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Society Develops New Guidelines on Prophylactic Ovary Removal

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Doctors call removing both ovaries and the fallopian tubes bilateral salpingo-oophorectomy (BSO). When a woman with no known ovary or fallopian tube problems has the procedure to reduce her risk of ovarian and breast cancer, it's called prophylactic BSO.

New guidelines on prophylactic BSO were developed by the Society of Gynecologic Oncologists (SGO). The guidelines address the role prophylactic BSO can play in reducing the risk of both ovarian and breast cancer.

Most inherited cases of breast and ovarian cancer are associated with two abnormal genes: BRCA1 (BReast CAncer gene one) and BRCA2 (BReast CAncer gene two). Abnormal BRCA1 and BRCA2 genes are found in 5% to 10% of all breast cancer cases in the United States. Women with an abnormal BRCA1 or BRCA2 gene have up to an 85% risk of developing breast cancer by age 70. If breast cancer already has been diagnosed, the risk of recurrence (the cancer coming back) is also much higher than average. Women with an abnormal BRCA1 or BRCA2 gene also have a much higher-than-average risk of ovarian cancer -- from 15% to 60%.

To reduce future risk of ovarian and breast cancer, SGO guidelines recommend that:

  • Women at high risk for developing breast and ovarian cancer because they have an abnormal BRCA1 or BRCA2 gene should have prophylactic BSO to reduce their risk after they're done having children.
  • Women who have a strong family history of ovarian and/or breast cancer in first-degree relatives (mother, sister, aunt) but who don't have an abnormal BRCA1 or BRCA2 gene (or haven't been tested) should assume they have a higher-than-average risk of ovarian and breast cancer and should have prophylactic BSO to reduce their risk after they're done having children.
  • Women with an average risk of ovarian cancer shouldn't have prophylactic BSO routinely and should carefully weigh the pros and cons of prophylactic BSO if they're considering the surgery.

Prophylactic BSO in a woman with an abnormal BRCA1 or BRCA2 gene can:

  • reduce her risk of BRCA-related ovarian cancer by 96%
  • reduce her risk of breast cancer by 50% to 80% (for premenopausal women)
  • significantly reduce her risk of breast cancer coming back if she's been diagnosed

Women with a strong family history of ovarian and/or breast cancer in first-degree relatives but who don't have an abnormal BRCA1 or BRCA2 gene may have a different abnormal gene that's not routinely tested for or recognized. This other abnormal gene may increase ovarian and breast cancer risk. So the guidelines recommend that women with a strong family history without an abnormal BRCA1 or BRCA2 gene have prophylactic BSO to reduce their cancer risk once they're done having children.

A woman with average ovarian cancer risk might consider prophylactic BSO if she is having a hysterectomy (removal of her uterus). In this situation, doctors often suggest having prophylactic BSO at the same time as the hysterectomy. Still, prophylactic BSO may not make sense for all women at average risk because the decrease in breast and ovarian cancer risk is likely outweighed by the possible long-term risks of prophylactic BSO. Removing the ovaries causes an abrupt drop in estrogen levels; this estrogen drop can harm future bone and cardiovascular health, especially in younger, premenopausal women. Some research suggests that having prophylactic BSO also could cause thinking or memory problems later in life.

If you have an abnormal BRCA1 or BRCA2 gene and/or a strong family history of ovarian or breast cancer and haven't had prophylactic BSO, you may want to talk to your doctor about these new guidelines. If you're done having children, prophylactic BSO might make sense for you. Ask your doctor about all of your options to reduce the risk of both ovarian and breast cancer.

If you're a breast cancer survivor, you probably should talk to your doctor about prophylactic BSO, no matter your genetic status or family history. Prophylactic BSO can reduce your risk of:

  • the breast cancer coming back
  • developing a new, second breast cancer
  • ovarian cancer

You can learn more about prophylactic BSO by visiting the Breastcancer.org Prophylactic Ovary Removal pages.

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