Ovarian Cancer Balti, Experts ‘Preventive Interventions Only Effective Choice’

“I have a long journey ahead of me, but I know I’ll make it.” Last Sunday, Bianca Balti posted on Instagram that she had undergone surgery for ovarian cancer, after a double mastectomy in December 2022, which she decided to undergo because she was a carrier of the Brca1 genetic mutation, which increases the risk of developing breast and ovarian cancer. On World Gynecological Cancer Day, aBRCAdabra Ets, the first national association created to support all carriers of the pathogenic variant of the Brca1 and Brca2 genes and their families, and which has been collaborating with health workers and institutions for years to promote correct information on Brca-associated tumors, reminds us that prevention, especially in these tumors, is essential.

“Unfortunately, there are still no effective screening tests for ovarian tumors in terms of early diagnosis and reduction of mortality, and this tumor is still the leading cause of death from gynecological cancer,” explains Chiara Cassani, a gynecologist at the University of Pavia – Fondazione Irccs Policlinico San Matteo, and member of the association’s Technical Scientific Committee. “The only effective prevention strategy to reduce risks today is the preventive removal of tubes and ovaries because ultrasound scans and clinical checks are not sufficient to provide the same certainty and in 80% of cases the tumor is discovered in a widespread state, therefore with multiple areas already affected, such as the peritoneum, intestine, liver, diaphragm, omentum.”

The guidelines “are clear on this subject – Cassani emphasizes – There are different ages at which surgery is recommended: 35-40 years for the Brca1 mutation, 40-45 for the Brca2 mutation. In cases like these, however, much also depends on the woman’s will. In any case, these are surgical interventions with definitive consequences, such as the impossibility of having children naturally or the consequences linked to early menopause”. Faced with the news of a tumor, “each woman goes through a unique and personal path of acceptance – the specialist highlights – which also depends a lot on her character and her life choices. It is not an easy path, neither with regard to surgery, nor for the subsequent therapy or the check-ups that will come, which are often and rightly accompanied by stress and fear. It is something that requires commitment and perseverance and does not necessarily bring the desired results”.

It is therefore essential, “especially on this day, to remember the importance of the paths recommended by the guidelines – says Ketta Lorusso, head of Gynecology oncology at Humanitas San Pio X Milan, full professor at Humanitas University and member of the aBRCAdabra technical scientific committee – I believe that the Balti case sheds even more light on the importance of primary prevention that in ovarian cancer can only be done in Brca mutated women. Finding out that you have a mutation that represents an increased risk of contracting ovarian cancer like Brca must not be information that overwhelms us and that we do not know how to manage; on the contrary, it must be managed, because knowing that we have a greater predisposition (the gene does not transmit the disease but a greater predisposition to get sick) to get sick must lead us to implement risk reduction strategies”.

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The message to get across, according to Lorusso, “is very clear: in a tumor that unfortunately has no secondary prevention, because the symptoms are nonspecific and we always arrive very late in diagnosing the disease and because screening doesn’t work, there is no other prevention than primary prevention, which we can only do in Brca-mutated women. In the Balti case – the oncologist points out – Bianca got sick before being able to undergo risk reduction surgery and found the disease already at a third stage. It is important not to lose hope, because today for patients with Brca mutation we have a new class of prodigious drugs, the PARP inhibitors, used as maintenance therapy at the end of first-line chemotherapy and increase survival. We are not just talking about drugs that only slow down the recurrence of the disease, but drugs that help us treat and cure a greater number of patients”.

The personal decision on the timing and methods of intervention of each BRCA-mutated woman is certainly a central issue when talking about preventive interventions. “A carrier woman can choose to undergo the removal of two main target organs, namely the breasts and ovaries, in certain age groups and after a multidisciplinary evaluation. It is a conscious choice that a woman sews on herself and matures over time and is neither right nor wrong, it is her own choice – concludes Ornella Campanella, president of aBRCAdabra – The idea of ​​living with this risk can be very scary, but if we think about it for a moment it is an extraordinary opportunity because it truly allows you to play ahead of cancer and transform a heavy inheritance into an extraordinary life opportunity. We wish Bianca the best of luck and she knows that aBRCAdabra is always by her side”.

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