Four BRCA mutation carriers undergo removal of ovaries during C-section 

A pioneering two-in-one surgery to remove the ovaries and fallopian tubes during a caesarean section, has been performed on four UK patients with genetic risk variants for ovarian cancer.

Ovarian cancer has a poor prognosis, largely because early-stage disease is usually asymptomatic and thus it it not detected until it is at a more advanced stage. BRCA1 and BRCA2 risk variant carriers have a higher cumulative lifetime risk of developing ovarian cancer. The only risk reduction treatment on offer is removal of the ovaries by age 40 for BRCA2 mutation carriers, and by age 35 for BRCA1 mutation carriers (see BioNews 744). There is a reduction in the risk of post-operative complications from undergoing two separate surgeries by combining removal of the ovaries and a C-section into a single surgery.

'Offering this two-in-one surgery could prove very beneficial to other women at high risk of ovarian cancer, who would then avoid the need for separate risk-reducing surgery,' Professor Adam Rosenthal, from University College London Hospitals, who performed the operations told BBC Radio 4's Today programme. 'I think it's important to remember that women are getting older when they have children now and the older you are, the more appropriate it is to have your ovaries removed because your risk of ovarian cancer if you've got one of these genes increases with age.'

All women in the study were over the age of 40 and three had conceived via IVF. All four women reported high satisfaction with the procedure and no serious adverse events were recorded.

Despite concerns by the authors of the study, published in Obstetrics and Gynecology, that there was not much evidence to support the possibility of breastfeeding after removal of the ovaries, one of the two women who had not had a mastectomy was able to breastfeed her baby.

Authors called for the two-in-one surgery to be offered to all pregnant BRCA carriers who required a C-section, and suggested the combined surgery was more cost-effective.   

Professor Rosenthal led research into a screening tool to detect ovarian cancer earlier in women with BRCA risk variants, who wished to defer surgery, with results from the NHS cohort published last year (see BioNews 1167).