Preventing ovarian cancer
Dear OncoLink "Ask The Experts,"
What is the best way to prevent ovarian cancer? I have a very high possibility of contracting it as my mother and several other close family members have died from ovarian cancer. Is it total hysterectomy with removal of ovaries or just removal of ovaries? What evidence supports your answer? At present I am in a British screening program and have been advised that I should have my ovaries removed, I am 48 years old.
Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:
Prophylactic removal of the ovaries is the most definitive option for preventing ovarian cancer. If you are currently involved in a formal cancer-screening program and have been advised to undergo removal of your ovaries, I would consider this option carefully. In most cases, removal of the ovaries can be accomplished laparoscopically (with the use of small endoscopic instruments). Laparoscopic surgery can be performed on an outpatient basis, and avoids the need for a large abdominal incision.
You have not mentioned if you or your family members have undergone testing for the BRCA1, BRCA2, or HNPCC mutations. In the absence of an HNPCC mutation, or the history of endometrial cancer, there is little definitive evidence that performing a hysterectomy in addition to removal of the ovaries is beneficial. In fact, performing a hysterectomy may require an abdominal incision and an inpatient hospitalization. However, women who are experiencing other problems associated with their uterus (abnormal bleeding, fibroid tumors, etc.) may want to consider having a hysterectomy at the time of ovarian removal.
Although removal of the ovaries is the most effective way to prevent ovarian cancer, patients should know that the surgery is not completely protective. Primary peritoneal cancer (which is clinically similar to ovarian cancer) has been reported to occur in about 2-10% of women who have undergone prophylactic ovarian removal because of hereditary risk factors.