In 2013, the famous Hollywood star and United Nations envoy, Angelina Jolie, made a global statement advocating genetic testing and prophylactic procedures, when she was found to be carrying a mutation in BRCA1 gene which put her at 87% risk of breast cancer and 50% risk of ovarian cancer. At the time, Jolie, who had previously witnessed her mother and aunt falling prey to the lethal disease, unknowingly changed the course of the life of women at low risk of ovarian cancer.
Echoing her response, researchers from Barts Cancer Institute, Queen Mary University, have recently estimated the cost effectiveness and associated life expectancy for pre-emptive surgery of ovarian cancer and recommended a reduction in the threshold risk by 4%. The recommendations were published by the British Medical Journal (BMJ) today.
With advancement in genetic testing technology, the focus of medicine is gradually shifting towards preventive medicine. These simple, non-invasive genetic tests can be a good predictor of a person’s likelihood of developing a disease and their use is becoming increasingly important for life-limiting conditions like cancers.
Marked as the seventh most common cancer in women, the threshold for ovarian cancer preventive surgery has been recommended to be reduced to 4%. Currently, women over 40 years of age, who are at a risk of 10% or more of developing ovarian cancer, can opt for a surgical removal of ovaries and fallopian tubes.
For Jolie, who had an evident genetic predisposition, ignoring the genetic test’s result was a hard pill to swallow. Despite hurdles present, Jolie underwent a double mastectomy. Although her decision was met by mixed reactions as in 2013, preventive medicine was still in its infancy at the time. Furthermore, in 2015, the star underwent laparoscopic bilateral salpingo oophorectomy (ovaries removal surgery) following which the trend of preemptive surgeries saw a global rise.
After the surgery, Jolie said “The most important thing is to learn about the options and choose what is right for you personally. I know my children will never have to say, ‘Mom died of ovarian cancer”.
Women At Low Risk Of Ovarian Cancer
Research has shown that the underlying role of hereditary predisposition is present in about 20%-25% of ovarian cancer diagnoses. The inherited genetic mutation in one of the two genes is known as breast cancer gene 1 (BRCA1) or breast cancer gene 2 (BRCA2) mutations. These genetic aberrations increase the risk of ovarian cancer from 1.3% to 39%. Other rare genetic variants that are found to contribute towards ovarian cancer include BCRA2, RAD51C, RAD52D and BRIP1 genes, but their penetrance is little.
The study, led by Ranjit Manchanda, has surfaced at a relevant time and its findings are crucial in deciding the fate of British women at a risk of ovarian cancer. Manchanda highlighted 152,000 deaths take place annually across the world due to ovarian cancer.
Experts used an arithmetic model to estimate the costs and the effects in terms of quality adjusted life years (QALYs), incidence of cancer and the incremental cost effectiveness ratio. QALY is a measurement tool that accounts for the quantity and quality of life with respect to healthcare interventions while ratios are arithmetic products of life expectancy and quality of the remaining years in one’s life.
The results of the study suggest that surgery for women who were at a risk of ovarian cancer as low as 4%, was cost effective. The cost effectiveness corresponded to 20,000-£30,000 ($29,500-$44,500) for each QALY.
The rate was equivalent to an average increase of more than 42.7 days in life expectancy for an overall incremental cost effectiveness ration of £19,536 per QALY. According to experts, these figures which may seemingly look small, are highly significant in health statistics.
Study results indicate that not only is spending on pre-emptive surgeries beneficial for females but it also helps reduce the financial burden inflicted on women diagnosed with ovarian cancer. Specialist consultations, treatments including radiology procedures and medications leading to palliative care serves are normally very expensive. However, if the likelihood of the disease is minimized through surgery, the relative cost is low.
It is important to note that the patient is required to make an informed decision when opting for surgical removal of ovaries. Although the cancer is prevented by surgery, some medical complications may follow afterwards. It is worth noting that though the incidence of ovarian cancer among women can occur at any age, it is most likely to present itself in the post-menstrual stage of a woman’s life.
Furthermore, younger women who undergo ovarian removal surgery reach an early menopause and their child bearing ability is lost. While the ovaries are removed, the secretion of female sex hormones progesterone and estrogen is also affected due to which hormonal replace therapy is usually prescribed. These women are also found to develop osteoporosis and heart conditions later in life.
According to Manchanda, his team’s finding will be helpful for clinical practices of ovarian cancer screening and prevention. He stated that in the era of evolving genetic discoveries, “lower-risk” women might use surgery as a crucial tool for cancer risk management.