A study from the Abramson Cancer Center at the University of Pennsylvania, published in the Journal of Clinical Oncology (JCO), shows that women undergoing prophylactic oophorectomy (removal of ovaries) can take short-term hormone replacement therapy (HRT) to combat the associated symptoms of menopause without fear of significantly increasing breast cancer risk.

The study used a mathematical model to assess the expected outcomes of prophylactic oophorectomy - the surgical removal of both ovaries - and subsequent hormone replacement therapy in women with BRCA1 and BRCA2 mutations.

The model, based on the most current epidemiological data, predicts that prophylactic oophorectomy significantly increases life expectancy in women with BRCA1 and BRCA2 mutations, and that short-term HRT - used to treat the uncomfortable side effects associated with oophorectomy-induced menopause - did not significantly alter the gain in life expectancy, when stopped by age 50. The gain in life expectancy from oophorectomy ranged from 3.34 to 4.65 years, depending on age at oophorectomy.

"Women at increased risk for breast and ovarian cancer have been reluctant to undergo oophorectomy since the data from the Women's Health Initiative on HRT was released," said Dr. Katrina Armstrong, lead author of the study and Assistant Professor of Medicine and Epidemiology at the University of Pennsylvania School of Medicine. "Our study shows that removing the ovaries is an essential risk reduction strategy for BRCA1 and BRCA2 carriers, which shouldn't be avoided because of confusion or fear about hormone replacement therapy."

The researchers noted that although HRT was associated with relatively small changes in life expectancy when stopped by age 50, larger reductions in life expectancy were found when the therapy was continued indefinitely, beyond the age of natural menopause.

"This analysis shows that the impact of HRT on life expectancy for the short term is relatively minor. Women undergoing prophylactic oophorectomy should feel free to make their decision about hormone replacement therapy based on quality of life rather than life expectancy," Armstrong said.

An accompanying editorial by Judy Garber, MD, MPH and Anne-Renee Hartman, MD of the Dana-Farber Cancer Institute in Boston supported the findings, but cautioned about the widespread prescription of HRT following oophorectomy.

"The Armstrong model is a huge step forward and should help ease physician concerns about recommending short-term HRT for menopausal symptoms," Garber and Hartman said. "However, many aspects of the effect of HRT on breast cancer risk in mutation carriers remain unclear. Until there are more data from mutation carriers with which to evaluate the model, physicians should carefully weigh the results of this analysis and other emerging data in their recommendations to young BRCA1 and BRCA2 carriers."

SOURCES:
Journal of Clinical Oncology, online edition, February 23, 2004
American Society of Clinical Oncology (http://www.asco.org)