Personalizing Cancer Prevention

Two years after actress Angelina Jolie’s preventive double mastectomy, her doctors removed her ovaries and fallopian tubes when a blood test showed early signs of ovarian cancer. For women with the same genetic mutations considering a similar surgery, a personalized approach that examines age and other factors should be considered, according to Yale ovarian cancer experts.

“The current clinical standard of care is for women with certain genetic mutations to undergo a risk review, and, if necessary, to remove the ovaries and fallopian tubes between the ages of 35 and 40,” said Dr. Elena Ratner, assistant professor of obstetrics, gynecology, and reproductive sciences at Yale School of Medicine, and a member of the Smilow Cancer Hospital at Yale-New Haven’s Gynecologic Oncology Program, and Yale Cancer Center’s Cancer Prevention and Control Program.

“This surgery immediately puts the body into a postmenopausal state so the decision needs to be made on an individual basis to determine which risk-reducing procedures are necessary,” Ratner added.

She said that there are many other pharmacologic and lifestyle modifications that can be used to reduce cancer risks before turning to surgery. If surgery is chosen, Yale provides clinical quality-of-life programs that can help counteract the side-effects of menopause.

New research has shown that malignant cancer cells are more likely to come from cells outside of the ovaries that travel through the fallopian tubes, according to Dr. Gil Mor, professor of obstetrics, gynecology, and reproductive sciences at Yale School of Medicine, a member of Yale Cancer Center, and director of the Discovery to Cure Program.

“Removing the ovaries is a sound approach for postmenopausal women, but for younger women, removing the fallopian tubes could be a better approach to preventing ovarian cancer,” said Mor. “In younger women who have the surgery, the body goes through a postmenopausal state in 24 hours, while in nature this process takes 10 years. This sudden lack of hormones has consequences like bone loss, loss of memory and libido, and negative effects on the cardiovascular system. This decision should be made based individual circumstances and the age of the patient.”

–Karen N. Peart, courtesy of Yale School of Medicine

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