Removing ovaries cuts breast cancer risk in women with BRCA gene mutation: Canadian study

Angelina Jolie authored an op-ed for Tuesday’s May 14, 2013 New York Times where she writes that in April she finished three months of surgical procedures to remove both breasts as a preventive measure.
Angelina Jolie authored an op-ed for the May 14, 2013 New York Times where she writes that in April she finished three months of surgical procedures to remove both breasts as a preventive measure. (AP Photo/Carlo Allegri, File)

Last month, Hollywood actress Angelina Jolie revealed that she had her ovaries and fallopian tubes removed. The news came two years after she had a double mastectomy; she tested positive for carrying the BRCA gene mutation.

Now, new Canadian research is backing up her preventative surgeries: an oophorectomy – when doctors remove ovaries – could cut risk of death in women who have the BRCA gene mutation and are diagnosed with breast cancer, scientists say.

Canadian doctors out of Women’s College Hospital say that women who carry the BRCA 1 or BRCA 2 gene mutation face a significantly increased risk of breast cancer compared to their peers in the general population. The gene is a rarity, though.

READ MORE: Angelina effect – Why the actress had ovaries, fallopian tubes removed

In Canada, about one in 250 women carry the BRCA1 or BRCA2 mutation that puts them at an 80 per cent risk of breast cancer, according to Dr. Kelly Metcalfe, a University of Toronto professor and cancer prevention expert at Women’s College Hospital.

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“It’s significantly elevated compared to the average woman,” Metcalfe told Global News.

The average woman has an 11 per cent risk of breast cancer, Metcalfe said.

READ MORE: Angelina Jolie reveals she had ovaries and fallopian tubes removed

For their research, Metcalfe and her colleague Dr. Steven Narod looked at the health outcomes of 676 women with the mutation – 345 underwent oophorectomy after being diagnosed with breast cancer while 331 retained both ovaries.

The researchers found that 20-year survival for the entire group was 77.4 per cent. But the surgery was tied to a steep reduction in death caused by breast cancer in women with the BRCA 1 mutation.

Nine women died from ovarian cancer in the group who didn’t have oophorectomies.

READ MORE: Removing ovaries cuts risk of cancer death in women with BRCA gene

Removal of ovaries typically happened six years after breast cancer diagnosis. For BRCA 1 mutation carriers who had an oophorectomy within two years after their diagnoses, there was a 73 per cent reduction in death compared to their peers who chose not to remove their ovaries.

The protective effect of the surgery on deaths from breast cancer was long lasting, the researchers say. The women steered away from cancer immediately after diagnosis and for another 15 years.

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The typical woman has a one per cent risk of ovarian cancer – with BRCA1, that risk jumps to 60 per cent. With BRCA2, the risk is 40 per cent.

Metcalfe says that’s why doctors recommend that women with these genes remove their ovaries by age 40 or once they’ve completed childbearing.

READ MORE: Double mastectomy could save the lives of women with BRCA gene, study says

“The problem with ovarian cancer is we don’t have good screening to detect these cancers early, not like we have with breast cancer screening where we can catch cancer early, it’s treatable and the survival rates are high,” she said.

For ovarian cancer picked up in the later stages, the five-year survival rate is below 50 per cent.

Metcalfe suggests the “Angelina effect” is legitimate.

“She’s really spreading the message,” Metcalfe said of Jolie.

“There was an increased awareness, more women were accessing the information online, there was an increased interest in women having genetic testing who had put it off previously. They understood the effects and the benefits associated with genetic testing,” she said.

READ MORE: Breast cancer and genetics – Angelina Jolie’s double mastectomy

In March, the 39-year-old actress wrote candidly about having her ovaries and fallopian tubes removed once doctors detected early signs of cancer.

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In the fallout of the surgery, Jolie went into premature menopause and won’t be able to have any more children.

“I went through what I imagine thousands of other women have felt. I told myself to stay calm, to be strong, and that I had no reason to think I wouldn’t live to see my children grow up and to meet my grandchildren,” she wrote in a candid New York Times piece.

“I feel deeply for women for whom this moment comes very early in life, before they have had their children. Their situation is far harder than mine,” she said.

The Canadian research was published Thursday in the journal JAMA Oncology.

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