Dear Judy,
I notice you have a number of letters about ovarian cancer lately. They hit home. Our mother was recently diagnosed with the illness, in an advanced stage.
I know that there’s sometimes (often?) a genetic component to the disease. I have a sister who’s had breast cancer. I am 33 and I want my ovaries removed.
My sister (the one who’s had breast cancer and a mastectomy) says I’m crazy to even consider the option. As I’ve had no children as yet, she says I am thinking of lopping off my future with such a measure. She also says, having had a part of her body surgically removed, she is in a better position to tell me how sad the loss really is.
But I’m really scared I’ll have the same fate as my mother. Or maybe my sister. So what to do?
Carrie
Dear Carrie,
To answer your question –or rather to help answer it — I consulted Dr. Laszlo Vasarhelyi, a specialist in the field. He writes:
“I do appreciate your concern and dilemma, especially in light of the history of cancer in the family. I know and have treated many women whose families have had a history of breast and ovarian cancers. And yet — they did not develop either one.
“Yes, genetics play a role in the development of these cancers. But it does not necessarily affect the entire family.
“So my suggestion would be, No. Do not have an oophorectomy. Especially since you are young and of childbearing age. You may not think about starting a family now, but who knows the future? You may well change your mind.
“So I would suggest that right now, you consult someone very knowledgeable about genetics, as well as a trusted gynecologist.
“Having said that, you need to be followed religiously with physical exams and all the appropriate imaging studies.”
And now this is my suggestion — somewhat different from Dr. Vasarhelyi’s. As you know, there are genetic tests available to determine whether or not you inherited a predisposition for both breast and ovarian cancers.
Specifically, they can tell whether or not you have a BRCA1 or a BRCA2 gene alteration. If you do, then you are at higher risk for those cancers than women without the genetic alteration. But as Dr. Vasarhelyi notes: even these tests are not conclusive, and cannot definitively tell you that you will get cancer. Or that you won’t get ovarian or breast cancer.
Some dilemma, huh?
Like, Dr. Vasarhelyi, I believe you need to consult a trusted gynecologist as well as a specialist in the field of genetic testing — both of whom may (or may not) allay your fears, depending on the results of that testing.
Then, if you’re still fearful about your health – I say, go with your gut.
If you feel that with your family history surgical removal of your ovaries will give you a greater sense of security and peace of mind, then go with that instinct. This is a choice you alone can make.
And by the way — in the future? Keep your health decisions to yourself. Don’t bother mentioning them to your sister. No one but you is in any position to make them. And you’ll feel better knowing that the only advice you took was your doctor’s — and your own.
Thank you for writing
Judy
Personally I also think she should talk to a shrink. quick. Carrie has serious psychological issues, and I think the fact that she consults a complete stranger on the most consequential decisions of her life reveals a lot about her mental state. She needs to calm down first. Even if she is carrying the “bad” gene, she has plenty time to think this through.
Carrie, my heart goes out to you. We are all under a death sentence from the minute we are born, but you seem to feel the hangman’s breath. If you decide to go with your gut, as Judy suggests, freeze some eggs first. It will make the decision less final.