BRIP1: Screening & Prevention

45-50
(or earlier based on the youngest case of ovarian cancer in the family)

Surgical removal of ovaries and fallopian tubes

Risk-reducing removal of ovaries and fallopian tubes (RRSO).

• Discuss your plans for pregnancy and fertility concerns with your doctor, and request a referral to a fertility specialist if indicated.
• Discuss options for managing the effects of early menopause with your doctor.
• 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.

At the time of surgical removal of the ovaries

Surgical removal of the uterus

BRIP1 mutations are not known to increase the risk of endometrial cancer. However, some people may choose to have their uterus removed at the time as risk-reducing surgery to remove the ovaries and fallopian tubes.

Talk with your healthcare team about the possible benefits, risks and costs of hysterectomy as part of your surgical plan.

The following factors may affect your decision about hysterectomy at the time of RRSO:

• If you have a medical history of fibroids or other issues involving the uterus or cervix you might consider a hysterectomy.
• If you are considering hormone replacement, the type of hormone recommended depends on whether or not you have your uterus.
  • Estrogen alone increases the risk for uterine cancer.
  • Estrogen combined with progesterone protects against uterine cancer, but is linked to a higher risk for breast cancer than estrogen alone.

Before age 50

Salpingectomy (removal of the fallopian tubes only)

Researchers are studying whether the removal of the fallopian tubes only (salpingectomy), while delaying oophorectomy until closer to the age of natural menopause is a safe option for lowering risk in people who are not ready to remove their ovaries. If you are interested in this approach, talk with your doctor about the benefits and risks, and consider enrolling in a research study.

• Salpingectomy, followed by delayed oophorectomy requires two separate surgeries.
• At this time, it is not known how effective salpingectomy is for lowering the ovarian cancer risk in high-risk people.

For women who choose this surgery, the guidelines also recommend the following:

• If you choose to have risk-reducing salpingectomy first, the guidelines recommend that you undergo surgery to remove your ovaries (known as a completion oophorectomy) at the recommended age.
• Discuss your plans for pregnancy and fertility concerns with your doctor, and request a referral to a fertility specialist prior to surgery.
• The surgery should include a procedure known as an abdominal wash at the time of surgery. The pathologist should do an extensive exam of the fallopian tubes using a procedure called SEE-FIM to look for any abnormal changes in the tissue.
• If an abnormality known as a "serous tubal intraepithelial carcinoma" or STIC lesion is noted in your pathology report, you should be referred to a gynecologic oncologist for follow up care.

No set age

Medications to lower your risk

Oral contraceptives (birth control pills) have been shown to lower the risk for ovarian cancer in people with increased risk. Have a discussion with your doctor about the benefits and risks of oral contraceptives for lowering ovarian cancer risk.

Research on the effect of oral contraceptives on breast cancer risk has been mixed.

No set age

Symptom awareness

Become aware of ovarian and primary peritoneal cancer symptoms. Report any symptoms that persist for several weeks and are a change from normal to your doctor.

Routine ovarian cancer screening using transvaginal ultrasound and a CA-125 blood test has not shown benefit and is not recommended.

Symptoms of ovarian cancer include:

• pelvic or abdominal pain
• bloating or distended belly
• difficulty eating
• feeling full sooner than normal
• increased urination or pressure to urinate