• Posted September 15, 2024

Ovarian Cancer in the Family? Know Your Risks

Nearly a quarter of all ovarian cancers are fueled by family genetics, so what should you do if your mom or sister are diagnosed?

According to one expert, knowing whether you are at high risk is the first step toward taking measures that can mitigate that increased danger. Getting a genetic test for yourself is how you find that out.

What do you do if that test comes back positive?

According to Dr. Shaina Bruce, a gynecologic oncologist at the Penn State Cancer Institute, women at increased risk for ovarian cancer are typically advised to have their fallopian tubes and ovaries removed when they are done having children.

Mutations on BRCA1 and BRCA2, two genes known to also increase the risk for breast, prostate and other kinds of cancer, are the key culprits behind ovarian cancer. A patient with a mutation on their BRCA1 gene has a 40% greater likelihood of developing ovarian cancer, Bruce said, while a BRCA2 mutation increases cancer risk by 20%.

“The trouble with removing ovaries in a young woman in her 30s and 40s is that it puts the patient into surgical menopause,” Bruce explained. “Also, the estrogen that your ovaries make is important,” because it protects a woman’s heart and bones and can lower her dementia risk, she added.

However, doctors have discovered in the past decade that more than 80% of ovarian cancers actually begin in the fallopian tubes. 

Penn State is now participating in a study that will compare removing only the fallopian tubes of women with a BRCA1 mutation (with a plan to remove the ovaries later) to removing both the tubes and ovaries in these women.

Another option to lower your risk if you’re “having your tubes tied” is to ask to have the tubes removed altogether, Bruce said.

In any case, the surgery -- whether it’s removing just the fallopian tubes or the ovaries and tubes -- is a minimally invasive outpatient procedure. It’s three small incisions and usually takes a couple of weeks to recover, Bruce said.

Still, some women opt to wait on surgery until they are done having children. Screening for ovarian cancer regularly with transvaginal ultrasounds and a blood test to look for cancer-indicating antigen is an option that’s often recommended in young patients, Bruce noted.

For BRCA1 patients, doctors usually don’t recommend surgery until age 35 to 40. The recommended age for preventive surgery for BRCA2 patients is 40 to 45.

“If a patient is younger than that, we can safely do screening until they’re ready for risk-reducing surgery,” Bruce explained.

Currently, doctors don’t screen women for ovarian cancer unless they have a genetic predisposition for it.

Besides genetics, there are other factors that can raise the risk of ovarian cancer, Bruce said:

• Using hormone replacement therapy after menopause

• Never having been pregnant

• Having endometriosis

Still have qualms about getting preventive surgery? Compared with the surgery to remove ovarian cancer itself, preventive surgery is usually worth it, Bruce said.

“Ignorance is bliss, right? Unfortunately, in oncology I hear that more often than I’d like to admit," Bruce said. "But I would say knowledge is power. If you know you have a predisposition, often there’s something that can be done about it. Usually, what can be done preventatively or to reduce your risk is less invasive than what would need to be done if you were diagnosed with the cancer in question.”

SOURCE: Penn State, news release, Sept. 11, 2024