Prophylactic oophorectomy: why and when?

Ovarian cancer presents at a late stage and is associated with a very poor chance of cure. Ability to predict women who are at genetic risk has directed our thoughts to the possibility that the timely removal of the ovaries in these women is likely to prevent cancer and save lives. Only approximately 10% of ovarian cancers arise as a result of an inherited condition; it is this group which is most likely to benefit from prophylactic oophorectomy. Women in this group may be identified following referral on the basis of personal or family histories of disease. With continued improvement in genetic screening, the literature regarding prevention of ovarian cancer appears to be moving beyond the appropriateness of prophylactic oophorectomy to a discussion of the technical aspects of the procedure. There is little doubt that this type of surgical prophylaxis will become more popular. Numerous studies have now demonstrated that prophylactic oophorectomy will not only offer a high degree of protection against ovarian cancer but also against breast cancer. It is important for the future that research continues to examine the operative technique and its implications, particularly with regard to Fallopian tube and peritoneal cancer.