Our Summary

This research paper reviews the effectiveness of a risk-reducing surgery for women carrying BRCA1 or BRCA2 mutations, which significantly increase the risk of developing certain cancers. These mutations are associated with a higher likelihood of developing breast cancer and high-grade serous cancer (HGSC) of ovarian, tubal and peritoneal origin. The surgery in question, known as risk-reducing salpingo-oophorectomy (RRSO), involves removing the ovaries and fallopian tubes to reduce the risk of cancer.

The researchers analyzed 10 studies, involving over 8,000 participants, to assess the benefits and potential harms of RRSO in women with BRCA1 or BRCA2 mutations. They found that overall survival was longer for women who had undergone RRSO compared to those who had not. Moreover, the surgery was associated with lower mortality rates from HGSC and breast cancer.

However, the authors caution that the evidence quality was very low due to potential bias and the study designs. They also note that there was insufficient data on potential adverse effects of the surgery, such as bone fractures, quality of life changes, or severe adverse events. Furthermore, they found no evidence to support differential effects of the surgery based on the specific type of mutation (BRCA1 or BRCA2) or the age at which the surgery was performed.

In conclusion, while the research suggests that RRSO may increase overall survival and lower HGSC and breast cancer mortality for BRCA1 and BRCA2 carriers, the authors advise that these results should be interpreted with caution, and that further research is needed.

FAQs

  1. What is risk-reducing salpingo-oophorectomy (RRSO) and who is it for?
  2. What were the findings of the research regarding the effectiveness of RRSO in women with BRCA1 or BRCA2 mutations?
  3. What are the potential adverse effects of the risk-reducing salpingo-oophorectomy (RRSO) and were they considered in the research?

Doctor’s Tip

A doctor might tell a patient considering salpingo-oophorectomy that while the surgery may reduce their risk of developing certain cancers, it is important to weigh the potential benefits against the risks and potential adverse effects. They may also recommend discussing the decision with a genetic counselor to fully understand the implications of their BRCA1 or BRCA2 mutation and the potential impact of the surgery on their overall health and quality of life. Additionally, the doctor may advise the patient to continue regular screenings and follow-up care even after undergoing the surgery.

Suitable For

Patients who are typically recommended salpingo-oophorectomy include:

  1. Women with BRCA1 or BRCA2 mutations: These mutations significantly increase the risk of developing breast cancer and high-grade serous cancer of ovarian, tubal, and peritoneal origin. RRSO can reduce the risk of developing these cancers in women with these mutations.

  2. Women with a strong family history of breast or ovarian cancer: Even in the absence of known genetic mutations, women with a strong family history of these cancers may be recommended to undergo RRSO to reduce their risk.

  3. Women with a personal history of breast cancer: Women who have already been diagnosed with breast cancer may be recommended to undergo RRSO as a risk-reducing measure to prevent the development of ovarian cancer.

  4. Women with a personal history of ovarian cancer: Women who have been diagnosed with ovarian cancer may also be advised to undergo RRSO to reduce the risk of developing a second primary cancer in the ovaries or fallopian tubes.

  5. Women with other genetic mutations associated with an increased risk of ovarian cancer: In addition to BRCA1 and BRCA2 mutations, there are other genetic mutations, such as Lynch syndrome, that are associated with an increased risk of ovarian cancer. Women with these mutations may also be recommended to undergo RRSO.

Overall, the decision to undergo salpingo-oophorectomy is typically made on a case-by-case basis, taking into account the individual’s personal and family medical history, genetic mutations, and overall risk factors for developing ovarian and breast cancer.

Timeline

Before Salpingo-Oophorectomy:

  • Patient is identified as carrying BRCA1 or BRCA2 mutations, which increase the risk of certain cancers
  • Patient undergoes genetic counseling and testing to assess their risk
  • Patient may choose to undergo regular screenings or opt for risk-reducing surgery
  • Patient discusses the potential benefits and risks of salpingo-oophorectomy with their healthcare provider
  • Patient undergoes pre-operative evaluations and tests to ensure they are a suitable candidate for surgery

After Salpingo-Oophorectomy:

  • Patient undergoes the surgical procedure to remove the ovaries and fallopian tubes
  • Patient may experience side effects such as pain, fatigue, and temporary hormonal changes
  • Patient follows post-operative care instructions provided by their healthcare provider
  • Patient may undergo hormone replacement therapy to manage menopausal symptoms
  • Patient undergoes regular follow-up appointments to monitor their health and discuss any concerns or symptoms
  • Patient may experience long-term benefits such as lower risk of developing ovarian and breast cancer, and potentially longer overall survival

Overall, the decision to undergo salpingo-oophorectomy is a personal one that should be made in consultation with healthcare providers and based on individual risk factors and preferences.

What to Ask Your Doctor

  1. What are the potential benefits of undergoing a risk-reducing salpingo-oophorectomy (RRSO) for women with BRCA1 or BRCA2 mutations?
  2. What are the potential risks or adverse effects associated with RRSO?
  3. How will RRSO impact my risk of developing breast cancer and high-grade serous cancer?
  4. Are there any alternative risk-reducing strategies or treatments that I should consider before undergoing RRSO?
  5. What is the recommended age for undergoing RRSO for women with BRCA1 or BRCA2 mutations?
  6. How will RRSO affect my hormone levels and menopausal symptoms?
  7. How often will I need follow-up appointments or monitoring after undergoing RRSO?
  8. Will RRSO impact my fertility or ability to have children in the future?
  9. Are there any lifestyle changes or precautions I should take after undergoing RRSO?
  10. Can you provide me with more information or resources about RRSO and its potential benefits and risks?

Reference

Authors: Eleje GU, Eke AC, Ezebialu IU, Ikechebelu JI, Ugwu EO, Okonkwo OO. Journal: Cochrane Database Syst Rev. 2018 Aug 24;8(8):CD012464. doi: 10.1002/14651858.CD012464.pub2. PMID: 30141832