1. If I ONLY read YOUR title and summary and I was debating this decision for myself, boy would I make the wrong choice. From:

1.Removal of ovaries does not prevent ovarian cancer
2.This surprising - and not good news-...
3.women with the gene mutations still have a cancer risk nine times higher than women without the inherited BRCA1 or BRCA2 gene mutation
4.[it's a]method of risk-reduction but that it will not completely prevent ovarian cancer.

Wow. The heck with removing them. Right?

Wrong. You say this non-preventive, surprising-not good-news means that even if you remove the ovaries, your risk is still 9x higher. Nine times higher than what?

The observed incidence of cancer among the women with intact ovaries was 1,015 per 100,000 per year --about 58 times the incidence in the general population, the researchers reported. By contrast, the incidence among women who had a prophylactic bilateral salpingo-oophorectomy was 217 per 100,000 per year (4.3%) -- only 9.3 times the expected rate for the general population.

And 4.3% may actually be too high as "it is possible that these are actually metastases of subclinical disease that was present at the time of surgery."

I've chosen a different statement from the same author:

Women with mutations in BRCA1 and BRCA2 are at sharply increased risk for ovarian cancer, and it is standard practice for physicians to recommend a salpingo-oophorectomy, but only about 60% of women follow through and have the surgery. "I would like to see it be 100%," Dr. Narod said, as soon as women are at or near the end of their child-bearing years.


"These cancers are not detectable early, the mortality rate is 80% -- if they get it most people succumb to it -- and they can't be screened for," he said. "So that leaves prevention."

http://www.medpagetoday.com/HematologyOncology/OtherCancers/tb/3713

Posted at 12:29PM on Jul 12th 2006 by Michelle

2. Michelle -- Thank you for your personal perspective.

Your leap to conclusion in this comment made, "Wow. The heck with removing them. Right?" is all your own. No where in the post do I come to that conclusion or make that suggestion.

Even after having their ovaries and fallopian tubes removed on a preventive basis, women who carry one of two gene mutations known to be linked to high rates of breast and ovarian cancer are still at risk of developing ovarian cancer.

While a percentage of women who have the preventive procedure go on to develop ovarian cancer might not seem significant to you -- for women with the genetic mutation who choose to have their ovaries and fallopian tubes surgically removed in the belief it will prevent ovarian cancer -- it is a surprising statistical finding reported by the researchers of this study that you can be diagnosed with ovarian cancer when you have no ovaries. I found that surprising.

Senior author Dr. Steven Narod, a leading researcher in the field of inherited breast and ovarian cancers, said the study shows that even after having their ovaries and fallopian tubes removed, women with the mutations known as BRCA1 or BRCA2 still face a risk of developing ovarian cancer that is significantly higher than that faced by women who did not inherit either of the genes.

"It is still nine times higher than the average woman," said Narod, director of the familial cancer research unit at Toronto Womens College Hospital.

I believe if you reread the post, the nine times higher that what? question you pose was already clearly stated, but the above is the exact quote from Dr. Narod.

I hope that this is a decision you personally never have to make, but for those of us who have had to or will have to consider this procedure, the facts are that it is not the fool-proof method of prevention previously considered to be true.

While I appreciate knowing what you would do faced with this choice, this type of medical choice is not to be taken lightly and your commentary deeming one choice over another as right or wrong -- as someone who has not actually had to face this choice -- is a disservice to women who actually do have to make this decision. I refer to how you begin your post.

You begin your post with: "If I ONLY read YOUR title and summary and I was debating this decision for myself, boy would I make the wrong choice." Do you make medical decisions based on something you read in a blog? I believe our readers possess a greater intelligence than to base medical decisions on something they read in a blog or a single research study without doing additional research and speaking with their physician.

Posted at 12:54PM on Jul 12th 2006 by Dalene