1. Home>
2. Specialties>
3. General Medicine>
4. Summary and Comment

Prophylactic Oophorectomy in Women with BRCA Mutations

Women with BRCA mutations who underwent prophylactic oophorectomy developed fewer ovarian cancers than did those who chose surveillance only.

Women who have inactivating mutations in the BRCA1 or BRCA2 genes have higher risks for breast and ovarian cancer. In 2 studies, investigators evaluated whether prophylactic oophorectomy reduced subsequent risk for either cancer.

In a prospective follow-up study, researchers enrolled 170 eligible women (age, 35 or older) with BRCA mutations who were referred for genetic counseling at Memorial Sloan-Kettering Cancer Center during 6 years; 98 women underwent prophylactic bilateral salpingo-oophorectomy, and 72 chose surveillance (mean follow-up, 24 months). Among women who selected surveillance, breast cancer was diagnosed in 8, ovarian cancer in 4, and peritoneal cancer in 1. Among women who underwent salpingo-oophorectomy, breast cancer was identified subsequently in 3 and peritoneal cancer in 1; 3 early-stage ovarian cancers were found at surgery. The hazard ratio for the development of breast or BRCA-related gynecologic cancer after salpingo-oophorectomy was 0.25.

In a retrospective multicenter study, 6 of 259 BRCA-positive women were found to have stage I ovarian cancer at the time of prophylactic oophorectomy, and 2 subsequently developed peritoneal carcinomas. Among 292 matched controls who didn't undergo prophylactic surgery, 58 were diagnosed with ovarian cancer during a mean follow-up of 8.8 years. Thus, oophorectomy reduced the subsequent risk for ovarian or peritoneal cancer by 96%. In a subgroup analysis to determine breast-cancer risk, 21 of 99 women who underwent oophorectomy developed breast cancer compared with 60 of 142 controls (risk reduction, 53%).

Comment: As noted by an editorialist, the effectiveness of prophylactic oophorectomy in carriers of BRCA mutations provides a rationale for genetic testing of women with family histories of breast cancer.

— Robert W. Rebar, MD

Published in Journal Watch General Medicine June 14, 2002

Citation(s):

Kauff ND et al. Risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 mutation. N Engl J Med 2002 May 23; 346:1609-15.

• Medline abstract (Free)

Rebbeck TR et al. Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations. N Engl J Med 2002 May 23; 346:1616-22.

• Medline abstract (Free)

Haber D. Prophylactic oophorectomy to reduce the risk of ovarian and breast cancer in carriers of BRCA mutations. N Engl J Med 2002 May 23; 346:1660-2.

• Medline abstract (Free)

2011 Year in Review