Women who are carriers of one of the BRCA1/2 cancer risk alleles are advised to have preventive surgery to stop ovarian cancer, but a new U.K. study reveals that extra surveillance can be effective in the short term for those who wish to delay surgery.
The well-known BRCA1/2 gene variants significantly increase the risk for a number of cancers in woman who are carriers, including ovarian cancer.
Preventive surgery—pre-menopausal bilateral salpingo-oophorectomy (RRSO)—is recommended for women carrying these variants after the age of 35 (BRCA1 variant) or 40 (BRCA2 variant), but mostly due to the serious fertility implications of the surgery between 20-40% of affected women do not decide to have it immediately.
Writing in the Journal of Medical Genetics, Adam Rosenthal, a consultant gynecologist specializing in gynecological oncology at University College London EGA Institute for Women’s Health, and colleagues describe a surveillance system set up to monitor high-risk women with BRCA1/2 variants who decided to delay preventive surgery.
Overall, 875 female BRCA1/2-heterozygotes were recruited to trial the surveillance system. Of these 767 went on to have 4-monthly tests using the Risk of Ovarian Cancer Algorithm (ROCA) test.
During follow-up (1277 women screen years), eight ovarian cancers were detected. Two when surgery was carried out and six based on the screening. Of the six detected on screening, five were completely removed surgically.
The researchers calculated that this kind of extra surveillance can improve quality-adjusted life years and also save money on treatment costs that would be incurred without the screening.
“Given that 4-monthly surveillance appears to consistently down-stage ovarian cancer, is associated with a high surgical cytoreduction rate at relatively low levels of surgical complexity, and reduces the need for neoadjuvant chemotherapy, we feel that this form of surveillance can be offered to BRCA-heterozygotes aged 35 years [or older] following informed consent, until they are prepared to undergo RRSO,” write the authors.
“Such surveillance should be viewed strictly as a short-term option only, as unlike RRSO it cannot prevent ovarian cancer; women undergoing such surveillance should be counselled extensively about its limitations, and that delaying RRSO indefinitely could result in diagnosis with an incurable ovarian cancer.”
