Considering Your Options
- An inherited BRCA1 or BRCA2 mutation puts you at higher risk for developing ovarian cancer (as well as breast cancer), as does a strong family history of ovarian or breast cancer without a known genetic mutation
- Prophylactic surgery, which means surgery before you show signs of disease, significantly reduces your odds of developing ovarian cancer
- The surgery to remove the ovaries is called an oophorectomy. Women with BRCA mutations usually have their fallopian tubes removed as well (called a bilateral salpingo-oophorectomy) since their risk of fallopian tube cancer is also higher
- Women must weigh the pros and cons of cancer-prevention surgery
Dehn speaks from personal experience; “My mom had breast cancer. She had the BRCA-1 mutation so she was at higher risk for breast and ovarian cancer. I got tested, and I know how scary it is while you’re waiting for those results. I thought about what I would do if my BRCA-1 [test] came back positive. I tell my patients that I, personally, would have had my ovaries removed."
Read More- She might plan to have her children before age 30
- She might choose to freeze her eggs
- She might decide that she’ll have surgery after 35, and after maybe having one or two pregnancies and breastfeeding her babies
- She might decide to wait until she’s 40
Since there is currently no good test to screen for ovarian cancer, the National Comprehensive Cancer Network recommends prophylactic ovarian surgery (which includes the fallopian tubes) for BRCA mutation carriers by age 35, or by the completion of childbearing (National Comprehensive Cancer Network).
Surgery Has Its Own Risks
Although the surgery can significantly reduce the risk of developing ovarian cancer, a trip to the OR is never risk-free. For some, the risks of surgery may not be worth the reduction in cancer risk. And the procedure, along with the sudden loss of estrogen, has potential side effects:
Bone thinning (osteoporosis). Removing your ovaries reduces the amount of bone-building estrogen your body produces. This may increase your risk of a broken bone.
Discomforts of menopause You may experience side effects such as hot flashes, depression, sleep disturbances, vaginal dryness, and a lowered sex drive.
Increased risk of heart disease. Your risk of heart disease may increase if you have your ovaries removed.
Lingering risk of cancer. Prophylactic oophorectomy doesn’t completely eliminate your risk of ovarian cancer, which can still originate in the peritoneum (the membrane that lines the abdominal cavity and covers abdominal organs).
Are There Alternatives to Oophorectomy for Preventing Ovarian Cancer?
Researchers are studying other ways to reduce the risk of ovarian cancer in people who have a high risk of the disease. Currently, however, none have shown to cut the risk as much as having an oophorectomy. For this reason, most doctors recommend the surgery.
There’s No One Right Choice
Women who discover they are BRCA mutation carriers, or have a strong family history of disease even without a known mutation, have difficult decisions to make.
"There’s no one right way to go about this," Dehn says. " If you’ve been diagnosed with a BRCA-1 or -2 mutation, or you’ve been told you have a higher risk because of another genetic mutation, the most important thing you can do is talk to a genetic counselor and then get several opinions. You can also talk to a gynecologic oncologist about minimally invasive surgery.
"It’s important to get all of your options ahead of time, and to take your time making this decision," Dehn says. "It’s also important to talk to other women who’ve gone through this so that you know what to expect afterward."
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