Risk-reducing early salpingectomy and delayed oophorectomy as a two-staged alternative for primary prevention of ovarian cancer in women at increased risk: a commentary

F. Gaba, J. Piek, U. Menon, R. Manchanda*

*Corresponding author for this work

Research output: Contribution to journalEditorialpeer-review

9 Citations (Scopus)

Abstract

Ovarian cancer (OC) is the leading cause of death from gynaecological malignancies in the UK. Despite considerable funding to develop new treatments, the 10-year survival rate remains poor at ~30%. This translates into 4271 deaths annually in the UK, 42 700 in Europe, and 152 000 deaths annually worldwide. High-penetrance (e.g. BRCA1/BRCA2) and moderate-penetrance (e.g. RAD51C/RAD51D/BRIP1) gene mutations account for most of the known hereditary risk of OC. At least 10% of women with epithelial OC carry these germline mutations. BRCA1/BRCA2 carriers have a 17–44% risk of OC and 65–72% risk of breast cancer (BC), whereas RAD51C/RAD51D/BRIP1 carriers have a 6–11% risk of OC. Primary surgical prevention in the form of risk-reducing salpingo-oophorectomy (RRSO) remains the most effective option and gold standard for OC risk reduction, particularly given the lack of an effective national OC screening programme. The role of RRSO for primary surgical prevention has expanded to include not just BRCA1/BRCA2 carriers but also women at intermediate risk (≥4–5% lifetime-risk of OC). Risk-reducing salpingo-oophorectomy reduces OC risk by 80–96%. Although initial data suggest that premenopausal RRSO reduced BC risk by half, more recent publications have questioned this.1 Nevertheless, RRSO reduces all-cause (hazard ratio, HR = 0.40, 95% CI 0.26–0.61), BC-specific (HR = 0.44, 95% CI 0.26–0.76), and OC-specific (HR = 0.25, 95% CI 0.08–0.75) mortality.2
Original languageEnglish
Pages (from-to)831-839
Number of pages9
JournalBJOG-An International Journal of Obstetrics and Gynaecology
Volume126
Issue number7
DOIs
Publication statusPublished - 8 Feb 2019

Keywords

  • PROPHYLACTIC SALPINGECTOMY
  • MUTATION
  • SURGERY

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