Our Summary

This research paper investigates whether a certain type of surgery, called risk-reducing salpingo-oophorectomy (RRSO), affects the chance of women with specific genetic traits (BRCA1 and BRCA2 pathogenic variants) getting breast cancer. Women with these genetic traits are more likely to develop breast and ovarian cancer, and RRSO is a surgery often used to reduce the risk of ovarian cancer.

The researchers looked at data from 876 families who were part of the Breast Cancer Family Registry. They found that RRSO was associated with a decreased risk of breast cancer for women with the BRCA1 and BRCA2 pathogenic variants, especially in the first 5 years after the surgery. After 5 years, this protective effect was less strong, and for BRCA2 mutation carriers, it almost disappeared.

The researchers concluded that while RRSO is primarily used to prevent ovarian cancer, it’s also important to consider its impact on breast cancer risk. According to their findings, RRSO can reduce the risk of breast cancer, particularly in the first 5 years after surgery, for women carrying these specific genetic traits. This information could be useful for doctors and patients when deciding whether and when to have this surgery.

FAQs

  1. What is risk-reducing salpingo-oophorectomy (RRSO) and why is it used?
  2. How does RRSO affect the risk of breast cancer in women with BRCA1 and BRCA2 pathogenic variants?
  3. Does the protective effect of RRSO against breast cancer last indefinitely for women with BRCA1 and BRCA2 mutations?

Doctor’s Tip

One helpful tip a doctor might tell a patient about salpingo-oophorectomy is to discuss the potential impact on breast cancer risk, especially if the patient has specific genetic traits like BRCA1 and BRCA2 pathogenic variants. It’s important to understand that while RRSO is primarily aimed at reducing ovarian cancer risk, it can also have a protective effect on breast cancer, particularly in the first 5 years after the surgery. Patients should weigh this information when considering the timing and necessity of undergoing this procedure.

Suitable For

Patients who are typically recommended salpingo-oophorectomy include:

  1. Women with BRCA1 and BRCA2 pathogenic variants: Women who have these genetic mutations are at a higher risk of developing breast and ovarian cancer. Salpingo-oophorectomy can help reduce the risk of ovarian cancer in these patients and may also have a protective effect against breast cancer, especially in the first 5 years after surgery.

  2. Women with a strong family history of ovarian and breast cancer: Women who have a family history of these cancers may be recommended salpingo-oophorectomy to reduce their risk of developing ovarian and breast cancer.

  3. Women with a personal history of breast cancer: Some women who have already been diagnosed with breast cancer may choose to undergo salpingo-oophorectomy as a risk-reducing measure to decrease their chances of developing ovarian cancer in the future.

  4. Women with other high-risk factors for ovarian cancer: Women with certain medical conditions or risk factors that increase their likelihood of developing ovarian cancer may also be recommended salpingo-oophorectomy as a preventive measure.

Overall, the decision to undergo salpingo-oophorectomy should be made in consultation with a healthcare provider, considering individual risk factors, genetic mutations, and personal preferences.

Timeline

Before salpingo-oophorectomy:

  • Patients with BRCA1 and BRCA2 pathogenic variants may have a higher risk of developing breast and ovarian cancer.
  • Patients may undergo genetic testing to determine if they carry these genetic traits.
  • Patients may discuss their options with their healthcare provider, including the possibility of undergoing risk-reducing salpingo-oophorectomy.
  • Patients may undergo counseling to understand the potential risks and benefits of the surgery.
  • Patients may undergo pre-surgical tests and evaluations to ensure they are medically fit for the procedure.

After salpingo-oophorectomy:

  • In the immediate post-operative period, patients may experience pain, discomfort, and fatigue.
  • Patients may need to stay in the hospital for a few days for monitoring and recovery.
  • Patients will need to follow post-operative care instructions, which may include restrictions on physical activity and lifting heavy objects.
  • Patients may experience menopausal symptoms due to the removal of the ovaries.
  • Patients will need to attend follow-up appointments with their healthcare provider to monitor their recovery and discuss any concerns or complications.
  • Patients may undergo regular screening for breast cancer, as the risk-reducing effect of the surgery may decrease over time, especially for BRCA2 mutation carriers.

What to Ask Your Doctor

  1. What is the purpose of salpingo-oophorectomy and how does it relate to my specific genetic traits (BRCA1 and BRCA2 pathogenic variants)?

  2. What are the potential risks and benefits of undergoing salpingo-oophorectomy for reducing the risk of ovarian and breast cancer?

  3. What is the recommended age or timing for undergoing salpingo-oophorectomy in relation to my genetic traits and personal health history?

  4. How will salpingo-oophorectomy impact my hormone levels and menopausal symptoms?

  5. What are the potential long-term effects and considerations to be aware of after undergoing salpingo-oophorectomy?

  6. Are there any alternative risk-reducing strategies or treatments that I should consider before deciding to undergo salpingo-oophorectomy?

  7. What is the post-operative recovery process like and what follow-up care will be necessary after the surgery?

  8. How often should I undergo screenings or surveillance for breast and ovarian cancer after undergoing salpingo-oophorectomy?

  9. Are there any specific lifestyle changes or precautions I should take after undergoing salpingo-oophorectomy to further reduce my cancer risk?

  10. What are the chances of developing breast cancer after undergoing salpingo-oophorectomy, especially in the long term?

Reference

Authors: Choi YH, Terry MB, Daly MB, MacInnis RJ, Hopper JL, Colonna S, Buys SS, Andrulis IL, John EM, Kurian AW, Briollais L. Journal: JAMA Oncol. 2021 Apr 1;7(4):585-592. doi: 10.1001/jamaoncol.2020.7995. PMID: 33630024