Question: What is the role of prophylactic bilateral salpingoophorectomy in women at high risk of ovarian cancer?
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Answer:
A meta-analysis of Risk Reduction Estimates Associated With Risk-Reducing Salpingooophorectomy in BRCA1 or BRCA2 Mutation Carriers (1) found that Risk-Reducing Salpingooophorectomy (RRSO) was associated with a statistically significant reduction in the risk of BRCA1/2 -associated ovarian or fallopian tube cancer (HR = 0.21; 95% CI = 0.12 to 0.39). Data were insufficient to obtain separate estimates for ovarian or fallopian tube cancer risk reduction with RRSO in BRCA1 or BRCA2 mutation carriers.
A 2004 Systematic review of management options for women with a hereditary predisposition to ovarian cancer (2) found four cohort studies which examined whether prophylactic oophorectomy reduced the lifetime risk of developing ovarian cancer. All the cohort studies found that prophylactic oophorectomy reduced the lifetime risk of developing ovarian cancer; however, this risk reduction was statistically significant in only two cohort studies.
A controlled study of mental distress and somatic complaints after risk-reducing salpingo-oophorectomy in women at risk for hereditary breast ovarian cancer (3) found more somatic morbidity such as osteoporosis, palpitations, constipation, musculoskeletal disease and pain and stiffness but lower levels of mental distress among women who had undergone RRSO compared to controls
(Evidence level IIa)
The American College of Obstetricians and Gynecologists have published a guideline on Elective and risk-reducing salpingo-oophorectomy (4)
(Evidence level IV)
References:
1. Meta-analysis of Risk Reduction Estimates Associated With Risk-Reducing Salpingooophorectomy in BRCA1 or BRCA2 Mutation Carriers / Timothy R. Rebbeck, Noah D. Kauff , Susan M. Domchek. Journal of the National Cancer Institute 2009 Vol 101(2): 80-87 Full text
2. Review of management options for women with a hereditary predisposition to ovarian cancer / Rosen B, Kwon J, Fung M F, Gagliardi A, Chambers A. Gynecologic Oncology 2004 VOL 93(2): 280-286 Abstract
3. A controlled study of mental distress and somatic complaints after risk-reducing salpingo-oophorectomy in women at risk for hereditary breast ovarian cancer / Michelsen TM, Dorum A, Dahl AA Gynecologic Oncology 2009 VOL 113(1): 128-33 Abstract
4. ACOG Practice Bulletin No. 89. Elective and risk-reducing salpingo-oophorectomy. Obstetrics & Gynecology. 111(1):231-41, 2008 Jan Summary
Search date: March 2010
Classification of evidence levels
Ia Evidence obtained from meta-analysis of randomised controlled trials.
Ib Evidence obtained from at least one randomised controlled trial.
IIa Evidence obtained from at least one well-designed controlled study without randomisation.
IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.
III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.
IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.
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