BREAST CANCER AND OVARIAN CANCER RISK

There’s an important piece of medical research released tonight which every woman with breast cancer or a family history of breast cancer needs to hear about.

The study looks at whether they need to worry about their risk of ovarian cancer, and what they should do about it.

Up to half of families with multiple cases of breast cancer do not end up having mutations in the major breast cancer genes, the BRCA 1 and BRCA 2 genes. Still, it’s clear there’s a genetic link somewhere…to another gene or genes which have not yet been identified.

What risk do these genes play in terms of ovarian cancer, if any? And do women need to do something about it?

Women with breast cancer or a family history of breast cancer need to look out for signs of ovarian cancer as well, though the risk is small. A study looks at whether they need to worry about their risk of ovarian cancer, and what they should do about it.

Up to half of families with multiple cases of breast cancer do not end up having mutations in the major breast cancer genes, the BRCA 1 and BRCA 2 genes. Still, it’s clear there’s a genetic link somewhere…to another gene or genes which have not yet been identified.

What risk do these genes play in terms of ovarian cancer, if any? And do women need to do something about it? Desiree Ellison was diagnosed this year with breast cancer at the age of 40. Her sister was diagnosed a year ago at the age of 36.

Desiree was worried it was hereditary, as did her doctors. “They thought it would be best I have some kind of testing and I agreed to that immediately,” said Desiree.

Certainly, if one carries one of the two main breast cancer genes, BRCA 1 or BRCA 2, that person is at an increased risk for ovarian cancer. In fact, that risk can be as high as sixty times higher than that of the general population.

Dr. Noah Kauff, a geneticist at Memorial Sloan Kettering Cancer Center, New York, says, “For women who have BRCA1 and BRCA 2 mutations, we actually recommend in many cases preventive removal of the ovaries after childbearing is completed.”

Dessiree did not have the BRCA 1 or 2 genes.

So now the question is, do inherited cases like hers, likely caused by still-unidentified genes, also carry an ovarian cancer risk that needs to be addressed? Until now, it’s been a big question mark.

“Most clinical genetic services thought it to be safest to presume that patients may be at risk for ovarian cancer and discuss risk reduction strategies either screening or preventative surgery,” Dr. Kauff states.

And many women like Desiree did have preventive surgery. “I was ready to go get operated to have everything removed,” she recalls.

But now, new research done by Dr. Noah Kauff and his team at Memorial Sloan Kettering shows that women who do have a family history but do not carry the BRCA 1 or 2 genes are not at risk for ovarian cancer.

They studied 165 families with multiple cases of breast cancer —on average 4 -- but no identified BRCA mutation. Only one case of ovarian cancer was diagnosed in those studied. “Which is exactly what would have been expected in an average risk population and this strongly suggests that these women were not at increased risk for ovarian cancer. Things such as risk reducing surgical removal of the ovaries are probably not necessary,” says Dr. Kauff.

“When they came back and said I didn’t have to have my ovaries or my uterus removed I was relieved. They gave me good news, they gave me hope,” Dessiree says.

The authors say this is going to be an ooh--ahh among geneticist over the water cooler; it’s the first time there’s reliable data to show strong evidence these patients with strong family histories of breast cancer but without the BRCA genes are not at increased risk of ovarian cancer.

There is ongoing research to map the undiscovered genes associated with inherited breast cancer. There may be a small increased risk of ovarian cancer associated with them if a larger study were to be done, but still, that wouldn’t prompt aggressive screening or surgery.