1. Prophylactic oophorectomy is associated with reduced the risk of ovarian, fallopian tube, and peritoneal cancer by 80% in BRCA1 and BRCA2 mutation carriers.
2. Prophylactic oophorectomy reduces all-cause mortality by 77%.
Evidence rating level: 2 (Good)
Study Rundown: Prophylactic bilateral salpingo-oophorectomy has already been demonstrated to reduce the risk of breast and ovarian cancer in BRCA1 and BRCA2 mutation carriers. The purpose of this ongoing cohort study was to investigate the optimal age of this procedure and its impact on overall mortality. After a mean follow-up of 5.6 years, the authors found that prophylactic oophorectomy had a significant impact on all-cause mortality, with mortality falling by 77% among women unaffected by cancer at study entry. Rates of ovarian, fallopian tube and peritoneal cancer were also significantly reduced, and the study findings supported the current recommendation of oophorectomy at age 35 years for BRCA1 carriers. Based on these results, the authors concluded that prophylactic oophorectomy has a profound impact on cancer risk and overall mortality for BRCA1/BRCA2 carriers. Nevertheless, longer follow-up will be required to demonstrate the long-term impact of this procedure on mortality, particularly non-cancer mortality.
In-Depth [prospective cohort study]: The study authors expanded a cohort of BRCA1/BRCA2 mutation female carriers from 1828 to 5783 women enrolled from 43 different centers located internationally between 1995 and 2011, excluding those with ovarian, fallopian tube or peritoneal cancer at baseline screening (but not breast cancer). After filling out a baseline questionnaire and at least one follow-up survey, patients were followed for a mean of 5.6 years, with endpoints being diagnosis of ovarian, fallopian tube, or peritoneal cancer, death, or date of most recent follow-up. Cox proportional hazards regression models were used to estimate the impact of surgery, adjusting for age at study entry, mutation, parity, oral contraceptive use, and history of breast cancer. At 5.6 years, 186 new cases of these cancers were diagnosed, with a hazard ratio 0.20 (95% CI, 0.13-0.30, P < 0.001). Adjusted HR for all-cause mortality to age 70 years associated with oophorectomy was 0.31 (95% CI, 0.26-0.38, P < 0.001). Similar effects were seen for women with both ovaries intact at baseline (HR 0.25, 95% CI 0.18-0.35, P < 0.001) and for those with a history of breast cancer (HR 0.24, 95% CI, 0.17-0.32, P < 0.001).
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