Tracking a Killer
Dr. Steven Narod's work on identifying the link between mutations in the genes BRCA1 and BRCA2 and hereditary breast cancer opened the door for additional research. His new program of work is directed at translating the emerging knowledge into the prevention and management of breast and ovarian cancer.
His program is divided into four research themes.
Dr. Narod's first task is to identify gene/environment interactions in hereditary breast cancer. He will track approximately 5,000 women who carry the genetic mutation. The risk of breast cancer will be correlated with predictive factors and the information will be used to identify potential modifiers of cancer risk in this high risk group.
The second phase will focus specifically on preventive oophorectomy - removal of one or both ovaries. Because women who carry a mutation of BRCA1 have a lifetime risk of approximately 40 percent of developing ovarian cancer, prevention of the disease in these women is critically important. Current prevention techniques include oral contraceptives, tubal ligation and prophylactic oophorectomy, but the latter carries with it some impairment of quality of life. The purpose of Dr. Narod's study is to evaluate the impact of prophylactic surgical oophorectomy on the lives of 300 women over a five-year period. In addition to assessing quality of life issues, the study will measure the level of risk reduction of ovarian and peritoneal cancer, and establish whether the risk reduction is related to the age of the surgery, the surgical procedure, previous use of oral contraceptives and/or tubal ligation.
In his third phase of research, Dr. Narod will seek to identify the relationship of several treatment factors - including surgery, radiotherapy, chemotherapy and the drug tamoxifen - to selected outcomes in women with BRCA1 or BRCA2 mutations.
Finally, Dr. Narod will calculate the risk of developing breast cancer for non-carriers, with regard to age, family history and the degree of relationship from affected women.