Prophylactic oophorectomy for patients with germline BRCA mutations

The prevalence of BRCA1 mutation and BRCA2 mutation in the general population ranges between 1/300 and 1/800. Both of these mutations are inherited in an autosomal dominant fashion, and they are associated with a mean cumulative risk of ovarian cancer of 40% for BRCA1 and 18% for BRCA2. Over 70% of women who are diagnosed with ovarian cancer have advanced disease. Therefore, prevention and early detection are paramount in reducing the high mortality rate associated with this disease. Because of the increased risk of ovarian cancer for women who are BRCA mutation carriers, risk-reducing bilateral salpingo-oophorectomy (rrBSO) is a feasible option for primary prevention. This procedure has been shown to decrease the risk of subsequently developing ovarian cancer as well as breast cancer. In addition, rrBSO has been associated with lower all-cause, breast cancer-specific and ovarian cancer-specific mortality . The procedure can be performed laparoscopically and can be combined with a hysterectomy in some patients including women with Lynch syndrome and those who will take tamoxifen or hormone replacement therapy following their rrBSO. However, despite the tremendous benefits derived from rrBSO in this patient population, the decision to undergo surgery and timing of such procedure involves complex, emotionally charged, and often life-changing decision making. Furthermore, the resulting surgical menopause can have significant psychological and physical health consequences that should be taken into account during preoperative counseling and postoperative follow-up.