Prophylactic salpingo-oophorectomy in BRCA1/2 carriers

Prophylactic salpingo-oophorectomy has been widely recommended for women with BRCA1 or BRCA2 mutations based on evidence from retrospective studies that have found a strong protective effect against cancers of the ovary and fallopian tube. Now a new international prospective study that included approximately 1,800 women with germline BRCA1 or 2 mutations has found the procedure reduces the overall risk of ovarian, tubal and peritoneal cancers by 80%.

In this study, 30% underwent a bilateral prophylactic salpingo-oophorectomy prior to the study. More than a quarter (27%) underwent the procedure after entering the study, and 43% did not undergo the procedure at all. Thirty-two ovarian, tubal and peritoneal cancers were diagnosed in the women who never received the procedure. Among those who underwent surgery, 11 (2%) were found to have ovarian or tubal cancers at the time of the procedure, and these results parallel those of prior studies. In addition, seven primary peritoneal cancers were diagnosed during follow-up (median 3.5 yrs) after the procedure. The estimated cumulative incidence of peritoneal cancer was 4.3% at 20 years. However, it's impossible to be certain that these "primary peritoneal cancers" were not recurrences of occult ovarian or tubal cancers that were not identified by the pathologist at the time of prophylactic surgery.

The researchers estimated that the risk of ovarian cancer up to age 75 in women with both ovaries is 62% in BRCA1 carriers and 18% in BRCA2 carriers. Because of this, they support the recommendation for prophylactic bilateral salpingo-oophorectomy after age 35 in BRCA1 carriers. While BRCA2 carriers may be able to postpone the procedure until closer to menopause without significantly diminishing the protective effect against ovarian and fallopian tube cancer, waiting diminishes the level of protection the procedure provides against breast cancer.

Finch A, Beiner M, Lubinski J, et al. Salpingo-oophorectomy and the risk of ovarian, fallopian tube, and peritoneal cancers in women with a BRCA1 or BRCA2 mutation. JAMA. 2006;296:185-192.