Prophylactic and Risk-reducing BSO for Women Based on Their Level of Risk for Ovarian Cancer

Prophylactic and Risk-reducing BSO for Women Based on Their Level of Risk for Ovarian Cancer

Jonathan S. Berek, MD, MMedSc, FASCO

Oct 29, 2010

My colleagues and I recently published a summary of our Society of Gynecologic Oncologists’ recommendations on Prophylactic and Risk-Reducing Bilateral Salpingo-oophorectomy (BSO) in the September issue of Obstetrics & Gynecology.

We reaffirmed the recommendation that women who are at high risk for ovarian cancer based on the identification that they carry a BRCA1 or BRCA2 mutation should undergo a risk-reducing BSO after completing childbearing, as its value is well documented. These operations are associated with a substantial reduction in the mortality from ovarian and fallopian tube cancers, and a reduction in the mortality from breast cancer.

Women with a strong family history who are untested or who test negative may be at higher-than-average risk for ovarian cancer. Because there are no effective ovarian cancer screening tools at present, prophylactic BSO is also indicated in these women at higher-than-average risk.

For premenopausal and perimenopausal women at average risk of ovarian cancer who are undergoing a hysterectomy for benign conditions, the decision to also perform a BSO should be individualized after appropriate informed consent. There is a plausible increased risk of several important negative outcomes after prophylactic BSO, especially an increase in mortality from cardiovascular disease and an increase in neurologic diseases. These are dependent on the age at BSO. Therefore, many women in this category might choose to preserve their ovaries as the benefit of this might substantially outweigh the risk.

Physicians should thoroughly discuss these issues with their patients who might be planning to undergo surgery under these circumstances. The prevalence of BSO in the U.S. also underscores the necessity of future research.

Please consult the full report for detailed information.


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