Prophylactic oophorectomy in women at increased cancer risk

Bilateral prophylactic salpingo-oophorectomy is widely used for cancer risk reduction in women with BRCA1/2 mutations. Bilateral prophylactic salpingo-oophorectomy significantly reduces breast cancer risk by approximately 50% and ovarian cancer risk by 80-95% but may be accompanied by menopausal symptoms, impaired quality of life and accelerated bone loss. Therefore, decisions regarding the timing of bilateral prophylactic salpingo-oophorectomy and the use of post-bilateral prophylactic salpingo-oophorectomy hormone replacement therapy must be carefully considered.

Over the last year, studies have further examined issues related to quality of life associated with bilateral prophylactic salpingo-oophorectomy and have demonstrated that hormone replacement therapy following bilateral prophylactic salpingo-oophorectomy in unaffected women does not negate the breast cancer risk reduction that bilateral prophylactic salpingo-oophorectomy provides. Studies have provided additional information on the residual risk of cancer following bilateral prophylactic salpingo-oophorectomy, have demonstrated its benefit in Lynch syndrome and have suggested a short-term mortality benefit following bilateral prophylactic salpingo-oophorectomy in BRCA1/2 mutation carriers.

We review the recent studies regarding bilateral prophylactic salpingo-oophorectomy and their implications for the clinical management of women who are at increased cancer risk.