Let me start by saying that while I’m a supporter of efforts to raise awareness and cure the cancers that kill women, my first choice is prevention. So, when I learned that I was indeed a BRCA2 carrier, I didn’t pause long before choosing to undergo both prophylactic mastectomies AND a prophylactic oopherectomy (meaning I had both healthy breasts and healthy ovaries removed). Drastic you say?
An estimated 15-40 percent of women with a BRCA1 or BRCA2 mutation will develop ovarian cancer, vs. an estimated 1.4 percent of women who have neither the BRCA1 or BRCA2 mutation. How could I possibly surrender my breasts in a determined effort to cheat cancer, only to wait for it to show up in my ovaries? I decided the ovaries had to go with the breasts. My sister, a breast cancer survivor and BRCA2 carrier opted to keep her ovaries and I’ve always wondered about the wisdom of her decision. Well, in a bizarre twist of double-stranded DNA, it seems her BRCA2 mutation just might give her a survival advantage should she ever develop ovarian cancer.
Women with ovarian cancer who have the BRCA2 gene mutation are more likely to survive the malignancy than women with the BRCA1 mutation or women without either mutation, according to Kelly Bolton, a research fellow at the National Cancer Institute. Bolton and colleagues evaluated 3,531 cases of epithelial ovarian cancer (1,178 women with BRCA1 mutations, 367 with BRCA2 mutations, and 1,986 with neither mutation). The five-year survival of women without mutations was 36 percent, while survival rates for BRCA1 and BRCA2 mutation carriers were 46 percent and 61 percent, respectively.
The researchers do not know why women with BRCA2 mutations had better survival rates than BRCA1 carriers and can only hypothesize at this point as to why BRCA carriers had better survival rates than women without either mutation. The leading hypothesized explanation is that the BRCA mutations compromise the ability of the gene carrier’s DNA to self-repair, making it more vulnerable to chemotherapy. In other words, the mutation that makes us more susceptible to cancer also makes our malignant cells more susceptible to chemotherapy drugs. The chemotherapy could thus be more effective at killing cancer cells in BRCA carriers.
Had I known this prior to my surgeries, I’d still have opted for the oopherectomy. I’m all for surviving by any means necessary. If I can do so by preventing cancer rather than curing it, all the better. Nonetheless, these findings are both important and fascinating to a BRCA carrier who is sister to multiple other BRCA carriers.
Any fascinating BRCA facts in your pile of interesting tidbits? If so, please share.
Susan Beausang, President, 4Women.com