Pre-Emptive Surgeries: Good Thinking or Dangerous Trend?

By: Dr. Christine Horner

Last year, one of the most famous women in the world, actress Angelina Jolie, announced she had undergone a double mastectomy and breast reconstruction. She chose this surgery because she had a genetic mutation of the BRCA1 gene which is associated with a high risk of breast and ovarian cancer.

Surgery may have been the best course of action for Ms. Jolie, but it may not be for many other women with the BRCA gene mutations. Please read my previous article “BRCA Genes: What’s Your Breast Cancer Risk?” if you would like to review more details of this genetic abnormality.

Now, the tabloids are reporting that Ms. Jolie is considering having her ovaries removed as well. Because ovarian cancer is known to be more deadly and more difficult to detect, you may think that pre-emptive surgery makes the most sense. But does it?

Ovarian Cancer Risk and BRCA Genes

Ovarian cancer is uncommon. Only about 1.4 percent of women in the general population will develop ovarian cancer sometime during their lives. By contrast, according to the most recent estimates, 39 percent of women who inherit a harmful BRCA1 mutation, and 11 to 17 percent of women who inherit a harmful BRCA2 mutation, will develop ovarian cancer by the age of 70. Conversely, there is a 61% chance a woman with a BRCA1 gene mutation and an 83-89% chance in women with the BRCA2 mutation, will not develop ovarian cancer. In other words, the chance that a woman will not develop ovarian cancer is much less than the chance that she will.

Even though the risk of ovarian cancer is not significant, a study published in February 2014 in the Journal of Clinical Oncology made headlines when the researchers announced that women with the BRCA1 mutation should have their ovaries removed before age 35. In this large study, nearly 6,000 women with BRCA mutations were followed for about 5 years. The researchers found that preventive removal of the ovaries, called oophorectomy, reduced the risk of ovarian cancer by 80 percent, breast cancer by 48 percent and the risk of death from any cause by 77 percent.

With these statistically-impressive results, who wouldn’t want to consider this option? Oophorectomy sounds like an excellent preventative treatment. The word “oophorectomy” even sounds a little exotic or sexy.

But trust me, as a former surgeon, I can tell you there is nothing sexy about this procedure. Just the opposite.

Why Not?

There are many reasons why a woman may want to think twice about this operation. Oophorectomy is just a euphemism for female castration. Castrating women-especially at a young age-is associated with serious complications. When both ovaries are removed, the fall in hormone production is sudden and severe. When this occurs, the adverse effects on a woman’s health, quality of life and longevity can be harsh, demoralizing and even life-threatening.

A landmark study published in 1983 in the Journal of the American Medical Association revealed a significant increased death rate among women 40-50 years of age who had hysterectomies and did not take estrogen replacement. The researchers found that those women who had both of their ovaries removed had a death rate 8 times higher than normal. Hormone replacement therapy can help mitigate the increased risk; however, it does not always prevent or treat all of the adverse effects.

Also important to note is that while the risk for breast and ovarian cancer is very much reduced with oophorectomy, it is not 100% effective. Women who undergo this procedure can still develop breast and ovarian cancers.

The Real Risks

With any surgical procedure, there are general risks such as infection, bleeding, and reactions to anesthesia, including death. This type of operation carries a specific risk of injuries to the pelvic floor. The results of which can lead to various problems including pelvic organ prolapse, urinary incontinence, bowel dysfunction, sexual dysfunction and pelvic organ fistula formation.

The following is a list of other serious health consequences reported in the medial research as a consequence of an oophorectomy:

  1. Increase in cardiovascular disease, including heart attacks and strokes
  2. Cognitive impairment or dementia
  3. Parkinson’s Disease
  4. Osteoporosis and bone fracture
  5. Decline in psychological well being
  6. Reduced sexual function
  7. Premature death

Non-invasive Natural Options

Fortunately, surgery and all of its potential complications is not the only option when it comes to lowering the risk of ovarian cancer in women with the BRCA gene mutations. There have been a number of studies that have documented certain foods, herbs and nutritional supplements that directly influence the gene and dramatically lower the risk of both breast and ovarian cancer.

