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Ovarian cancer: Operation protects genetically prone women

(Vienna, 20 September 2010) One in eight women develops breast cancer during her lifetime. Affected women, particularly those who are young, sometimes show a genetic risk which runs in the family. This is due to mutations in the BRCA1 or BRCA2 gene, which also clearly increases the frequency of ovarian cancer. An international study in which scientists from the breast health centre at the Department of Obstetrics and Gynaecology in Vienna played a decisive role has now proven for the first time that the prophylactic removal of the ovaries and/or breast drastically reduces the mortality risk.

"Women with mutations in the BRCA1 and BRCA2 gene have about an 85 percent risk of developing breast cancer. The threat of ovarian cancer can increase up to 65 percent," said Ao. Univ. Prof. Dr. Christian Singer from the Division of Gynaecology and Gynaecologic Oncology at the Department of Obstetrics and Gynaecology of MedUni Vienna. Genetically determined breast and ovarian cancer frequently occurs in some specific families. Where these diseases are common, women can be examined for such risks. For some years they have also been offered the option of prophylactically removing the ovaries and fallopian tubes and/or surgical removal of the breast. Says the expert: "We are not entitled to issue any advice in this direction due to the Austrian Genetic Engineering Act. In Sweden, however, some 80 percent of affected women opt for such interventions, in our country 11 to 15 percent. In southern countries this is taboo."

Until recently, however, it had not been known exactly how great the prophylactic benefit of such operations really is. Now an international team of scientists with the collaboration of Singer has analysed this effect in 2,482 women with mutations in the BRCA1 or BRCA2 gene (found in the years 1974 to 2008) and a period of observation until 2009. The results were published in the Journal of the American Medical Association (JAMA) on 6 September.

Says the gynaecologist: "It has been found that the removal of the ovaries reduced the mortality risk from all causes in women by 60 percent. Breast cancer mortality fell by 66 percent, mortality due to an ovarian carcinoma by 80 percent." Ovarian cancer is one of those malignant diseases which, in many cases, are diagnosed too late and are essentially difficult to treat. The prophylactic removal of the breast also had an effect: in these women not a single case of breast cancer was found.

Says Singer: "This was the first time that a positive effect of such interventions was clearly proven. In practice we get very different responses by affected women. Some, mainly those where near relatives have died of such forms of cancer, are more likely to opt for such an operation, others reject it."

On 1 October an information day of the breast health centre at MedUni Vienna in Palais Ferstel (1st district, Bankgasse 3; 12.00 pm - 4.30 pm) with the title "Women in Focus" will demonstrate how important preventive check-ups, early diagnosis and the best possible therapy are in all cases of breast cancer. Leading Austrian experts will present the latest findings and are available to answer any questions by visitors. The Vienna specialists on the genetic foundations of breast cancer are also active in other fields. They took part in a scientific study, for example, which was published on Sunday in "Nature Genetics". In this study, a co-factor to the BRCA1 gene for the development of breast cancer was discovered on chromosome 19.