Women with BRCA1 gene mutations face many decisions upon finding out they have this heightened risk factor for breast and ovarian cancer, as well as other cancers.

People carrying the BRCA1 mutation are at an increased risk for serous/serous-like endometrial cancer, an aggressive form of uterine cancer.

One option to lower their risk for either is surgery, but a new study shows that only removing ovaries and fallopian tubes may not be enough — a hysterectomy could be more effective at cutting their chances of developing the disease.

People carrying the BRCA1 mutation are at an increased risk specifically for serous/serous-like endometrial cancer, an aggressive form of uterine cancer.

The salpingo-oophorectomy (RRSO) surgery — a standard treatment for BRCA+ women with mutations in the BRCA1 gene, BRCA2 gene, or both — may not be enough to protect them. The surgery involves removing a woman’s ovaries and fallopian tubes. A hysterectomy removes the uterus, but not the ovaries and fallopian tubes.

Dr. Noah D. Kauff, director of Clinical Cancer Genetics for the Duke Cancer Institute in Durham, North Carolina, led a team that examined the risk of uterine cancer in women who had RRSO surgery as well as BRCA1 and BRCA2 gene mutations. Without ovaries or fallopian tubes, it created a cleaner subset of people to see if their mutation put them at risk for uterine cancer.

They looked at 1,083 women — of them, 67.1 percent had a history of breast cancer. Of 627 women with BRCA1 mutations, five developed uterine cancer; of 453 women with BRCA2 mutations, three developed uterine carcinoma, a type of uterine cancer.

At seven to 13 years after RRSO, five serous/serous-like endometrial carcinomas were observed. In four out of five of those cases, the women previously had breast cancer (three used tamoxifen). The study was published in JAMA Oncology.

RRSO can still be useful, especially in cases when a woman still wants to conceive in the future, said one oncologist.

Most uterine cancers are carcinomas, Kauff explained to LifeZette. Most uterine carcinomas are associated with an 80 to 85 percent survival rate five years after diagnosis, but serous is a more aggressive type with just a 50 to 55 percent survival rate at five years post-diagnosis.

The authors say there is a 2.6 percent risk of serous/serous-like carcinoma through age 70 for BRCA1+ women who undergo RRSO at age 45.

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“This suggests women with BRCA1 are at increased risk of serous uterine cancer,” Kauff said.

That’s something he thinks doctors and BRCA+ patients should keep in mind when discussing surgical options. RRSO can still be useful, he said, especially in cases when a woman still wants to conceive in the future. But a hysterectomy in addition to RRSO may be more effective in lowering a woman’s risk for uterine cancer if she has the BRCA1 mutation.

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Dr. Konstantin Zakashansky, an associate professor of gynecologic oncology at the Icahn School of Medicine at Mount Sinai in New York City, said women undergoing ovarian removal should “definitely consider” a prophylactic hysterectomy at the same time to lower their uterine cancer risk.

“In a majority of cases, it should not pose significant additional risk to the surgery and can be performed using a minimally invasive approach,” Zakashansky said, noting it could be done via laparoscopy.

Meanwhile, it is most often the individuals and families affected by cancer who lead the charge toward greater awareness, more research, and a cure. As experts uncover more genetic similarities across all cancer types, advocates are hoping people come out to support them during key events. 

In Newport Beach, California, this week, more than 100 breast cancer survivors (women, men and children) as well as supporters brought a pink ribbon to life. Susan G. Komen Orange County is celebrating its 25th anniversary, and Race for the Cure, which last year raised $1.76 million, is scheduled for Sept. 25 at Fashion Island, the Orange County Register reported.

Breast cancer remains the second most common cancer in women after skin cancer, according to the National Cancer Institute.