Dear OncoLink "Ask The Experts,"
I'm a 50-yr-old healthy female who has been having yearly intravaginal ultrasounds and CA125 tests because of my family history (my mother died of ovarian cancer at the age of 55). My Ca125 is considered normal (it is 31), but has been increasing every year over the past 10 years. Do you recommend removal of the ovaries to decrease my risk of ovarian cancer?
Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:
The majority of patients who suffer from ovarian cancer do not have a family history of the disease. In fact, only approximately 10% of ovarian cancer is due to an inherited predisposition, with the majority of cases due to mutations in the BRCA1 and BRCA2 genes. For patients who are known to carry the mutation, the lifetime risk for developing ovarian cancer is between 20% and 40%.
Prophylactic removal of the ovaries may usually be accomplished on an outpatient basis through a procedure called laparoscopy, which uses minimally invasive cameras and instruments to remove the ovaries and fallopian tubes. Studies have clearly shown a significant reduction in the risk of developing ovarian or primary peritoneal cancer after prophylactic ovarian removal in women with known BRCA1 and BRCA2 mutations.
Currently, we do not have proven, effective screening methods for ovarian cancer. Experts recommend screening every 6 months with exams, transvaginal ultrasounds, and CA125 tests for women at high risk. There are clinical studies currently in progress to assess the effectiveness of various strategies in the early detection of ovarian cancer. Some protocols utilize the Risk of Ovarian Cancer analysis (or ROC) to calculate the risk of ovarian cancer based on CA125 values.
If you have any family history of breast or colon cancer, you should certainly consider seeing an expert in genetic counseling for an evaluation of your genetic risk and possible testing for mutations in the genes that we know are responsible for hereditary ovarian cancer. Otherwise, you may want to discuss the option of prophylactic removal of your tubes and ovaries with your gynecologist.
Mar 18, 2010 - The decision to perform prophylactic bilateral oophorectomy at the same time as hysterectomy should be taken with caution as it may do more harm than good, especially in women not at high risk for development of ovarian or breast cancers, according to a review published in the March issue of the Journal of Minimally Invasive Gynecology.
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