Risk-reducing salpingo-oophorectomy is offered to women who have higher than average risk to develop ovarian cancer. The average risk of a woman being diagnosed with ovarian cancer by her 85th birthday is 1 in 82 (AIHW 2012). In contrast, women with a mutation in the cancer predisposition genes BRCA1 or BRCA2 have a much higher lifetime risk of breast cancer and ovarian cancer. The risk for BRCA1 mutation carriers is 65% for breast cancer and 39% for ovarian cancer; these risks are 45% and 11%, respectively, for BRCA2 mutation carriers.
Another high risk group is women with MMR (mismatch repair) gene mutation, also called Lynch syndrome or Hereditary Nonpolyposis Colorectal Cancer (HNPCC). Women who carry these mutations have 14% risk to develop ovarian cancer. They are also have a very high risk to develop endometrial/ uterine cancer, up to 71%.
These cancer risks can be greatly reduced with surgery, and in most cases can be completed laparoscopically (key hole).
Risk-reducing salpingo-oophorectomy is removal of the ovaries and fallopian tubes in a woman with a hereditary ovarian cancer syndrome. Risk reduction requires removal of the tubes as well as the ovaries because some malignancies currently categorized as ovarian cancers may arise in the tubal epithelium.
Risk-reducing hysterectomy is removal of uterus in a woman with a hereditary endometrial/ uterine cancer syndrome or women who are planning to take Tamoxifen for chemoprophylaxis of breast cancer.
Women with proven familial cancer syndromes, such as:
●Breast-ovarian cancer syndrome (BRCA mutations)
●Lynch syndrome (HNPCC)
Timing of risk-reducing bilateral salpingo-oophorectomy (rrBSO) requires balancing the procedure-related consequences of sterility and premature menopause against the risk of ovarian and tubal cancer. Generally, rrBSO should be performed as soon as childbearing is complete or by age 40 years.
Similarly risk-reducing hysterectomy should be done as soon as childbearing is complete.
Dr Sem will discuss the best options with you and guide you in making the best decision for your circumstances.
Intensive Screening
Unfortunately, there is no effective screening for ovarian cancer. Approximately 75% of patients with ovarian cancer will present at advanced stage, where overall survival is much lower. Performing regular ultrasound and tumour marker (CA125) has not shown to improve detection rate and overall survival.
Women who have high risk to develop endometrial cancer and not yet ready to undergo risk-reducing hysterectomy, may consider regular hysteroscopy and endometrial sampling. However there are risks associated with this approach, including infection, uterine perforation and anaesthetic risks.
Chemoprophylaxis
Combined oral contraceptive use in BRCA1 and BRCA2 mutation carriers appears to decrease the risk of ovarian cancer.
Estrogen-progestin contraceptives have not been evaluated in women with Lynch syndrome.