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Prophylactic and Risk-Reducing Bilateral Salpingo-oophorectomy

Recommendations Based on Risk of Ovarian Cancer

Berek, Jonathan S., MD, MMS; Chalas, Eva, MD; Edelson, Mitchell, MD; Moore, David H., MD; Burke, William M., MD; Cliby, William A., MD; Berchuck, Andrew, MD for the Society of Gynecologic Oncologists Clinical Practice Committee

doi: 10.1097/AOG.0b013e3181ec5fc1
Current Commentary
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Women who do not have a documented germline mutation or who do not have a strong family history suspicious for a germline mutation are considered to be at average risk of ovarian cancer. Women who have confirmed deleterious BRCA1 and BRCA2 germline mutations are high risk of ovarian cancer. In addition, women who have a strong family history of either ovarian or breast cancer may carry a deleterious mutation and must be presumed to be at higher-than-average risk, even if they have not been tested, because there could be other mutations that are either untested or yet undiscovered that confirm higher-than-average risk of these diseases. We reviewed studies pertaining to prophylactic bilateral salpingo-oophorectomy in women at average risk of ovarian cancer who are undergoing hysterectomy for benign disease. We also reviewed the role of prophylactic bilateral salpingo-oophorectomy in preventing ovarian cancer based on the level of risk of the patient. For women at average risk of ovarian cancer who are undergoing a hysterectomy for benign conditions, the decision to perform prophylactic bilateral salpingo-oophorectomy should be individualized after appropriate informed consent, including a careful analysis of personal risk factors. Several studies suggest an overall negative health effect when prophylactic bilateral salpingo-oophorectomy is performed before the age of menopause. Ovarian conservation before menopause may be especially important in patients with a personal or strong family history of cardiovascular or neurological disease. Conversely, women at high risk of ovarian cancer should undergo risk-reducing bilateral salpingo-oophorectomy.

The decision to perform prophylactic bilateral salpingo-oophorectomy should be individualized for women at average risk of ovarian cancer who are undergoing a hysterectomy for benign conditions.

From the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Women's Cancer Center, Stanford Cancer Center, Stanford, California; Winthrop University Hospital, Mineola, New York; Abington Memorial Hospital, Abington, Pennsylvania; Gynecologic Oncology of Indiana, Indianapolis, Indiana; Columbia University Medical Center, New York, New York; Mayo Clinic, Rochester, Minnesota; Duke University Medical Center, Durham, North Carolina; Society of Gynecologic Oncologists, Chicago, Illinois.

Corresponding author: Jonathan S. Berek, MD, MMS, Department of Obstetrics & Gynecology, Stanford University School of Medicine, 300 Pasteur Drive, HH333, Stanford, CA 94305; e-mail: jberek@stanford.edu.

Financial Disclosure Mitchell Edelson's spouse is an employee of Merck. The other authors did not report any potential conflicts of interest.

© 2010 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.