Benefits seen in ovary removal for high-risk women

CHICAGO - Surgery to remove healthy ovaries gives a triple benefit to high-risk women: It lowers their threat of breast and ovarian cancer, and boosts their chances of living longer, new research suggests.

The study is the largest to date to find advantages for preventive surgery for women who carry BRCA gene mutations. Women with the faulty genes have a dramatically higher cancer risk than other women - five times greater for breast cancer and at least 10 times greater for ovarian cancer.

The study, in Wednesday's Journal of the American Medical Association, found benefits for women with two different BRCA gene variants whether they had previously had breast cancer or not.

The results offer more tailored evidence for women considering ovary removal, a surgery that ends fertility, fast-forwards them into early menopause, and may contribute to osteoporosis or heart problems later in life.

"It's really critical to have the best information when making such a profound decision," said senior author Timothy Rebbeck of the University of Pennsylvania School of Medicine.

The researchers followed nearly 2,500 women with BRCA mutations in Austria, England, the Netherlands, and the United States. All the women were cancer-free at the start. They were watched for an average of four years.

They got counseling to help them choose between surgery or increased screening to watch for cancers early.

Ten percent of the women chose mastectomy and 40 percent chose to have their ovaries removed; some had both. More than half the women had neither surgery.

The women who chose ovary removal had impressive results:

1 percent were later diagnosed with ovarian cancer that showed up in cells missed by surgeons, compared with 6 percent of the women who kept their ovaries.

11 percent were diagnosed with breast cancer, compared with 19 percent of the women who kept their ovaries.

3 percent of those who had surgery died, compared with 10 percent of the others.

The study also found preventive mastectomy lowered the risk of breast cancer. No breast cancers were seen in the women who had their breasts removed. That may seem unsurprising, but mastectomy can leave breast tissue that can turn cancerous.

The study was observational, meaning it cannot prove one choice was better than another. But the results will help doctors counsel patients, said Virginia Kaklamani of Northwestern University.