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ICARE Newsletter Summer 2015

Ask the Expert

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The following question was addressed to Dr. Steven Narod who is a Tier I Canada Research Chair in Breast Cancer and a senior scientist at Women’s College Research Institute in Toronto, Canada. Dr. Narod is a world-leader in the field of breast and ovarian cancer genetics. Over the course of his career, he has profoundly shaped current knowledge about cancer risks, prevention and screening amongst carriers of BRCA1 and BRCA2 mutations.

Q. As a BRCA mutation carrier, will salpingectomy (removal of the fallopian tubes while keeping the ovaries) lower my risk for developing ovarian cancer?

A. As many ovarian cancers originate in the fallopian tubes, bilateral salpingectomy has been proposed as a consideration among BRCA carriers who are not ready to remove their ovaries.1 Specifically, bilateral salpingectomy has been suggested as an interim procedure to reduce ovarian cancer risk after childbearing is complete, followed by later oophorectomy (removal of the ovaries). At this time there is no data to prove that salpingectomy reduces ovarian cancer risk among BRCA carriers and the benefit is based on theory. In contrast, bilateral salpingo-oophorectomy (i.e., removal of the ovaries and the fallopian tubes) has been shown to reduce the risk of ovarian cancer and of all cause of death dramatically.2 Bilateral salpingectomy has gained interest because it preserves ovarian function, which prevents premature menopause and its associated adverse effects experienced by some women but it cannot yet be assumed to be equivalent to oophorectomy.

1. Walker JL et al. Society of Gynecologic Oncology recommendations for the prevention of ovarian cancer. Cancer. 2015 Mar 27. PMID: 25820366.
2.
Finch AP et al. Impact of oophorectomy on cancer incidence and mortality in women with a BRCA1 or BRCA2 mutation. J Clin Oncol. 2014 May 20;32(15):1547-53. PMID: 24567435.

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