Study: Risk-reducing ovarian cancer surgery and quality of life
People with an inherited BRCA gene mutation are recommended to have surgery to remove their ovaries before the age of natural menopause to reduce their risk of ovarian cancer. This surgery can cause short-term and long-term effects. This study assesses the quality of life among people who have their fallopian tubes surgically removed and later have their ovaries removed compared to people who have their ovaries and fallopian tubes removed at the same time. (Posted 7/26/22). Este artículo está disponible en español.
Contents
At a glance | Guidelines |
Study findings | Questions for your doctor |
Strengths and limitations | Clinical trials |
What does this mean for me? | Related resources |
STUDY AT A GLANCE
What is this study about?
This study is about menopause-related quality of life in people with an inherited mutation who had surgery to reduce their ovarian cancer risk. The researchers compared people who first removed their only (risk-reducing or RRS) and later removed their ovaries to people who had their fallopian tubes and ovaries removed at the same time (risk-reducing salpingo-oophorectomy or ). See image of reproductive tract below.
Why is this study important?
Current guidelines recommend RRSO (removal of the ovaries and fallopian tubes) for people with an inherited BRCA mutation—between ages 35-40 for and ages 40-45 for –who have completed childbearing. However, risk-reducing removal of the ovaries at these ages results in early menopause and may lead to related short-term (hot flashes, sleep disturbances, impaired sexual function and others) and long-term (possible risk of heart disease, , impairment and others) effects.
Experts believe that the most common type of ovarian cancer usually begins in the fallopian tubes. This knowledge shift regarding where ovarian cancer begins has led to the possibility that risk-reducing removal of the fallopian tubes followed by delayed removal of the ovaries could lower cancer risk while postponing menopause and the associated side effects.
Study findings
A total of 577 people participated in this study, with an average age of 37. Among these participants:
- 297 had a BRCA1 mutation.
- 280 had a BRCA2 mutation.
- 394 patients had RSS (removal of fallopian tubes)
- 154 had RRSO (removal of both fallopian tubes and ovaries)
Quality of life, sexual distress and functioning were measured at three months and again at one year after surgery.
- Reported quality of life was better among participants who only had their fallopian tubes removed (RSS) compared to participants who had their fallopian tubes and ovaries removed (RSSO) in a single procedure.
- Comparatively, patients who had RRS reported a better quality of life, even when patients who had RRSO used hormone replacement therapy.
- People who chose RRSO reported more impaired sexual function after their surgery compared to those who chose RRS with delayed RRO.
- People who chose RRSO reported more sexual distress after their surgery compared to those who chose RRS with delayed RRO.
Overall, patients have better menopause-related quality of life after RRS than after RRSO. In this study, this was true regardless of whether or not a patient took hormone replacement therapy. Even though patients who used hormone replacement therapy after RRSO had worse symptoms than patients who chose RRS, using hormonal replacement therapy after RRSO did reduce the severity of symptoms after RRSO compared to patients who did not use hormone replacement after RRSO.
Strengths and limitations
Strengths
- This was a study conducted at all university hospitals and some general hospitals in the Netherlands. Patients were followed up at 3 and 12 months after surgery.
- A large number of participants were included in the study, many of whom chose RRS with delayed RRO.
Limitations
- The study was not designed to show whether people who chose RRSO had a lower risk for developing ovarian cancer compared with people who chose RRS with delayed RRO. We still do not yet know if RRS with delayed RRO is as effective as RRSO for reducing ovarian cancer risk. Another study known as SOROCk is looking at this outcome but will not have results for at least another 10 years.
- Participants chose which surgery they preferred (RRS with delayed RRO or RRSO). Patient preference may have biased the results.
What does this mean for me?
Current guidelines recommend risk-reducing removal of the ovaries and fallopian tubes (RRSO) between ages 35-40 for BRCA1 mutation carriers and ages 40-45 for BRCA2 mutations carriers upon completion of childbearing.
This study in the Netherlands found that patients with a BRCA mutation have better menopause-related quality of life after an RSS than an RRSO. (RSS is not standard of care in the US.) A similar study called WISP (which is no longer enrolling participants) is being conducted in the US. A much larger, longer-term study called SOROCk is currently enrolling BRCA1 mutation carriers in the US. The goal of SOROCk is to learn if RRS with delayed RRO lowers ovarian cancer risk as safely and effectively as RRSO.
Reference
Steenbeek MP, Harmsen MG, Hoogerbrugge N, et al. Association of Salpingectomy With Delayed Versus Salpingo-oophorectomy With Quality of Life in BRCA1/2 Pathogenic Variant Carriers: A Nonrandomized Controlled Trial. JAMA Oncol. 2021;7(8):1203–1212.
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posted 7/26/22
The National Comprehensive Cancer Network (NCCN) provides guidelines for the management of gynecologic cancer risk in people with BRCA1 and BRCA2 mutations.
