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"Oophorectomy" is the removal of the ovaries to treat or prevent ovarian cancer or other ovarian abnormalities. “Risk-reducing salpingo-oophorectomy” (RRSO) refers to the removal of healthy ovaries and fallopian tubes 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. In women at increased risk for ovarian cancer, bilateral risk-reducing salpingo-oophorectomy has been shown to be a highly effective tool to lower the risk for both ovarian cancer and breast cancer.
After risk-reducing salpingo-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. Some 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 BRCA1 mutations undergo bilateral salpingo-oophorectomy (removal of the ovaries and fallopian tubes) between the ages of 35 - 40 or after childbearing is completed. Delaying risk-reducing removal of ovaries and fallopian tubes until age 40-45 is “reasonable” for BRCA2 mutation carriers who have undergone risk-reducing mastectomy, because the average age of ovarian cancer onset is 8-10 years later than in BRCA1 mutation carriers. Guidelines recommend that women with mutations in BRIP1, RAD51C, and RAD51D should consider risk-reducing removal of ovaries and fallopian tubes at age 45-50.
This surgery has been shown through research to improve survival in BRCA mutation carriers. Research on improved survival for women with mutations in other genes that increase ovarian cancer risk is ongoing. 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 surgery 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.