ICARE Newsletter Summer 2014

Ask the Expert

The following question was addressed by Dr. Steven Narod who is a Tier I Canada Research Chair in Breast Cancer and a senior scientist at Women’s College Research Institute in Toronto, Canada.  Dr. Narod is a world-leader in the field of breast and ovarian cancer genetics. Over the course of his career, he has profoundly shaped current knowledge about cancer risks, prevention and screening amongst carriers of BRCA1 and BRCA2 mutations.

Q. As a BRCA mutation carrier, am I at an increased risk for endometrial cancer? Should I have a hysterectomy?

A. Most published studies in BRCA mutation carriers have reported that there is not a substantially higher risk of endometrial cancer. In fact, a recent report of 4456 BRCA carriers suggested that any increased incidence of uterine cancer among mutation carriers was related to the use of tamoxifen.1Results from this study indicated that even with tamoxifen use, the excess risk of endometrial cancer was small, with a 10-year cumulative risk of 2%. It has been suggested that these risks can be further reduced given the option of raloxifene (which does not raise uterine cancer risk) or aromatase inhibitors (which can be used in postmenopausal women for breast cancer prevention). As a result of our current understanding of this topic, I believe that there is no compelling reason to perform a hysterectomy to reduce the risk of uterine cancer in BRCA mutation carriers during preventive surgery to remove the ovaries and fallopian tubes. Nevertheless, it is important that the healthcare provider discuss the actual risks with the patients prior to surgery so that they can make a properly informed decision.

Segev Y, et al. Gynecol Oncol. 2013 Jul;130(1):127-31. PMID: 23562522.