April 15, 2015- Dr Andrew Kaunitz discusses risk-reducing gynecologic surgery for women who are BRCA mutation carriers—those with a mutation in either the BRCA1 or BRCA2 tumor suppressor gene. There is one brave woman in this position who I think will help many find courage.
On March 24, 39-year-old Oscar-winning actress and filmmaker Angelina Jolie Pitt published a story in The New York Times in which she detailed her recent laparoscopic bilateral salpingo-oophorectomy and initiation of hormone replacement therapy (HRT). Ms Jolie Pitt, who carries the BRCA1 mutation, lost her mother, grandmother, and aunt to hereditary breast/ovarian cancer. Some 2 years ago, she made news by describing her decision to move forward with risk-reducing bilateral mastectomy.
Many premenopausal BRCA mutation carriers defer risk-reducing gynecologic surgery because they fear menopausal symptoms resulting from loss of ovarian function. Mutation carriers, many of whom have seen their relatives battle breast cancer, are understandably concerned and worry that they cannot safely use HRT, a concern shared by many clinicians.
However, contrary to what many assume, mutation carriers with intact breasts can safely use hormone therapy from 3.6 to about 5.5 years, with follow-up of about 5 years for the largest study.[3-5] In women who have undergone risk-reducing bilateral mastectomy, use of HRT is associated with even fewer safety concerns.
Ms Jolie's bravery 2 years ago in publicizing her decision to undergo risk-reducing breast surgery led many women with high-risk family histories to seek out genetic counselling and testing. Now, her courage in sharing her story regarding her gynecologic surgery will provide mutation carriers with confidence that a fear of menopausal symptoms need not deter them from making life-saving decisions regarding risk-reducing surgery.
One last thing. I want to put in a plug regarding an excellent organization for BRCA carriers, known as FORCE, or Facing Our Risk of Cancer Empowered.
- Jolie Pitt A. Angelina Jolie Pitt: Diary of a surgery. The New York Times. March 24, 2015. http://www.nytimes.com/2015/03/24/opinion/angelina-jolie-pitt-diary-of-a-surgery.html?_r=1# Accessed April 14, 2015.
- Jolie A. My medical choice. The New York Times. May 14, 2013. http://www.nytimes.com/2013/05/14/opinion/my-medical-choice.html Accessed April 14, 2015.
- Eisen A, Lubinski J, Gronwald J, et al. Hormone therapy and the risk of breast cancer in BRCA1 mutation carriers. J Natl Cancer Inst. 2008;100:1361-1367. Abstract
- Rebbeck TR, Friebel T, Wagner T, et al. Effect of short-term hormone replacement therapy on breast cancer risk reduction after bilateral prophylactic oophorectomy in BRCA1 and BRCA2 mutation carriers: the PROSE Study Group. J Clin Oncol. 2005;23:7804-7810. Abstract
- Domchek SM, Friebel T, Neuhausen SL, et al. Is hormone replacement therapy (HRT) following risk-reducing salpingo-oophorectomy (RRSO) in BRCA1 and BRCA2 mutation carriers associated with an increased risk of breast cancer? J Clin Oncol. 2011;29 Suppl:1501.
AUTHOR: Andrew M. Kaunitz, MD
Medscape Ob/Gyn © 2015 WebMD, LLC.
Medscape. Apr 15, 2015.