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"Oophorectomy" is the removal of the ovaries to treat or prevent ovarian cancer or other ovarian abnormalities. “Risk-reducing oophorectomy” refers to the removal of healthy ovaries in women who have an elevated risk for ovarian cancer. Women with elevated hereditary risk for ovarian cancer also have an elevated risk for fallopian tube cancer. For this reason, when their ovaries are removed prophylactically, the fallopian tubes must also be removed.
“Bilateral salpingo-oophorectomy” (BSO) refers to the surgical removal of both ovaries and both tubes. In women at increased risk for ovarian cancer, bilateral prophylactic oophorectomy has been shown to be a highly effective tool to lower the risk for both ovarian cancer and breast cancer.
After prophylactic oophorectomy, there is still a small risk for developing cancer of the “peritoneum,” which is the lining of the abdomen. This type of cancer, called “primary peritoneal cancer,” is related to ovarian cancer. Although the risk remains, it is quite small. Currently there is no proven method of preventing or screening for primary peritoneal cancer.
Previously, all ovarian cancers were believed to develop in the lining of the ovary as a result of the constant rupture and repair process during ovulation. New research, however, suggests that many ovarian cancers in BRCA gene mutation carriers may actually start in the distal fallopian tube (part of the tube closest to the ovary), causing researchers to question whether salpingectomy (removal of the fallopian tubes) might reduce ovarian cancer risk.
Current expert guidelines recommend that women with BRCA mutations undergo bilateral salpingo-oophorectomy (removal of the ovaries and fallopian tubes) between the ages of 35 - 40 or after childbearing is completed. This surgery has been shown through research to improve survival in mutation carriers. However, the surgery also causes immediate surgical menopause, which can be accompanied by short and long-term side effects and health consequences.
Concerns regarding menopausal symptoms should not discourage BRCA mutation carriers from pursuing risk-reducing removal of ovaries and fallopian tubes when appropriate. It is important for women who have undergone surgical menopause or who are considering prophylactic salpingo-oophorectomy to discuss menopausal symptoms and management with their health care team. Effective treatment for such symptoms is available, and is considered appropriate for many women with BRCA mutations.
The decision to undergo prophylactic surgically is highly personal. Confronting your personal cancer risk can be confusing and frustrating. Therefore, it is important to consult with experts in genetics and gynecologic oncology when determining your risk for ovarian cancer and making the risk-management decisions that are best for you.