SGO: 5 Recommendations to Reduce the Risk of Ovarian Cancer
The Society of Gynecologic Oncology (SGO) recently released recommendations to help reduce the risk of ovarian cancer in women. These include recommendations for prophylactic salpingo-oophorectomy in general risk groups and BRCA1 and BRCA2 mutation carriers. This is reported in MedVibes.
Advances in ovarian cancer pathology and molecular etiology have allowed clinicians to make recommendations for ovarian cancer prevention. “We’re interested in how to prevent ovarian cancer.” said Joan L. Walker, MD, of the Stephenson Cancer Center at the University of Oklahoma Health Sciences Center. “Too few women are currently being genetically tested, but if they receive the test, their family members can decide whether to undergo preventive surgery based on the test results.”
These recommendations include:
Patients with epithelial ovarian cancer should undergo genetic testing. This includes testing for the BRCA1 and BRCA2 genes, two mutations that increase a woman’s lifetime risk of ovarian and breast cancer, so patients’ families can also be tested for the genes or counseled on how to reduce the associated tumor risk, if necessary.
Oral contraceptives may reduce the risk of ovarian cancer in women with BRCA mutations and average risk. Women should be informed of the contraindications and side effects of taking the pill to help them weigh the potential risks against the benefits.
Women aged 35 to 40 years with an increased genetic risk of ovarian cancer should have a tubal oophorectomy or oophorectomy to reduce their risk of developing ovarian cancer.
Women at increased genetic risk for ovarian cancer who do not wish to undergo a tubal oophorectomy should be considered for a salpingo-oophorectomy if they have given birth.
Women at average risk for ovarian cancer who have given birth may be considered for hysterectomy, other pelvic surgery, or birth control such as a tubectomy.
Two distinct types of ovarian cancer have been identified; type 1 tends to appear early in the cancer and has a much lower incidence, while type 2 appears later in the disease and causes most ovarian cancer-related deaths.
Researchers believe that tubectomy may reduce the risk of type 2 ovarian cancer. Evidence suggests that most type 2 cancers develop from epithelial cell tumors of the fallopian tubes.
”Currently, there are no recommendations for ovarian cancer prevention in the general population because it is still a relatively rare cancer,” Walker and his colleagues write. “Our new understanding of the role of the fallopian tubes in the development of ovarian cancer has led us to propose that removal of the fallopian tubes may improve the chances of preventing ovarian cancer.”
Oral contraceptives can reduce the lifetime risk of ovarian cancer by 40 to 50 percent in the general female population.Iodice and colleagues conducted a meta-analysis that included 18 retrospective case-control studies and showed that the risk of ovarian cancer was halved in BRCA1 and BRCA2 mutation carriers using oral contraceptives (overall relative risk = 0.5; 95 percent confidence interval, 0.33 -0.75). An additional benefit was obtained with prolonged oral administration of the drug (relative risk = 0.64; 95% confidence interval, 0.53-0.78 for each additional 10 years of administration).
Previous studies have shown that for women with BRCA1 or BRCA2 mutations, the most effective way to reduce the risk of ovarian cancer is tubo-oophorectomy. The authors’ recommendations reduced the risk of ovarian cancer by 70 to 85 percent, the risk of breast cancer by 37 to 54 percent, and the risk of death from malignancy, according to the study.
Women should take control of their health by maintaining a normal weight, exercising and staying on the pill until they reach the end of their childbearing years,” Walker concluded. “It’s important to keep track of your family history, know your risk and take steps to reduce it.”
Expert commentary
Dr. W. Brawley, chief medical officer of the American Cancer Society, wrote in an editorial that the potential risks of tumor risk reduction strategies should be considered.
”Almost every medical intervention can result in some harm,” Brawley writes. “When evaluating the effectiveness of preventive interventions for tumors, it is important to weigh the potential benefits of the intervention against the harms. This is often difficult because evaluation criteria often vary widely.”
About 1.3 percent of women will develop ovarian cancer during their lifetimes. Considering that this is a relatively rare malignancy, recommendations for those at high risk for ovarian cancer are most useful, Brawley wrote.
The SGO recommends that all women diagnosed with ovarian cancer should consult a genetic counselor and consider having relevant genetic testing, and that their family members should also consider receiving relevant counseling.” Brawley adds.
”Genetic testing should be preceded by relevant genetic counseling,” Brawley wrote. “The average physician is not trained to counsel and explain relevant genetic risks to patients. However, interpretation of the relevant genes is necessary if the patient is to make a fully informed decision about the use of relevant preventive interventions.”