Managing your Ovarian Cancer Risk
How do I manage my risk of Ovarian Cancer?
If you have inherited an alteration in BRCA1 or BRCA2 , your risk of ovarian cancer is greatly increased compared to the average woman. The exact risk depends on a number of factors, including the gene, the specific alteration, your age, and your family history.
Broadly speaking, the risk of ovarian cancer for a woman with a BRCA1 alteration is between 40-60%. The majority of this risk is for those women over the age of 40. The risk of ovarian cancer for a woman with a BRCA2 alteration is between 10-30%, and the majority of this risk is after the age of 50 years.
Controversies in Ovarian Cancer Screening
Unfortunately, to date, no screening test has been proven to detect ovarian cancer at an early enough stage to improve survival in women with BRCA gene alterations. Much research to date has focused on the utility of a marker (CA125) that can be detected in the blood. This protein is often secreted by ovarian cancers, and is therefore commonly elevated in the blood of women with ovarian cancer. However, not all ovarian cancers produce this marker. Furthermore, the levels of this marker can be increased in women with other gynaecological issues.
At the present time, we do not have enough evidence to recommend routine use of CA125-based screening for ovarian cancer. Recent studies have suggested that using this marker in combination with a transvaginal ultrasound, and taking into account a woman's age, BRCA mutation, and menopausal status, may help detect ovarian cancer at an earlier stage. However, there is not yet enough evidence that this approach might detect ovarian cancer at an early enough stage to allow curative treatment. Further studies are ongoing to determine if we can use this marker, or other markers, in ovarian cancer screening.
Therefore, at the present time, we recommend that women with BRCA1 or BRCA2 alterations consider risk-reducing ovarian surgery, by removing ovaries and fallopian tubes, to manage the risk of ovarian cancer. This is typically recommended at approximately the age of 40 years for carriers of BRCA gene alterations, but may be considered from 35 years of age onwards if there is a strong family history of early onset ovarian cancer.
In the video below, Dr Michael O'Leary explains how to manage your risk of ovarian cancer in more detail.
The decision to undergo risk-reducing ovarian surgery, and indeed the time at which it should be undertaken, is a difficult one. This surgery has a significant impact on fertility and family planning, and brings on an early (premature) menopause, which can be associated with negative consequences. In the next video here below, Dr O'Leary discusses how this surgery impacts your risk of cancer, how it impacts your health otherwise, and how you can manage the impact of premature menopause.
Two stage procedure?
A large proportion of ovarian cancers occurring in individuals with BRCA gene alterations starts in the Fallopian tube.
The PROTECTOR study (PReventing Ovarian cancer Through Early Excision of Tubes and Late Ovarian Removal) is underway across centres in the UK, to determine if risk-reducing surgery could be undertaken in two stages -
First stage: Early Removal (prior to menopause, but after the age of 30y) of the fallopian tubes (Risk-Reducing Early Salpingectomy, RRES)
Second Stage: Removal of the ovaries at a later date, closer to the menopause (Delayed Oophorectomy, DO).
By deferring oophorectomy to a later age, the risks associated with a premature menopause could be minimised.
This study will examine whether this is a safe approach to use in carriers of BRCA alterations, and may inform our guidelines for surgical management of BRCA alteration carriers in the future.