SAN FRANCISCOWomen who have survived breast cancer are at
increased risk for subsequent ovarian cancer, and this risk is
especially high in women diagnosed with breast cancer before age 50
and in African-American, Asian, and Hispanic women, according to data
presented at the 30th Annual Meeting of the Society of Gynecologic Oncologists.
Minorities Have Higher Rates
Wendy R. Brewster, MD, and her colleagues from the University of
California, Irvine, found relative risks (RRs) for ovarian cancer in
women diagnosed with breast cancer before age 50 of 1.79 for
non-Hispanic white women, 2.38 for African-American women, 2.86 for
Asian women, and 3.95 for Hispanic women.
We often think of breast cancer as a disease of Caucasian
women, Dr. Brewster said in an interview. When you see
such high rates of subsequent ovarian cancer in Asian and Hispanic
women, it raises the question of a possible genetic
susceptibility. She pointed out that there has been little work
on genetic susceptibility in African-American, Asian, or Hispanic women.
The analysis, based on data from the Surveillance, Epidemiology and
End Results (SEER) database, included 120,380 women with breast
cancer. Patients were stratified by age at diagnosis of breast
cancer, stage of breast cancer and race/ethnicity. Ovarian cancer as
a subsequent primary malignancy was diagnosed in 478 of these women.
The overall relative risk of ovarian cancer after a diagnosis of
breast cancer was 1.30.
Risk was significantly elevated in women diagnosed with breast cancer
before age 50 (RR 1.93). The largest increased risk of ovarian cancer
was in women diagnosed with breast cancer between the ages of 15 and
39 (RR 3.21).
Women age 50 or less at diagnosis of stage I/II breast cancer had a
higher relative risk of ovarian cancer than those diagnosed with more
advanced breast cancer at the same age (2.24 vs 1.52, P < .05).
Stage did not influence risk in postmenopausal women.
The most immediate implication of her research pertains to how
patients are counseled. Patients do not so commonly die from
breast cancer now, she said. We find it in earlier
stages. Ovarian cancer is a much more lethal disease, and a higher
percentage of women with ovarian cancer die, partly because it is not
detected early. We still do not have a good screening tool for
The main options for high-risk women are triple screening for those
who want to retain childbearing ability, or removal of the ovaries.
If you are younger, a lethal disease portends a much shortened
life, compared with developing the same disease decades later,
Dr. Brewster noted.
Ovariectomy or more intensive screening should be considered, she
said, and this may require a shift in the patients health
Those diagnosed with breast cancer may be less concerned about
having regular pelvic examinations because so much of their attention
has been directed to the breast cancer, Dr. Brewster said.
The patient diagnosed with breast cancer before the age of 50
and the black, Hispanic, or Asian patient with breast cancer should
be counseled to have careful, regular screening due to the increased
risk of ovarian cancer.