Our Summary

This research paper looks at whether having preventative surgery to remove the ovaries and fallopian tubes (called prophylactic salpingo-oophorectomy or PSO) can help reduce the risk of death from cancer in patients who have previously had breast cancer and carry specific risky gene variations (BRCA1 or BRCA2).

The study found that this surgery was associated with a significantly lower risk of death, particularly in patients carrying the BRCA1 variant, those with a type of cancer called triple-negative disease, and those with invasive ductal carcinoma. However, this type of surgery did not seem to reduce the risk of cancer returning in the same breast or appearing in the other breast.

On the other hand, preventative removal of the breast (prophylactic mastectomy or PM) did seem to reduce the risk of cancer returning in the same breast, but didn’t affect overall survival or the risk of dying from breast cancer.

In conclusion, the study suggests offering PSO to all patients with BRCA1/2 breast cancer who are having surgery to try to cure their cancer, to reduce their risk of death. In particular, it should be offered to those with the BRCA1 variant at the time of their breast surgery.

FAQs

  1. What is prophylactic salpingo-oophorectomy and who can it benefit?
  2. Does prophylactic salpingo-oophorectomy reduce the risk of breast cancer returning?
  3. Does prophylactic mastectomy affect overall survival or the risk of dying from breast cancer?

Doctor’s Tip

One helpful tip a doctor might tell a patient about salpingo-oophorectomy is to discuss the potential benefits and risks of the surgery, especially in relation to their specific situation and risk factors. It is important to have an open and honest conversation with your healthcare provider to make an informed decision about whether or not to proceed with the surgery. Additionally, patients should be aware of the potential impact of the surgery on their overall health and quality of life, and should discuss any concerns or questions they may have with their doctor.

Suitable For

Overall, patients who are typically recommended salpingo-oophorectomy are those who have a history of breast cancer and carry specific risky gene variations, such as BRCA1 or BRCA2. These patients may benefit from this surgery in terms of reducing their risk of death from cancer, especially if they have triple-negative disease or invasive ductal carcinoma. It is important for healthcare providers to discuss the potential benefits and risks of this surgery with their patients to make an informed decision about their treatment options.

Timeline

Before salpingo-oophorectomy:

  • Patient is diagnosed with breast cancer and carries the BRCA1 or BRCA2 gene mutation
  • Patient undergoes genetic testing to determine if they are at high risk for ovarian and fallopian tube cancer
  • Patient discusses with their healthcare provider the option of prophylactic salpingo-oophorectomy to reduce their risk of cancer
  • Patient undergoes pre-operative testing and counseling to prepare for surgery

After salpingo-oophorectomy:

  • Patient undergoes surgery to remove their ovaries and fallopian tubes
  • Patient may experience side effects such as menopausal symptoms, hormonal changes, and emotional effects
  • Patient is monitored closely by their healthcare team for any post-operative complications
  • Patient may need hormone replacement therapy to manage symptoms of menopause
  • Patient may undergo regular screenings and follow-up appointments to monitor for any signs of cancer recurrence

Overall, salpingo-oophorectomy can be a life-saving surgery for patients at high risk for ovarian and fallopian tube cancer, particularly those with the BRCA1 gene mutation. It is important for patients to discuss their options with their healthcare provider and make an informed decision based on their individual risk factors and preferences.

What to Ask Your Doctor

  1. What is the purpose of salpingo-oophorectomy in my specific case?
  2. What are the potential risks and complications associated with this surgery?
  3. How will this surgery affect my hormone levels and menopausal symptoms?
  4. Will having this surgery reduce my risk of cancer recurrence or death?
  5. Are there any alternative options to reduce my risk of cancer recurrence?
  6. How will this surgery impact my overall quality of life and future health?
  7. What is the recovery process like after salpingo-oophorectomy?
  8. Will I need any additional follow-up care or monitoring after the surgery?
  9. How will this surgery affect my fertility and options for preserving fertility?
  10. Are there any genetic counseling or testing recommendations after undergoing salpingo-oophorectomy?

Reference

Authors: Martelli G, Barretta F, Vernieri C, Folli S, Pruneri G, Segattini S, Trapani A, Carolla C, Spatti G, Miceli R, Ferraris C. Journal: JAMA Surg. 2023 Dec 1;158(12):1275-1284. doi: 10.1001/jamasurg.2023.4770. PMID: 37792368