Women support delayed removal of ovaries

Expert Guidelines

The National Comprehensive Cancer Network (NCCN) creates guidelines for the management of risk in women at high risk for ovarian cancer. 

• The NCCN recommends risk-reducing salpingo-oophorectomy for women with BRCA1 and BRCA2 mutations. 
  • For women with BRCA1 mutations, the surgery is recommended between ages 35 and 40 and upon completion of childbearing. 
  • For women with BRCA2 mutations, delaying risk-reducing removal of ovaries and fallopian tubes until ages 40 to 45 is considered “reasonable." 
• The NCCN suggests that women with an MLH1, MSH2, MSH6, EPCAM (Lynch syndrome), BRIP1, RAD51C or RAD51D mutation consider undergoing risk-reducing surgery between the ages of 45 and 50. The NCCN states that not enough evidence exists to recommend risk-reducing surgery for all women with a PMS2 mutation.
• Women should discuss the benefits and risks of surgery with their doctors.  
• In their 2020 update, NCCN specifically commented that salpingectomy alone should not be considered standard of care for risk reduction.

Questions To Ask Your Health Care Provider

• Is risk-reducing removal of the fallopian tubes followed by delayed removal of the ovaries (RRESDO) an option for me?
• What can I expect after RRSO?
• What can I expect after RRESDO?
• How do the benefits of RRESDO compare to the risks?
• How would two surgeries with RRESDO impact my quality of life compared to one surgery with RRSO?
• If I have RRESDO, what type of screening should I consider prior to the second surgery?
• Do I qualify for any research studies on ovarian cancer risk reduction?
• I am experiencing menopause effects from my RRSO. Can you refer me to a menopause expert?

Open Clinical Trials

• 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 removal of just the fallopian tubes can reduce the risk of ovarian cancer nearly as much as removing both the ovaries and fallopian tubes among women with an inherited BRCA1 mutation. The study will also exam various patient-reported quality of life outcomes.
• NCT03382574: Pilot Study of Denosumab in BRCA1 or BRCA2 Mutation Carriers Scheduling Risk-Reducing Salpingo-Oophorectomy. This study is looking at the effects of denosumab on ovarian cancer risk markers among premenopausal women with a BRCA1 or BRCA2 mutation, who are scheduled to undergo risk-reducing surgery to remove their ovaries and fallopian tubes. Denosumab is an FDA-approved injectable medication that is used to treat osteoporosis and to prevent fractures in cancer patients with bone metastases.