ICARE Newsletter Summer 2014

New Study to Suggest Benefits of Oophorectomy in BRCA Mutation Carriers

A recent study published in the Journal of Clinical Oncology reported that prophylactic oophorectomy resulted in reducing the risk of ovarian cancer by 80%, and reduced all-cause mortality by 77%.1 The authors reported results on almost 5800 women, of whom 186 developed either ovarian, fallopian tube or peritoneal cancer. Women who had bilateral oophorectomy had a hazard ratio of 0.2 (95% CI: 0.13-0.39; p<0.001), meaning that their risk of developing ovarian cancer was reduced by 80% following the preventive removal of the ovaries. The hazard ratio for all-cause mortality to age 70 was 0.23 (95% CI: 0.13-0.39; p<0.001), which means that the risk of dying from any cause was substantially reduced by having the oophorectomy. The finding on all- cause mortality is striking and has important clinical implications. Specifically, these findings suggest the age distribution of ovarian cancers should not be the sole criterion for determining the best age at which to advise preventive surgery of the ovaries in BRCA mutation carriers. This is because removal of the ovaries may not just prevent ovarian cancer, but there may be additional benefits (particularly the reduction of breast cancer risk). However, there remain important quality of life issues to consider which need to be balanced with the probable gains in life expectancy. It is also important to note that the study did not uniformly collect information on whether the fallopian tubes were removed along with the ovaries. Nevertheless, it is now clearly evident that for the greatest reduction of ovarian cancer risk, removal of the fallopian tubes along with the ovaries is recommended. 

Furthermore, study findings imply that identifying BRCA mutations carriers in countries with limited resources to offer breast MRI screening or bilateral prophylactic mastectomy may still reduce mortality if these patients have access to salpingo-oophorectomy. Ultimately, it remains important to assess the long-term effects of removing the ovaries and fallopian tubes, and continue to work on designing effective treatments and preventive strategies.

1. Finch A et al. J Clin Oncol. 2014 May 20;32(15):1547-53. PMID: 24567435