Selenium: This essential mineral has several anticancer properties, including helping to repair oxidative DNA damage. The DNA repair mechanisms don’t work well in women with the BRCA1 gene mutations, which is why they are noted to have an increased number of DNA fragments or unrepaired segments of chromosomes in their blood. When women with this genetic abnormality were given selenium supplementation in a 2005 Canadian study, the number of DNA fragments in their blood returned to normal within 3 months.

Omega-3 fatty acids: This type of fat-found in generous amounts in wild caught salmon, flaxseeds, and walnuts-has many health promoting properties, including positively influencing the BRCA1 gene. According to a 2007 French study, omega-3 fatty acids may reduce the incidence of BRCA-related tumors by 30 percent.

Vitamin D: A study published in the Journal of Cell Biology found that vitamin D plays a significant role in turning off a pathway that can cause an activation of the mutated BRCA1 gene. A number of clinical studies show that vitamin D has a protective role against both breast and ovarian cancers.

Cruciferous vegetables: Cruciferous vegetables are a family of vegetables that includes broccoli, cauliflower, kale, Brussels sprouts, cabbage, bok choy, and about a dozen others. They are particularly helpful in warding off cancer, because they contain high quantities of several plant chemicals with strong anticancer properties including indole-3 carbinole (I-3C) or DIM, calcium-D glucarate, and sulforaphane. In a 2006 study published in the British Journal of Cancer, I3C was found to have several beneficial effects on the BRCA1 gene.

Ginkgo Biloba: Chinese researchers in 2011 discovered that this herb may prevent BRCA1-associated ovarian cancer risk.

BRCAs on-the-Blink Means Choices

If you carry the BRCA gene mutations, there are many options to lower your risk. Numerous considerations play a role in determining what course of action may be best for each individual. Surgery may be the superior approach in certain situations. However, for most women, effective alternatives to surgery including a healthy diet, lifestyle and research-proven nutritional supplements may be a wiser and safer choice-especially given all the serious complications associated with oophorectomy.

Regular non-invasive screenings using ultrasounds, thermography and or MRI scans are also very important. Avoid tests that use radiation because they have been proven to add to your risk.

Your circumstances and body are unique, so make sure you educate yourself as much as possible to determine which path is right for you.

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  2. Antoniou A, Pharoah PD, Narod S, et al. Average risks of breast and ovarian cancer associated with BRCA1 or BRCA2 mutations detected in case series unselected for family history: A combined analysis of 22 studies. American Journal of Human Genetics 2003; 72(5):1117-1130.

  3. Chen S, Parmigiani G. Meta-analysis of BRCA1 and BRCA2 penetrance. Journal of Clinical Oncology 2007; 25(11):1329-1333

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  5. Fan et al. “BRCA1 and BRCA2 as molecular targets for phytochemicals indole-3-carbinol and genistein in breast and prostate cancer cells.” Br J Cancer. 2006 Feb 13;94(3):407-26.

  6. Jiang W, Qiu W, Wang Y, Cong Q, Edwards D, Ye B, Xu C. “Ginkgo may prevent genetic-associated ovarian cancer risk: multiple biomarkers and anticancer pathways induced by ginkgolide B in BRCA1-mutant ovarian epithelial cells.Eur J Cancer Prev. 2011 Nov;20(6):508-17. doi: 10.1097/CEJ.0b013e328348fbb7.

  7. Ye B, Aponte M, Dai Y, Li L, Ho MC, Vitonis A, Edwards D, Huang TN, Cramer DW.

Ginkgo biloba and ovarian cancer prevention: epidemiological and biological evidence.Cancer Lett. 2007 Jun 18;251(1):43-52. Epub 2006 Dec 27.

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  2. Redaniel MT1, Gardner MP, Martin RM, Jeffreys M. “The association of vitamin D supplementation with the risk of cancer in postmenopausal women.” Cancer Causes Control. 2014 Feb;25(2):267-71. doi: 10.1007/s10552-013-0328-4. Epub 2013 Dec 15

  3. Kowalska E1, Narod SA, Huzarski T, Zajaczek S, Huzarska J, Gorski B, Lubinski J.

“Increased rates of chromosome breakage in BRCA1 carriers are normalized by oral selenium supplementation.” Cancer Epidemiol Biomarkers Prev. 2005 May;14(5):1302-6.

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