© 2005-2012 American Society of Clinical Oncology (ASCO). All rights reserved worldwide.
Women who have genetic mutations on their BRCA1 or BRCA2 genes have a significantly greater chance of developing breast and ovarian cancers. To reduce their risk of cancer, these women may undergo surgery to remove their ovaries, which produce estrogen, a hormone that can cause cancer to grow and spread.
This procedure is known as "prophylactic oophorectomy." However, removing the ovaries may cause the onset of significant menopausal symptoms, including hot flashes, vaginal dryness, sexual dysfunction, and sleep disturbances. While hormone replacement therapy (HRT) can alleviate these symptoms, many women at high risk for breast cancer are reluctant to use HRT because it has been shown to increase the risk of developing the disease. However, a new study published in the Journal of Clinical Oncology has shown that women with BRCA1 and BRCA2 mutations who underwent prophylactic oophorectomy and used HRT for an average of three years or less to ease the symptoms of menopause that can result from this procedure, did not increase their risk of breast cancer. Researchers examined breast cancer risk and its relationship to HRT among 462 women with BRCA mutations, 155 of whom had surgery to remove their ovaries. After 3.5 years, only 8% of the women who had the surgery developed breast cancer, compared to 21% of the women who did not undergo surgery. The study found that the women who had the surgery and were taking hormones experienced a 63% reduction in breast cancer risk, while those who had surgery but did not take HRT had a 62% reduced risk.All of the women who were on hormone replacement therapy took it for an average of three years or less.
What Does This Mean For Patients?
These findings indicate that women with BRCA mutations who have undergone prophylactic oophorectomy may use HRT for three years or less to ease menopausal symptoms without increasing their risk of breast cancer. However, the decision to undergo surgery to remove the ovaries and to begin taking hormone replacement therapy is a very personal choice. Women with BRCA mutations should talk with their doctors about the risks and benefits of all potential prevention options.