Mastectomy, Ovary Removal Reduce Some Cancer Risk and Mortality

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Dr. Anne Wallace, professor of clinical surgery at Moores UCSD Cancer Center in San Diego, said, "Prophylactically removing the ovaries in these women is extremely important as ovarian cancer screening is not very helpful."

Findings Unlikely to Change Practices

Doctors said the new findings are unlikely to change screening or treatment recommendations, which suggest that women with BRCA mutations get annual mammograms and MRI's, with the timing of each test staggered to schedule a test every six months.

"We already routinely discuss prophylactic surgery with BRCA-mutated patients, and we already routinely discuss and encourage genetic testing in women who are at high risk based on family history," said Dr. George Sledge Jr., professor at Indiana University's Simon Cancer Center.

Dr. Henry Mark Kuerer of the University of Texas MD Anderson Cancer Center said, "It has been well-known for some time that prophylactic mastectomy or oophorectomy reduced breast cancer risk in patients with BRCA mutations. I am doubtful that this will lead to more testing for BRCA genes."

But the results may encourage more women to get tested for the BRCA mutations. In an editorial accompanying the research, Dr. Laura Esserman of the University of California, San Francisco, and Dr. Virginia Kaklamani of Northwestern University wrote that the study highlights the importance of genetic counseling, which can help women understand and sort out all the ramifications of these risk-reducing surgeries.

"Due to the complex and sensitive nature of hereditary risk assessments, clinicians need to educate their patients about the risks and benefits of testing and be able to refer their patients to clinicians who can discuss surveillance and surgical prophylaxis," they wrote.

Women Feel Mix of Anxiety, Empowerment

It's not always an easy discussion between a patient and her doctor. When Schlager first heard her doctor recommend an oophorectomy, she dreaded the thought of going through early menopause.

"Women naturally go through menopause very gradually, and going through surgical menopause is like going off a cliff," she said. "I read about a lot of really bad experiences."

Dr. Fremonta Meyer, a psychiatrist at Dana-Farber Cancer Institute in Boston, said that women considering an oophorectomy are often anxious about the onset of menopausal symptoms.

"Some of the psychosocial research out there suggests that women would like and need a lot more information about hormone replacement therapy, such as what it is, the side effects and whether it affects the risk of developing breast cancer," Meyer said.

The prospect of having a mastectomy often brings up issues of body image, Meyer said.

"Reconstruction is ever-improving but there's still a risk you're not going to be satisfied with reconstruction," she said

Despite their initial anxiety, Meyer and other experts say that better knowledge about the effectiveness of mastectomies and oophorectomies gives women hope and empowerment.

"There's a psychological benefit of knowing you're not at risk of leaving your family early and not dying from an aggressive form of cancer," Meyer said.

Kuerer of the Anderson Cancer Center said, "They find this to be somewhat empowering in that, to an extent, they have the ultimate power in potentially altering their future medical health with prophylactic mastectomy.

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