ICARE Newsletter Summer 2016

Ask the Expert

The following question was addressed by Dr. Christine Laronga at the Moffitt Cancer Center:

Q. How should bone health be monitored in women with a BRCA mutation after removal of the ovaries (i.e., risk-reducing salpingo-oophorectomy (RRSO))?

A. Women with a BRCA mutation have a substantially high risk to develop ovarian cancer in their lifetime, yet there is currently no reliable screening method to detect ovarian cancer before it spreads beyond the ovaries.  Consequently, RRSO among BRCA carriers is generally recommended around age 35-40, recognizing that childbearing plans are a consideration when deciding on age at which to have this surgery. However, this surgery also leads to early menopause which affects bone health. A recent study looked at women with a BRCA mutation who had undergone RRSO and showed that only 44% of these women had gotten at least one DXA scan (which is a radiological test that measures bone density). Of these women, 32% had normal results, 55.6% had osteopenia (reduced bone density), and 12.1% had osteoporosis. Additionally, 4% of women had a fracture (not related to trauma) after surgery. Low bone density was not related to age, breast cancer history, prior chemotherapy, or hormone receptor blocker treatment, suggesting that this was mainly due to removal of the ovaries. These findings suggest that RRSO in BRCA carriers is a strong risk factor for bone loss – as a result, it may be prudent to offer these women screening for bone health following RRSO to allow for timely intervention. Furthermore, although there is a lack of data regarding the best interval for bone density screening among carriers following RRSO, obtaining a baseline DXA and then screening every two years is reasonable to consider in these women.

Garcia C, et al. Gynecol Oncol. 2015 Sep;138(3):723-6. PMID: 26086567.