Ovarian cancer incidence rates are subtly dropping in the United States. This may be the result of more women evaluating their genetic risk of the disease and taking aggressive, preventative action.
Oncologists know that mutations of the BRCA gene—specifically BRCA1 and BRCA2—can increase the risk of developing both breast cancer and ovarian cancer. These gene mutations could be passed down among family members. In fact, if one of your first degree relatives carries a BRCA gene mutation, there is a 50-50 chance you’re carrying it, too. And because BRCA mutations aren’t tied to the X or Y sex chromosome, that blood relative does not need to be a woman. You’re just as likely to inherit the risks of cancers associated with BRCA from your father as you are from your mother. While BRCA1 and BRCA2 are traditionally associated with cancers specific to females—that is, breast and ovarian cancers—it is important to note they have been shown to increase the risks of prostate cancer, male breast cancer and pancreatic cancer as well.
All of these factors make genetic testing imperative, both for women diagnosed with ovarian cancer and for their family members.
Why All Women With Ovarian Cancer Should Be Tested
Dr. Michael Birrer, Senior Scientist of the O’Neal Comprehensive Cancer Center, at UAB, says every woman diagnosed with ovarian cancer should undergo genetic testing. This suggestion echoes that of current guidelines, which recommend genetic tests for all women with ovarian cancer, regardless of age, specific type of ovarian cancer, or family history.
“Every single woman with ovarian cancer that walks through the door should get genetic testing,” Dr. Birrer says. “Complete genetic testing.”
In cases where genetic test results indicate that, yes, a woman with ovarian cancer is indeed carrying a BRCA gene mutation, Dr. Birrer says the appropriate next step should be a visit to a genetic counselor.
Genetic counselors can help direct women and their daughters, sons, and other relatives toward the best course of action. Often, this begins with repeating the genetic tests in a woman’s daughters to determine whether they have the mutation as well.
And if a daughter does test positive—though it is important to keep in mind that a BRCA mutation does not automatically mean a cancer diagnosis—several preventative measures for ovarian cancer are usually recommended, beginning when the daughter is 30 years old. (Prior to this time, no action is taken as the risk of ovarian cancer remains very low.)
Once the daughter reaches age 30, her doctor may begin a schedule of routine, fairly aggressive breast imaging tests, which consist of alternating mammograms and MRIs every six months.
“That’s pretty standard,” Dr. Birrer says. “And in fact, if it’s done correctly, we can detect the early development of breast cancer relatively sensitively and specifically.”
Aggressive Preventative Measures
Preventative tests in the wake of an identified BRCA mutation, however, are a bit more challenging for ovarian cancer than they are for breast cancer. Because there is no proven screening assay for ovarian cancer, even in this high-risk population, the next best recommendation is usually surgical removal of the ovaries and fallopian tubes.
These procedures, called prophylactic oophorectomies (preventative removal of the ovaries) and prophylactic bilateral salpingo-oophorectomies (preventative removal of the ovaries and both fallopian tubes) may sound drastic, but for women with high genetic risks, they can be life-saving.
(Of course, Dr. Birrer points out that these procedures are not recommended until after a woman has had the chance to have children.)
Some women with BRCA mutations may also choose to reduce their breast cancer risk with a surgical removal of both breasts, called a bilateral (double) mastectomy, Dr. Birrer says, simply because “they don’t want to worry about that stuff.”
Ovarian cancer is notoriously hard to detect in the early stages when it’s most effectively treated. That’s why women should evaluate their risk factors for the disease and be vigilant about possible symptoms and warning signs.