Understanding Previvors and Menopause

with Dr Versha Pleasant

In the realm of healthcare, the term "previvor" is gaining recognition, particularly among those at elevated risk for cancer due to genetic mutations. Unlike cancer survivors, previvors have not developed cancer but are at increased risk due to gene mutations such as BRCA1 and BRCA2. These individuals often face complex decisions regarding preventative measures, including surgeries like mastectomies, to reduce cancer risk.

Genetic Mutations and Cancer Risk

BRCA1 and BRCA2 are the most well-known gene mutations associated with increased breast and ovarian cancer risk. However, other mutations, including ATM, PLB2, CHC2, CDH1, RED51 C&D, STK-11, and TP53, also contribute to elevated cancer risks. The National Comprehensive Cancer Network (NCCN) provides guidelines for managing these risks, which may include early screening and risk-reducing surgeries.

The Role of Preventative Surgery

Risk-reducing mastectomy significantly lowers the risk of developing breast cancer by removing breast tissue. However, it does not eliminate the risk entirely, as some breast tissue may remain. "No matter how skilled a surgeon, a breast surgeon, they cannot remove 100% of the breast tissue," which means a very small potential risk of breast cancer remains. While mastectomy reduces cancer risk, it does not necessarily decrease mortality from breast cancer. Therefore, the decision to undergo such surgery should be carefully considered with healthcare providers.

Menopause and Hormonal Changes

For previvors, particularly those with BRCA mutations, the removal of ovaries can lead to early surgical menopause, impacting hormone levels. The ovaries are the primary source of estrogen, and their removal can lead to symptoms such as hot flashes, night sweats, and increased risks of cardiovascular disease and osteoporosis. Hormone replacement therapy (HRT) can mitigate some of these effects, but its use must be tailored to individual needs and risks.

Hormone Therapy (HT)

HT can be beneficial for managing menopausal symptoms and reducing risks associated with early menopause. However, its application varies based on age and individual health profiles. Studies suggest that HT may offer protective benefits against certain conditions before age 50 but could pose risks after this age. "Menopausal hormone therapy can be very beneficial, but really dependent on sort of context and really dependent on age." Therefore, personalized medical advice is crucial.

Psychological and Emotional Considerations

The psychological impact of early menopause and the decisions surrounding preventative surgeries can be profound. Clinicians can support patients by discussing risks and benefits early, involving mental health professionals, and providing comprehensive care that addresses both physical and emotional well-being.

Conclusion

Navigating the intersection of previvor status and menopause requires informed decision-making and personalized care. Understanding genetic risks, the implications of preventative surgeries, and the role of HT are essential for managing health outcomes. Empowering individuals with knowledge and support from healthcare providers can lead to improved quality of life and better health management.