Decisions on a knife-edge

Women predisposed to ovarian cancer can reduce their risk with surgery, but with it comes early menopause. To avoid this, some doctors propose delaying part of the procedure. But is this safe? Charlotte Huff explores the costs of buying time.

More than two decades have passed, but Erika Archer Lewis clearly recalls the fear, uncertainty and struggle required to bring her 42-year-old mother back from the edge of stage 4 breast cancer. Lewis, a senior studying at the University of Texas when her mother was diagnosed, shuttled between Austin and Houston, supporting her through surgery, chemotherapy, radiation and, later, reconstructive procedures.

“It was a four-year ordeal,” Lewis recounts, sitting beside her husband one autumn morning in a sandwich shop north of Houston. Her own breast cancer risk, always a nagging worry, didn’t assume centre stage until 2013 when, then 42 and a mother herself, she had a series of breast-imaging callbacks. Her routine screening mammogram was abnormal, which led first to an ultrasound, then a MRI and then a biopsy of several worrisome areas before cancer ultimately was ruled out. “God, it felt like forever,” she says.

Determined to no longer live in a cancer limbo, Lewis got tested later that year for the BRCA gene mutations that can run in families and significantly raise a woman’s risk of developing breast or ovarian cancer. And when the results came back positive, she moved quickly. In early 2014, a surgeon removed both of her breasts and she recovered with the help of her husband, Jerry, and her mother, who recently celebrated 23 years free of cancer.

But the thornier dilemma – whether to relinquish her ovaries as well – was just emerging.

“For me, I feel quite a ways away from menopause,” says Lewis, who has two young daughters. “Although we were pretty confident that we were finished having children, I didn’t want to prematurely be thrown into menopause. I was more afraid of that actually than the double mastectomy, because of the hormonal changes it can cause and the imbalance in your body.”

Now there may be an alternative surgery, an experimental approach that’s built upon intriguing science. A small cadre of doctors are exploring whether removing the fallopian tubes but sparing the ovaries – for a stretch at least – will enable women like Lewis to preserve their hormonal balance a bit longer, and perhaps provide some buffer against ovarian cancer.

Reference:

• Angelina Jolie reflects on her decision to undergo a preventative mastectomy, after testing positive for the BRCA1 mutation.
• Key findings from a 2014 study in the Journal of Clinical Oncology tracking nearly 5,800 women, showing that ovarian removal greatly decreased the risk of developing ovarian cancer.
• By the numbers: the genetics of BRCA mutations and the cancer risks that they pose.
• A science journal overview of the fallopian tube–ovarian cancer connection, along with the stakes involved for those women with BRCA mutations.
• Analysis showing the rapid increase in the number of women from British Columbia – all without BRCA mutations – who began to get their tubes removed during routine pelvic surgeries, such as hysterectomies.