University of California, San Francisco published their findings online on December 17 in the journal Archives of Internal Medicine.
The researchers note that the average woman developing ovarian cancer is about 2%; however, women who carry the BRCA1 gene mutations have a 40% risk, while women who carry the BRCA2 gene mutation have a 20% risk. A research team led by Dr. Gabriel Mannis noted that for women at potentially increased risk for ovarian cancer, data regarding screening and risk reduction are limited. They explained that previous studies have reported on the behaviors of BRCA mutation carriers; however, less is known about the behaviors of non-BRCA carriers. Therefore, they conducted a large study aimed at identifying the prevalence and posttest predictors of risk-reducing and screening interventions.
The study group comprised 1,447 women who received BRCA screening and genetic counseling at two hospitals. The women were surveyed an average of 3.7 years after the BRCA testing; a response rate of 77.6% was achieved. The investigators analyzed data from 1,077 survey respondents; the data were subjected to analyses aimed at identifying predictors of risk-reducing salpingo-oophorectomy (RRSO), screening transvaginal ultrasonography, and screening serum cancer antigen 125 (CA-125).
The researchers found that among the women who responded, 201 (18.7%) received positive test results for a deleterious mutation (BRCA1 or BRCA2), 103 women (9.6%) received true-negative results, and 773 women (71.8%) received uninformative results. Overall, 19.1% of eligible women underwent RRSO and 39.6% used screening procedures. A positive BRCA result significantly predicted a RRSO (odds ratio: 28.1) and elevated serum CA-125 also significantly predicted a RRSO (Odds ratio: 13.0). A true-negative BRCA result reduced the odds ratio for RRSO to 0.1 and a normal CA-125 reduced the odds ratio to 0.3. Of the 71.8% of women who received uninformative results after BRCA testing, 12.3% subsequently underwent RRSO, 33.8% reported ever having undergone screening serum CA-125 since BRCA testing, and 37.3% reported ever having undergone screening transvaginal ultrasonography since BRCA testing. The investigators also found that despite the US Preventive Services Task Force recommending against screening for ovarian cancer in women without the gene mutations, approximately 20% of women whose test results did not clearly show the mutations still underwent screening in the year before taking the survey.
The researchers concluded that the results of BRCA testing strongly predict RRSO and ovarian cancer screening. Undergoing a RRSO and ovarian screening was reported by a significant percentage of non- BRCA carriers despite insufficient data to determine the effectiveness of these interventions.
Take home message:
This study did not clarify whether the women who did not carry the BRCA mutations underwent removal of their ovaries solely to reduce cancer risk. These women may have had other gynecologic conditions that required a hysterectomy; thus, removal of the ovaries at the time of an indicated hysterectomy does not significantly increase the surgical risk. A RRSO is not warranted for a woman who is not a BRCA carrier and does not have any gynecologic problems. The benefits do not outweigh the surgical risk and expense of the procedure.
Reference: Archives of Internal Medicine