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Call for preventive surgery to cut ovarian cancer risk

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Women with so-called ‘cancer genes’ should consider having their fallopian tubes removed to guard against a heightened risk of ovarian cancer, an expert has said.

Providing they have had children, women who are found to be carrying the BRCA1 or 2 genes, such as actress Angelina Jolie, should think about such a course of action, said Professor Sean Kehoe, one of the UK’s leading gynaecological oncologists.

Professor Kehoe, of the University of Birmingham, who has pioneered several studies to improve low survival rates in ovarian cancer, pointed to “a groundswell of evidence” suggesting the disease often starts in the fallopian tubes of women carrying the genes and not the ovaries as previously thought.

He said: “Women who carry the BRCA1 gene are currently advised to have their ovaries removed by the time they are 40; whilst carriers of the BRCA2 gene are advised to have them removed no later than 50. This procedure normally includes removal of the fallopian tubes.

“There may be certain situations whereby removal of the fallopian tube at an earlier age than that recommended for the ovaries be deemed appropriate - but there is a need to investigate this further.”

He added: “More research is needed to show that this approach would provide a worthwhile reduction in their risk of developing ovarian cancer, but based on recent findings there is evidence to support this concept.

“One disadvantage would be the need for two operations, hence the need to research this in much more detail.”

Ovarian cancer is known as the silent killer because its symptoms often present too late for effective intervention. Up to 7,000 women a year are diagnosed with the disease and 4,500 die. One in 10 ovarian cancers are caused by an inherited faulty gene.

Jolie is the latest and most high-profile star to highlight the dilemma facing women at high risk of developing breast cancer.

The star revealed in May that she had undergone a preventative double mastectomy to reduce her risk of developing the disease.

Her mother Marcheline Bertrand died of cancer in 2007.

Jolie, a mother of six and partner of Brad Pitt, said she took the decision to have the procedure because she found she carries BRCA1, which sharply increases her risk of developing breast cancer and ovarian cancer.

Writing for the New York Times, she said her doctors had estimated she had an 87% risk of developing breast cancer and a 50% risk of ovarian cancer.

Professor Kehoe said: “Recent studies suggest that the fallopian tubes may be the source of up to 50% of so-called ovarian cancers though research is ongoing. Pre-cancerous changes have certainly been noted in the fallopian tubes of BRCA carriers when carefully examined.

‘Unfortunately there are no diagnostic tests for identifying pre-cancerous or early cancerous cells in the fallopian tubes which would explain why the disease so often goes undetected until it has spilled out of the end of the tubes on to the ovaries and around the abdomen. Only then do symptoms develop. Tragically, by this time, the outcome is poor.

‘Generally speaking, women with the BRCA gene mutation have a lifetime risk of breast cancer up to 90% per cent, and their risk of ovarian cancer is between 10% and 40%. However, preventative measures mean the risks are hugely reduced.

‘Unfortunately, there is no effective screening process for detecting pre-cancerous or early cancerous changes in the fallopian tubes.

‘Blood tests may one day help in screening or early diagnosis of cancer in the fallopian tubes in the future but the technology is not yet that advanced.’

Liz Campbell, director of the charity Wellbeing of Women, which funds studies into the treatment and prevention of ovarian cancer, said: “This is a very exciting development in thinking which needs funding now so that research can establish whether it offers new treatments for women suffering with this terrible disease.”

Dr James Brenton, a Cancer Research UK ovarian cancer expert, said: “Removing the fallopian tube from women with a BRCA fault could reduce their risk of developing ovarian cancer without the side effects that removing the ovaries would have. But there have been no studies to show how effective this could be. Any woman who carries a BRCA fault should speak to her doctor to discuss the possibilities for them. There are things that can reduce women’s risk of ovarian cancer, for example taking the pill for around three years before a woman is 30 cuts her risk of developing the disease.

“And we need to understand more about BRCA faults and ovarian cancer. As sequencing DNA gets cheaper it will transform our knowledge of ovarian cancer and how we treat the disease. We’re looking at testing all women who have ovarian cancer to see if they have a BRCA fault and whilst this won’t affect their treatment, it will mean that if any of their family members are found to be carrying a fault they can take steps to reduce their risk of developing a cancer linked to BRCA faults - breast, ovarian and prostate.”


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