SEATTLE - Since Angelina Jolie announced she had a double mastectomy to prevent breast cancer and also plans to have her ovaries removed, the discussion of preventative surgeries has flooded the blogosphere. But, a Seattle researcher says ovary removal can be a reasonable option for women and has little psychological impact.
Women who have the genetic mutations BRCA1 or BRCA2 are at a significantly greater risk of developing breast and ovarian cancer. To reduce that risk, some women elect to have their breasts and/or ovaries removed.
While some might consider ovary removal drastic, Dr. Bonnie McGregor, a psychologist and behavioral scientist at the Fred Hutchinson Cancer Research Center, believes the effects of the procedure are a small price to pay for cancer prevention.
In 2009, McGregor lead a study with 119 women to assess the psychological impact of ovary removal as a means to prevent cancer.
McGregor knew women's concerns about cancer were lessened after they had their ovaries removed, but she wondered at what cost? Women who are not in menopause already experience the change immediately after the surgery. McGregor was concerned these women would experience depression or sleep loss, but she was pleasantly surprised by what she found.
"It wasn't as bad as we thought it would be," McGregor said. "The average woman reported after surgery that she was only bothered slightly by menopausal symptoms. And the level of symptoms was not as bad we predicted."
McGregor learned social support, relationship status and optimism were the most important factors in a woman's mental health after the surgery, even more so than hormone replacement therapy. Participants who had good relationship satisfaction complained less about sex dysfunction, she said.
"Until we have better treatments in place I think this is a reasonable option for women," McGregor said.
Dr. Elizabeth Swisher, medical director of the Breast and Ovarian Cancer Prevention Program at Seattle Cancer Care Alliance, said she only removes a woman's ovaries is she is at least in her late 30s and does not plan to have children in the future.
She said women with genetic mutations may be more likely to remove their ovaries than their breasts because the screening options are so much worse for ovarian cancer. In addition, when a woman's ovaries are removed it reduces her risk for cancer in her both her ovaries and her breasts.
Women who elect to have this surgery can develop menopause-related health concerns, including heart disease, diabetes and osteoporosis, but Swisher said estrogen can reduce the risk of these conditions and ease general menopause symptoms.
Swisher said she is sometimes faced with a patients who don't have a significant risk of developing cancer but want their ovaries removed anyway - just in case. She said she never removes a woman's ovaries if she is younger than her late 30s or if she does not have a genetic indicator putting her at risk for cancer.
"We never do surgery here in response to women's anxiety," Swisher said.
Still, Swisher hopes the publicity around Jolie's case will educate more women on the prevention options available to them.
"I'm excited that more women will arm themselves with the education necessary to assess their own risk," Swisher said.