Prophylactic oophorectomy

Increases life expectancy by 1.7 years for women aged 30 years with a BRCA 1 or BRCA 2 mutation.

Associated with reduced risk of ovarian and fallopian tube cancer in high risk women carriers of BRCA1 and BRCA2 mutations, but there remains a substantial risk for the development of peritoneal cancer.

A recent study suggests that the risk of ovarian, fallopian, and peritoneal cancer is reduced by 80% with prophylactic oophorectomy.

For women who are carriers of BRCA1 or BRCA2 mutations preventive oophorectomy reduces the risk of ovarian, fallopian tube, or peritoneal cancer and all cause mortality (Finch A et al).

In the above study 5,783 women followed for an average of 5.6 years: at the time of prophylactic oophorectomy 4.2% of women with the BRCA1 mutation had previously undiagnosed invasive cancer, as did 0.6% of women with the BRCA2 mutation.

Since the majority of patients with BRCA 1 carriers are estrogen receptor negative the reduced cancer mortality effect was unexpected. This

Prophylactic oophorectomy recommended at age 35 for women with the BRCA1 mutation, and probably also for BRCA 2 mutation.

Prophylactic oophorectomy following diagnosis of breast cancer among women with BRCA1 or BRCA2 mutation reduces the risk of dying of breast cancer: In a study of 676 women with the above mutations 345 underwent bilateral oophorectomy the adjusted hazard ratio was 0.38 for BRCA1 carriers. and 0.57 for BRCA2 carriers. (Metcalfe K et al).

Also reduces risk of breast cancer by 60%.

Among more than 25,000 women without a family history of ovarian cancer who had a hysterectomy, those keeping their ovaries were later diagnosed with ovarian cancer at a rate of 0.33%, compared with 0.02% in the women who also had elective bilateral salpingo-oophorectomy ( Jacoby VL et al).

In the above study no evidence of increased morbidity or mortality among the women choosing simultaneous BSO and hysterectomy, and cardiovascular events, hip fracture, and breast cancer were no more common in women undergoing BSO than in those choosing ovarian conservation.

Current guidelines from the American Congress of Obstetricians and Gynecologists recommends BSO for women known to be at risk for ovarian cancer but ovarian preservation in those without such risk.

The above findings are from the Women’s Health Initiative Observational Study, which enrolled 25,448 postmenopausal women who had previously had hysterectomies and no family history of ovarian cancer with slightly more than half (56%) had also undergone BSO along with the hysterectomy.

Leave a Reply

Your email address will not be published. Required fields are marked *