From: Reuters
Published April 23, 2008 03:29 PM

Simultaneous breast-ovary surgery feasible

NEW YORK (Reuters Health) - Women who are carriers of BRCA1/2 gene mutations that put them high risk for cancer may opt to undergo mastectomy and ovary removal as a cancer prevention strategy. Now, a small study suggests it's possible to combine the two procedures into a single operation, without undue complications.

On average, the combined procedure took 9.3 hours to perform and patients were hospitalized for 5.4 days afterward, according to the report in the online journal BMC Cancer.

Women with BRCA1 or BRCA2 mutations are known to be at greatly increased risk of both breast and ovarian cancer, Dr. Funda Meric-Bernstam and colleagues point out. By 70 years of age, up to 85 percent of carriers will develop invasive breast cancer and up to 65 percent will develop invasive ovarian cancer, the team from the University of Texas M. D. Anderson Cancer Center in Houston notes.

Women with these mutations may choose to be intensively monitored for any sign of cancer, to take preventive measures with tamoxifen treatment, or to undergo preemptive removal of her breasts and ovaries. Although the last approach is more aggressive, research has shown it to be highly effective in preventing the associated cancers.

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Typically, the mastectomy is performed first and the ovary surgery is performed months later during one of the breast reconstruction procedures that most patients elect to undergo.

The new findings, which are based on a review of 12 patients treated at the authors' center, suggest that mastectomy and ovary removal can be safely rolled into one operation. The average patient age was 43 years and 10 of the women had a prior breast cancer. Ten women also underwent bilateral breast reconstruction during the combined procedure.

None of the patients experienced any major complications during the operation. Afterward, however, there were three instances of problems related to the surgery that needed attention, and one case of pneumonia.

After an average of seven years, none of the patients developed a new cancer, but two had a recurrence at other sites in the body.

According to the authors, greater convenience for the patient is a key advantage with the combined procedure. Furthermore, doing both procedures at once reduces the theoretical risk that ovarian cancer will arise between staged procedures.

SOURCE: BMC Cancer, online April 14, 2008.

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