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Prophylactic Oophorectomy in BRCA1 and BRCA2 Mutation Carriers

From the Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA.

Address reprint requests to Timothy R. Rebbeck, PhD, Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, 904 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104; email trebbeck{at}cceb.med.upenn.edu

The availability of genetic testing for inherited mutations in the BRCA1 and BRCA2 genes provides potentially valuable information to women at elevated risk of breast or ovarian cancer. Unfortunately, women who have inherited a mutation in BRCA1 or BRCA2 have relatively few clinical management options available to reduce their risk of developing breast or ovarian cancer. Because most options for ovarian cancer prevention are not highly efficacious, many high-risk women consider the option of bilateral prophylactic oophorectomy (BPO), in the hope that removal of healthy ovarian tissue will reduce their risk of developing invasive malignancy. It is clear that BPO cannot completely prevent the subsequent development of ovarian cancers because reports have been made of patients who have developed cancers of epithelial ovarian origin subsequent to surgery. However, a number of studies have suggested that BPO may reduce the risk of subsequent breast or ovarian cancers in women. In general, these studies have been conducted in women who represent a heterogeneous group with respect to breast/ovarian cancer risk. Only one study of BPO has been undertaken in women whose elevated cancer risk has been based on knowledge of inherited mutations. This study indicated that a 50% to 70% breast cancer risk reduction could be achieved in women with BRCA1 mutations who underwent BPO. However, substantial additional information is required to provide clinically useful information about cancer prevention to women who carry mutations in BRCA1 or BRCA2.

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