Women who carry the BRCA1 or BRCA2 (BRCA1/2) gene mutation linked to breast and ovarian cancer may experience menopause a few years earlier than other women, a new study says.
Infertility is already a major concern faced by these women, who may opt to undergo surgery to remove their ovaries and breasts to lessen their risk of cancer or who feel under tremendous pressure to start a family before undergoing surgery.
BRCA mutation carriers’ cancer risk is substantially higher than non-carriers and increases dramatically with each decade of age. For many of those at risk, disease may develop at an early age.
"Now they have an additional issue to deal with," says Dr. Mitchell Rosen, a reproductive endocrinology and fertility expert at University of California, San Francisco Medical Center, and lead author of the new study.
"The earlier you go into menopause, the more likely you are to not be able to have kids," Rosen told Reuters Health.
BRCA1/2 gene mutations are passed down through families and in addition to breast and ovarian cancers, carriers are at higher risk than most people of developing several other cancer types, including fallopian tube cancer, endometrial, pancreatic, and prostate cancer in men.
Though rare, it is estimated that the BRCA1/2 mutation is found in 2 to 6 percent of all breast cancer patients, and 10 to 15 percent of epithelial ovarian cancer patients, according to a recent review article published in International Journal of Surgical Oncology.
Under normal conditions, the BRCA genes are tumor suppressors that help prevent cancer by repairing damaged cells. An average woman’s lifetime risk for breast cancer is 1 in 8 and the risk for ovarian cancer is 1 in 70.
However, research shows inheriting one mutant copy of the BRCA gene predisposes an individual to familial breast and ovarian cancer. The BRCA1 mutation is associated with an 80 percent lifetime risk of breast and ovarian cancer, according to Tufts University.
A number of studies examining the incidence of breast cancer report a lower risk with a BRCA2 mutation compared to individuals with BRCA1, the International Journal study points out.
In the new study, Rosen and colleagues surveyed 382 California women known to carry either BRCA mutation, and another 765 non-carrier women to determine if the onset of menopause is affected by the BRCA mutation.
Women in the study went through menopause naturally rather than undergoing surgery to remove their ovaries. Researchers compared the median age of both groups accounting for other risk factors, such as smoking and contraceptive use.
After controlling for other risk factors, women in the BRCA-mutation carrier group were significantly younger (50 years) at the start of natural menopause than the non-carrier group (53 years), the new study found.
The researchers also found smoking further compounds the risk of early menopause by severely shortening women’s reproductive years.
Among BRCA1/2 carriers who were current heavy smokers — those smoking about a pack a day — the youngest stopped menstruating by age 46, a full seven years earlier than average, according to the study published in the Jan 29, 2013 online edition of the Journal Cancer.
All the women in the study were white, so it’s unknown if the findings translate to other racial and ethnic groups. It’s also unclear if mutation carriers face heightened difficulties in conceiving, although Rosen and his colleagues suspect they might.
Ellen Matloff, director of cancer genetic counseling at the Yale Cancer Center in New Haven, Connecticut, and who isn’t connected with the new study, said that since most women carrying the BRCA1/2 mutation opt to have their ovaries surgically removed before natural menopause kicks in, it’s likely the findings will have little impact on their choice to start a family, reported Reuters Health.
"This study does not mean that you can't have children, and it doesn't mean that you have less time than you thought you did," Mattloff said, adding more research is needed to confirm the findings.
Still Rosen said that women who carry the BRCA mutation should always be counseled on fertility issues and told about options such as freezing eggs or embryos. He also encourages that embryos be tested to see if they too carry the genetic mutation.
Lynette Summerill is an award-winning writer and Scuba enthusiast who lives in San Diego with her husband and two beach loving dogs. In addition to writing about cancer-related issues for EmpowHER, her work has been seen in newspapers and magazines around the world.