More women should go under the knife like Hollywood star Angelina Jolie to reduce their risk of developing cancer, according to new research.
Jolie announced last year that she had surgery to remove her ovaries and fallopian tubes because she carried a gene mutation that dramatically increased her risk of developing cancer.
The procedure put her into menopause at age 39, and she will take replacement hormones for another decade or so.
Now a new study suggests that the current threshold for pre-emptive surgery to remove the ovaries and fallopian tubes of women aged 40 or over at high risk of developing ovarian cancer should be halved.
The research, published online by the Journal of Medical Genetics, suggests it would not only extend the lives of more women, but would be very cost effective, and help to compensate for the current lack of a reliable test to screen for the disease.
Ovarian cancer remains the leading cause of cancers affecting the reproductive system among women. It kills 152,000 women worldwide every year.
Pre-emptive surgery, known as risk reducing salpingo-oophorectomy, is the best option for curbing ovarian cancer risk among women at high risk of developing the disease.
These include those with a first degree relative affected by the disease and carriers of risk genes, such as BRACA1/2 , and to a lesser extent, RAD51C, RAD51D, and BRIP1 genes.
But the procedure is currently only available to women with at least a 10 per cent lifetime risk of developing the disease, a threshold that has never been tested for its cost effectiveness.
The researchers decided to compare the costs and effectiveness of pre-emptive surgery with no surgery for women aged at least 40 who had not yet gone through the menopause, but who were at risk of developing the disease, using mathematical modelling.
Different levels of lifetime risk were included in the analyses- 2%, 4%, 5%, 6%, 8% and 10% – to calculate the likelihood of developing ovarian cancer, breast cancer, and death from heart disease.
Costs were derived from official sources at 2012 prices and average life expectancies for women with and without breast or ovarian cancer were taken from national statistical data to calculate Quality Adjusted Years (QALYs) – a measure of years lived in good health.
When all the figures were analysed, the calculations showed that pre-emptive surgery at a lifetime risk level of four per cent or greater would be highly cost effective among women aged at least 40, and add up to around 43 extra days of life expectancy if hormone replacement therapy (HRT) were taken until natural menopause.
Dr Ranjit Manchanda, of Barts Cancer Institute at Queen Mary University London, said: “Our results are of major significance for clinical practice and risk management in view of declining genetic testing costs and the improvements in estimating an individual’s ovarian cancer risk.”
He added: “With routine clinical testing for certain moderate penetrance genes around the corner and lack of an effective ovarian cancer screening programme, these findings are timely as they provide evidence supporting a surgical prevention strategy for ‘lower risk’ individuals.”
