CDC Symptom Diary Card

Thursday, April 24, 2014

BRCA 1 Mutations: Treat Earlier

This latest important research shown in Fred Hutchinson Cancer Research Center News

Ovary removal by age 35 to reduce cancer risk?

Fred Hutch researchers weigh in on new recommendation that women with BRCA1 gene mutation have ovaries removed by age 35

Feb. 26, 2014
Breast cancer
Women who have a mutation of the BRCA1 gene can protect against breast cancer (shown) and ovarian cancer by having their ovaries removed by age 35, a new study has shown.
Photo by Science Photo Library / via AP images
Women who’ve inherited mutations of the BRCA gene could dramatically reduce their risk of breast and ovarian cancer by having their ovaries removed by age 35, a new study suggests.
The international team of researchers who followed nearly 6,000 women with BRCA mutations for an average of 5.6 years found that preventive removal of the ovaries, called oophorectomy, reduced the risk of ovarian cancer by 80 percent and the risk of death from any cause by 77 percent, according to the study published in the Journal of Clinical Oncology.
The study also found that women with the BRCA1 mutation were at a much greater risk of ovarian cancer than those with BRCA2 mutations.
“To me, waiting to have oophorectomy until after 35 is too much of a chance to take,” said Dr. Steven Narod, a professor of medicine at the University of Toronto and the study’s lead author. “These data are so striking that we believe prophylactic oophorectomy by age 35 should become a universal standard for women with BRCA1 mutations. Women with BRCA2 mutations, on the other hand, can safely delay surgery until their 40s, since their ovarian cancer risk is not as strong.”
Narod and his colleagues followed 5,787 women with the mutations, some for as long as 16 years. At the study’s outset, 2,123 women had already had an oophorectomy. Another 1,390 received the surgery during the course of the study, while 2,274 eschewed the surgery.
For women carrying the BRCA1 gene, the researchers estimated that delaying surgery until age 40 raised the risk of being diagnosed with ovarian cancer to 4 percent, while waiting till age 50 hiked that risk to 14.2 percent. This is compared to the rate among those who had an oophorectomy before age 40: 1.5 percent.
Experts agreed that the new study underscores the importance of early oophorectomy in women carrying the BRCA1 mutation.
“Until now, our recommendations for prevention of ovarian cancer have been identical for women with BRCA1 and BRCA2 mutations. This study changes that,” said Dr. Elizabeth Swisher, medical director of the Breast and Ovarian Cancer Prevention Program at Seattle Cancer Care Alliance and a professor in the department of obstetrics and gynecology at the University of Washington. “Women with BRCA1 mutations are at higher risk of ovarian cancer in their late 30s while women with BRCA2 mutations have no appreciable risk until after age 40. Therefore, women with BRCA1 mutations should ideally have their ovaries and fallopian tubes removed by the age of 35, while women with BRCA2 mutations can safely wait until age 40.”
There are, of course, downsides to having the ovaries removed. What women find most troubling is the immediate end of childbearing and the early entrance into menopause.
“There are both medical and quality of life downsides from the early menopause,” Swisher said. “I would recommend that women take estrogen unless they have previously had breast cancer.”
‘It’s a very personal decision’
The decision is one that each individual woman has to make with her doctor, said Dr. Larissa Korde, director of the Prevention Center at Fred Hutchinson Cancer Research Center.

“Women considering this have to look at a couple of different things: the risk of ovarian cancer and how  an oophorectomy affects breast cancer risk versus how early menopause affects general health,” Korde said. “You have to consider the side effects [of early menopause] like hot flashes and vaginal dryness, and the effects on bone health and cardiovascular health.”
Earlier oophorectomy might allow some women to keep their breasts.
“If you have your ovaries out there’s a significant protective effect against breast cancer,” Korde said. “If women have not had breast cancer and their ovaries have been removed we often prescribe short term hormone replacement therapy and breast cancer screening. That’s an option some women opt for.”
Ultimately Korde said, “it’s a very personal decision. Women have to deal with what their feelings are, what they’re afraid of, what risks they’re willing to take on and what side effects they’re willing to live with.”
Read more:
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Sunday, April 13, 2014

PALLIATIVE CARE: An Introduction

I have not forgotten my ovarian sisters or their families.  Our family has been grieving the loss of mom.  My life has been enmeshed with my mom's life for many years, and each moment of joy and pain is equally treasured.  We honored her life last weekend in Colorado, with family and friends from all around the region.  My sweet Aunt said that she felt uplifted at the end. My sister worked so hard on the arrangements, thank you sis.  We chose to share mom's joy, her smiles, elegance and cherished life events.  Her suffering made us stronger.  Now she rests in peace, with God.

As a person with cancer it is important to do all we can not only to learn about our cancer and treatments, but learn about resources that can assist us with our suffering. Palliative care can be an essential ingredient in the complex and everchanging recipe for our care.

My mom had the blessing of speaking with two palliative care nurses a week or so before she died.  They gave her attention, validated her integrity and spoke with and to her as a whole person. They assured her that they were THERE to ease her suffering, and she was so happy about that.

I had asked several years back if the hospital offered palliative care, and at that time they did not.  This service came to her too late, but it is not yet offered as a standard service.  It is still relatively new and if you think you need it, please ask about it.

Indirectly, I believe that mom's primary doctors were offering palliative treatments, but without defining it as such, her treatments were not coordinated. This happens far too often.

Mom suffered great abdominal pain, nausea, fatigue and emotional exhaustion from grappling with the ups and downs from multiple hospitalizations and an overall downward trend in her quality of life.  Plus a critical element, family education, really never happened.  

When an individual is deemed to have chronic pain and suffering from a serious illness, the caregivers and patient need to be on the same page.  To leave the education up to the patient places an unfair burden on them.  The patient may not want to appear needy and the palliative care team knows HOW to educate without undermining a patient's dignity.  How I wish mom had received this help earlier....

Had palliative care been introduced sooner, she may have had an overall better quality of life. Her family would have had support in supporting her better in the way mom wanted.  We all did the best we could, and every life experience is a lesson.  Mom had type 1 diabetes with all the trimmings, she suffered greatly.  In her suffering she still managed to shine a beautiful smile, joyful laugh or deep regard for her loved ones.

Cancer patients greatly benefit from palliative care.  This type of program has the purpose of enhancing quality of life by managing pain, stress and any other major issue inhibiting our ability to live as best we can with our illness. Please go to the lnk below to learn more about this treatment plan and to see if you or a loved one could benefit from this type of care.

Peace and Blessings