Radical surgery to remove all breast tissue and ovaries may be the best treatment option for women with a high risk of getting breast or ovarian cancer, say researchers. Although drastic, the procedure is far more effective than the two other treatment options open to this group of women: yearly mammography and ultrasound scans or treatment with drugs such as tamoxifen.
About one in 800 women carry a mutated version of the BRCA 1 gene and have a 50-85% chance of getting breast cancer and a 15-60% chance of getting ovarian cancer, say researchers from the Cancer Research Centre at Queen's University in Belfast. In a review published in last week's , they looked at all the treatment strategies open to this group of high risk women and assessed their effectiveness, to help women make a fully informed choice about their care.
Although yearly mammography reduces the risk of dying from breast cancer, aggressive forms of the disease can develop between visits, and the test carries its own risks, the researchers conclude. Even with screening, women have a 10-20% chance of dying from the disease over 20 years. And because tumours in these women tend not to be sensitive to oestrogen drugs such as tamoxifen, such drugs will have no impact on them. Little evidence exists that screening works for women at high risk of ovarian cancer.
However, two studies covering a total of 102 women who had surgery to remove their breasts, mostly between the ages of 35 and 40, have shown that the women were 90% less likely to get breast cancer than women who opted for screening. One of the studies, of 26 patients, had a median follow up of 13.4 years; the second study, of 76 women, had an average follow up of three years.
Similarly, women at high risk of getting ovarian cancer can reduce their chance of getting the disease 24-fold by having their ovaries removed. This operation also halves the risk of breast cancer.
Surgery does not remove the risk completely, because it is still possible that a tumour could develop in the lining of the breast or in the area where the ovaries used to be, said lead researcher Dr Paul Harkin, whose work is funded by Cancer Research UK.
The number of women in the world who have chosen surgery is small, said Dr Harkin. Only about half the women with a family history of breast or ovarian cancer choose to have the genetic test. And of the women who test positive most opt for screening.
“Surgery is far from ideal. But what we are doing is trying to encourage awareness so that women can have the options explained to them with some type of risk assigned,” he said. “I think this study also brings across the need for new medications and preventive strategies for this group of women.”
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YORKSHIRE POST NEWSPAPERS
Tracey Barraclough, age 42, who had a double mastectomy when she found that she had the BRCA 1 gene