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Understanding BRCA & HBOC > Risk Management > Surgical Removal of Ovaries & Tubes

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Surgical Removal of Ovaries & Tubes

Learn about the steps that high-risk women can take to manage their risk and protect their health.

Overview

"Oophorectomy" is the removal of the ovaries to treat or prevent ovarian cancer or other ovarian abnormalities.

Prophylactic 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.

New research suggests that some ovarian cancers may actual begin in the fallopian tube research. Some experts have proposed that "interval salpingectomy"—removing the fallopian tubes and leaving the ovaries intact until after natural menopause—might lower risk for ovarian cancer in high-risk women while avoiding the negative side effects and long-term health consequences associated with oophorectomy at a young age. After menopause women would then undergo a second procedure to remove their ovaries.

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.