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Key Words: BRCA1, BRCA2, breast cancer, prevention, risk reduction, ovarian cancer. (Definitions of many terms related to cancer can be found in the Cancer.gov Dictionary.)

The first study involved 170 women age 35 and older, all of whom carried either the BRCA1 or BRCA2 genetic mutation (see the journal abstract). Women with these mutations have a 60 to 85 percent risk of developing breast cancer and a 15 to 65 percent risk of developing ovarian cancer by age 70. The study was conducted at Memorial Sloan-Kettering Cancer Center in New York.

The medical name for the procedure performed in this study is a salpingo-oophorectomy. "Salpingo" refers to the fallopian tubes. "Oophorectomy" means surgical removal of the ovaries. Although the procedure is widely recommended in carriers of the BRCA1 and BRCA2 mutations, no previous studies had followed patients after the surgery to see whether they developed fewer cancers than patients who did not have the surgery.

Study participants were offered the choice of undergoing either preventive surgery or surveillance for breast and ovarian cancer. Surveillance included annual or twice-yearly gynecologic exams and twice-yearly vaginal ultrasound exams and tests of blood levels of CA-125, a protein that is a marker for ovarian cancer. Women who had not undergone preventive mastectomies were advised to have annual mammograms (an x-ray of the breast) and frequent clinical breast exams and to perform monthly breast self-examination.

During a follow-up period that averaged two years, three of 98 women who chose preventive surgery were diagnosed with breast cancer and one with cancer of the peritoneum (the lining of the abdomen). By contrast, of the 72 women who chose surveillance, eight were diagnosed with breast cancer, four with ovarian cancer, and one with peritoneal cancer. The time to development of cancer was longer in the surgery group than in the surveillance group.

In the same issue of the journal, another group of researchers reports that the preventive removal of both ovaries reduced the risk of breast, ovarian and other gynecologic cancers in women with BRCA1 and BRCA2 mutations (see the journal abstract). In this multicenter study, researchers examined 11 cancer registry databases and identified 551 women who had undergone the preventive removal of both ovaries. They compared the number of cancers in those women with the number of cancers in a matched control group of women who had not had the oophorectomy surgery.

Among 259 women who had preventive surgery, six were found to have stage I ovarian cancer at the time the surgery was performed; two women later developed peritoneal cancer. The follow-up period for this group was about eight years. By contrast, among 292 women who did not have surgery, 58 developed ovarian cancer during a follow-up period of nearly nine years.

Among women who had not previously had breast cancer, the disease was diagnosed in 21 percent of those who had preventive surgery (21 of 99 women), compared with 42 percent of those who did not have surgery (60 of 142 women), during 11 years of follow-up.

These two studies "contribute to mounting evidence" supporting preventative surgical removal of both ovaries "in carriers of BRCA mutations as an effective way of reducing the risk of both ovarian and breast cancer," comments Daniel Haber, M.D., Ph.D., of Massachusetts General Hospital in Charlestown, Mass., in an accompanying editorial. "Whether the resulting reduction in the risk of breast cancer, combined with intensive surveillance, is preferable to the more complete protection offered by prophylactic mastectomy [surgical removal of one or both breasts to try to prevent or reduce the risk of breast cancer] is likely to remain a highly personal choice."

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