Prevention
- Risk-reducing removal of ovaries and fallopian tubes, (known as risk-reducing salpingo-oophorectomy or RRSO) is recommended between ages 35-40 for BRCA1 and 40-45 for BRCA2 and upon completion of childbearing.
- Research shows that removing the ovaries can increase survival for women with BRCA1 or BRCA2 mutations.
- Women should talk with their doctors about the effects of early menopause and options for managing them.
- Women should talk with their doctors about the risks and benefits of keeping or removing their uterus (hysterectomy), including:
- Women with a BRCA1 or BRCA2 mutation have an increased risk for a rare form of aggressive uterine cancer; hysterectomy removes this risk.
- For women considering hormone replacement after surgery, the presence or absence of a uterus can affect the choice of hormones used.
- Estrogen-only hormone replacement is less likely to increase the risk for breast cancer, although it increases the risk for uterine cancer. Women who still have their uterus are typically given hormone replacement with both and progesterone.
- Adding progesterone to estrogen hormone replacement can protect against uterine cancer. However, the combination of these hormones may increase the risk for breast cancer more than estrogen alone.
- A medical history of fibroids or other uterine or cervical issues may justify a hysterectomy.
- Oral contraceptives (birth control pills) have been shown to lower the risk for ovarian cancer in women with BRCA mutations. Research on the effect of oral contraceptives on breast cancer risk has been mixed. Women should discuss the benefits and risks of oral contraceptives for lowering ovarian cancer risk with their doctors.
- Removal of the fallopian tubes only (salpingectomy) is being studied as an option for lowering risk in high-risk women who are not ready to remove their ovaries. Studies on the effects of salpingectomy are ongoing. Whether salpingectomy lowers the risk for ovarian cancer in high-risk women remains unknown.
- Consider enrolling in a research study looking at this procedure to lower cancer risk.
Screening
- There are no proven benefits to routine ovarian cancer screening using transvaginal and a blood test. These tests are not currently recommended.
- After RRSO, a very small risk remains for a related cancer known as primary peritoneal cancer (PPC). There is no effective screening for PPC after RRSO
- Women should be aware of the symptoms of gynecologic cancer and report abnormalities to their doctors, particularly if they persist for several weeks and are a change from normal. These symptoms can include:
- pelvic or abdominal pain
- bloating or distended belly
- difficulty eating
- feeling full sooner than normal
- increased urination or pressure to urinate
Updated: 01/29/2025
- Am I a candidate for RRS followed by delayed RRO to reduce my ovarian cancer risk?
- Do you recommend hormone replacement therapy after RRSO?
- Are there other ways to reduce my menopausal symptoms after RRSO instead of or in addition to hormone replacement therapy?
- Are there other ways to lower my risk for ovarian cancer?
The following are studies looking at ovarian cancer screening or prevention.
- NCT04251052: A Study to Compare Two Surgical Procedures in Women with BRCA1 Mutations to Assess Reduced Risk of Ovarian Cancer (SOROCk). This study is looking at whether women with BRCA1 mutations who remove just the fallopian tubes can reduce the risk of ovarian cancer nearly as much as women who remove their ovaries and fallopian tubes.
- NCT05287451: Risk Reducing Salpingectomy With Delayed Oophorectomy as an Alternative to Risk- Reducing Salpingo-oophorectomy in High Risk-Women to Assess the Safety of Prevention. This study will look at outcomes in women with BRCA1, BRCA2, , and who remove their fallopian tubes, followed by removal of their ovaries compared to women who undergo standard-of-care removal of their ovaries and fallopian tubes at the same time.
- Validating a Blood Test for Early Ovarian Cancer Detection in High-risk Women and Families: MicroRNA Detection Study (MiDE). The goal of MiDe is to develop a test to detect early-onset ovarian cancer. Currently, no reliable screening or early detection tests are available. Participants can be expected to provide up to 4 tubes of blood every 6 months for up to 5 years. These samples can be collected by mobile phlebotomy all around the US.
Additional clinical trials for ovarian cancer screening and prevention may be found here.
Updated: 04/10/2025
FORCE offers many peer support programs for people with inherited mutations.
- Our Message Boards allow people to connect with others who share their situation. Once registered, you can post on the Diagnosed With Cancer board to connect with other people who have been diagnosed.
- Our Peer Navigation Program will match you with a volunteer who shares your mutation and situation.
- Our moderated, private Facebook group allows you to connect with other community members 24/7.
- Check out our virtual and in-person support meeting calendar.
- Join one of our Zoom community group meetings.
Updated: 08/06/2022
Who covered this study?
cancernetwork
Risk-Reducing Salpingectomy Yields Higher QoL for BRCA1/2 Pathogenic Variant Carriers With Gynecologic Cancer
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