Mastectomies For BRCA Ovarian Cancer Survivors Likely Not Effective

Mastectomy (the surgical removal of one or both breasts and surrounding lymph nodes) and Salpingo-oophorectomy (the surgical removal of the ovaries and fallopian tubes) are the most common preventative approaches for women with BRCA gene mutations linked to breast cancer and ovarian cancer.

However, according to a recent study published by the Annals of Surgical Oncology journal, such approaches may not be cost-effective for women who have already had ovarian cancer. Furthermore, the study suggests that mastectomies for ovarian cancer survivors who carry BRCA gene mutations may not increase survival rates but merely provide a few survival benefits. The lifetime risk of ovarian cancer at any age is:

• Just below 2% for women in the general population
• Around 35-70% for women with BRCA1 gene mutation
• Around 10-30% for women with BRCA2 gene mutation

It has been found that over 10-20% of women with ovarian cancer carry BRCA gene mutations, regardless of their family history. The latest guidelines from the National Comprehensive Cancer Network and the Society of Gynecologic Oncology recommend that women who have been recently diagnosed with ovarian cancer should undergo genetic testing. With such guidelines, women are becoming more educated and aware of BRCA gene mutations, as well as when to seek proper care.

“The more we learn about genetic counseling and who should be seen, counseled and tested—the more this has opened up prevention opportunities for patients. I think it is really important for patients to be informed about their own risk and their family history. They should talk to their primary care providers about the testing that is appropriate for them and certainly anybody with a history of breast, ovarian, colon, endometrial and certain other cancers. Let those red flags come up, and talk with your provider about counseling and testing because it really could save your life,” said Dr. Jubilee Brown, a professor and associate director of Gynecologic Oncology at the Levine Cancer Institute, Carolinas HealthCare System.

Risk-reducing mastectomies compared with breast cancer screening

The researchers from the Duke University Medical Center conducted a study with a statistical model comparing mastectomy with breast cancer screening (MRI and mammogram). Clinical factors included in the model were age of ovarian cancer diagnosis, presence of BRCA genes, duration between diagnosis and mastectomy, treatment expenses, and survival rates. The researchers compared the treatment approaches every 6 months following ovarian cancer diagnosis and they analyzed their cost-effectiveness ratio. Treatments that were considered cost-effective included a ratio of under $100,000 annually, of life saved.

According to the researchers’ findings, the survival benefits and cost-effectiveness rate of mastectomy over breast cancer screening were greatly dependent on two factors - age of ovarian cancer diagnosis and duration between diagnosis and mastectomy.

Read on to learn more about these important findings and how they relate to women who have had ovarian cancer.