Risk Reducing Surgery
In general cancer is not an inherited illness however some cancers are more likely to occur if you have inherited a mutation in specific genes.
Genes are pieces of DNA that we inherit from our parents, we have two copies of each gene, one copy inherited from our mother and one copy inherited from our father. We have approximately 20 000 genes, each with a special function, that helps our bodies grow and function normally.
Some genes protect us against cancer by correcting damage that may happen to DNA during cell division, BRCA1 and BRCA2 are two examples of these tumour suppressor genes. If a person has a mutation in BRCA1 or BRCA2 they have a greatly increased risk of developing breast and ovarian cancer. Similarly, there are other gene mutations (such as those causing LYNCH syndrome) which cause a similar effect.
Managing ovarian cancer risk:
Causes
It is important to be aware of ovarian cancer symptoms as it is known as a ‘silent’ disease as its symptoms may be vague. Evidence suggests any of the following three symptoms, if occurring most days may suggest ovarian cancer
-
Persistent pelvic and abdominal pin
-
Abdominal bloating that is persistent
-
Difficulty eating and feeling full more quickly
Other symptoms may include a change to your bladder or bowel habit, back pain and fatigue. It is important to present to your GP should you develop any of these symptoms.
Screening
Unfortunately there is no validated screening test that has shown a benefit or reliably diagnoses ovarian cancer at a stage that makes a difference to the outcomes of women with ovarian cancer, therefore no current screening test exists or is recommended.
There have been several studies looking at the role of screening in high risk women (those with a BRCA mutation) but they have not yet shown a benefit or appropriate test.
How to reduce your risk of ovarian cancer if you have a genetic predispposition
We know that for women not wanting to have their ovaries removed the oral contraceptive pill may slightly reduce the risk of ovarian cancer, however if taken for more than four years in women with a BRCA mutation it may raise their risk of breast cancer.
Risk-reducing bilateral (both sides) salpingo-ophorectomy (removal of tubes and ovaries):
Removing the tubes and ovaries (via key hole surgery) before an ovarian cancer has occurred lowers the risk of having an ovarian cancer. Specifically, for BRCA related ovarian cancers it will reduce your risk to less than 5%.
​
Women with a genetic mutation are advised to consider risk reducing bilateral salpingo-ophorectomies (RRBSO) +/- hysterectomy as it is the only proven way to significantly and permanently reduce your risk of an ovarian cancer.
​
Dr Goulding is skilled in both the counselling and management of women with a genetic predisposition to gynaecological cancers.