Our work highlights the need for novel strategies to prevent breast and ovarian cancer. Despite the efficacy of oophorectomy, given the negative impact [on quality of life], we need to continue to strive towards other options for prevention.
—Susan Domchek, MD
The majority of women with BRCA1 and BRCA2 mutations experience sexual dysfunction, menopausal symptoms, cognitive and stress issues, and poor sleep following risk-reducing salpingo-oophorectomy, according to results of a study from the Abramson Cancer Center and the Perelman School of Medicine at the University of Pennsylvania. The team’s findings, which reaffirm the need for a better understanding of how to manage long-term effects of the risk-reducing procedure, were presented at the 2014 ASCO Annual Meeting.1
“These results reinforce the need for care providers to better understand and communicate with patients about the possible long-term effects of bilateral risk-reducing salpingo-oophorectomy,” said lead author Susan Domchek, MD, Director of the Basser Research Center for BRCA at Abramson Cancer Center. “Removal of the fallopian tubes and ovaries is associated with a decreased risk of death from breast and ovarian cancer for BRCA carriers, and is one of the most important interventions we have at the current time. However, this procedure comes with a price, so it’s extremely important that clinicians work with women to help alleviate symptoms.”
The study surveyed 637 women with BRCA1 or BRCA2 mutations who had undergone the risk-reducing surgical procedure to have both ovaries and fallopian tubes removed. Dr. Domchek and colleagues assessed participant quality-of-life through a series of questionnaires.
The median age of participants was 47 years, and the median age of risk-reducing salpingo-oophorectomy was 45. Forty-three percent of patients had a prior cancer history; of the 87% with breast cancer, 60% had undergone chemotherapy.
Most Patients Report Reduced Quality of Life
Results showed that suboptimal scores were present in the majority of patients for the majority of measures. Specifically, 73% of patients reported sexual dysfunction, such as the absence of satisfaction and presence of pain; 61% had problems sleeping; 57% had symptoms of menopause such as hot flashes and vaginal dryness; and 56% had elevated levels of stress. Hormone replacement therapy did help mitigate symptoms, particularly in women with no cancer history who underwent oophorectomy prior to age 50.
Currently, it is recommended that BRCA1/2 mutation carriers undergo oophorectomy between ages 35 and 40 given the substantial benefits in decreasing breast and ovarian cancer risk and improving overall survival. “Our work highlights the need for novel strategies to prevent breast and ovarian cancer. Despite the efficacy of oophorectomy, given the negative impact [on quality of life], we need to continue to strive towards other options for prevention,” Dr. Domchek said. ■
Disclosure: Dr. Domchek and all study authors reported no potential conflicts of interest. The study was supported by the Komen Foundation for the Cure and the Basser Research Center for BRCA.
1. Domchek SM, Li J, Digiovanni L, et al: Quality of life in BRCA1 and BRCA2 mutation carriers following risk-reducing salpingo-oophorectomy. Abstract 1508. Presented at the 2014 ASCO Annual Meeting, May 31, 2014.