Lowering the threshold for preventative surgery for those at high-risk of developing ovarian cancer could save lives

Lowering the threshold for preventative surgery for those at high-risk of developing ovarian cancer could save lives

More women should be offered surgery to remove the ovaries and fallopian tubes according to a recent study by researchers at Barts Cancer Institute, Queen Mary University of London, University College London, London School of Hygiene and Tropical Medicine, and Cambridge University.

Surgery to remove the ovaries and fallopian tubes is the "best method" for preventing ovarian cancer among women deemed to be at high risk of getting the disease, according to the researchers.

At present, the surgery is only offered to women at the highest risk of cancer (those deemed to have a 10 per cent risk or higher). This is undertaken only after they have decided that they have completed their families and after the age of 35-40 years.

The study found that in lowering the threshold for pre-emptive surgery, to a lifetime risk level of 4% or greater would be highly cost effective among women aged at least 40, and add up to around 43 extra days of life expectancy if hormone replacement therapy were taken until natural menopause.

Dr Ranjit Manchanda an Eve Appeal researcher from Queen Mary University of London and lead on the study, said: "With routine clinical testing for certain moderate penetrance genes around the corner and current lack of an effective ovarian cancer screening programme in at-risk women, these findings are timely as they provide evidence supporting a surgical prevention strategy for 'lower risk' individuals"

It also suggested that this would be cost effective for the NHS - offering the £2,165 surgery to women with a 4 per cent life time risk of the cancer, which would be at a cost per extra quality adjusted year of life lower than the £30,000 threshold used by the National Institute of Health and Care Excellence in assessing whether to recommend new drugs or healthcare interventions.

Prof Usha Menon, University College London, an Eve Appeal Researcher and co-author on the study said: "Our results are of major significance for clinical practice and risk management in view of declining genetic testing costs and the improvements in estimating an individual's ovarian cancer risk."

Manchanda continued: "This is a really important study which will lead to changes in clinical practice and provides significant impetus towards targeted surgical prevention. A number of at-risk women who could not access prevention will now have the opportunity to do so should they wish.

This study builds further on The Eve Appeal's high-risk research programme - GCaPPS - which looked into population-based screening versus the current method, which is based on family history in the Ashkenazi Jewish population. This high-risk group are known to have a higher proportion of people carrying the BRCA gene (1 in 40 compared to about 1 in 800). Its findings were significant - more than half the people carrying the gene identified through population screening (56%) would not have been identified through family history based screening.

Athena Lamnisos, Chief Executive of The Eve Appeal said: "Giving high-risk women the information they need to make important decisions is key to effective prevention of ovarian cancer. This is a significant study that could help to influence future clinical practice."