Preventive Removal of Ovaries, Fallopian Tubes Linked to Better Survival in BRCA-Positive Breast Cancer
Women with a BRCA mutation diagnosed with early-stage breast cancer who had their healthy ovaries and fallopian tubes removed – called prophylactic salpingo-oophorectomy by doctors – had better overall survival than women who didn’t have their ovaries and fallopian tubes removed.
The research was published online on Oct. 4, 2023, by the journal JAMA Surgery. Read the abstract of “Prophylactic Salpingo-Oophorectomy and Survival After BRCA1/2 Breast Cancer Resection.”
Overall survival is how long the women lived, whether or not the breast cancer came back.
BRCA1 and BRCA2 mutations
Two of the most well-known genes that can mutate and raise the risk of breast and/or ovarian cancer are BRCA1 and BRCA2. Women who inherit a mutation in either of these genes — from their mothers or their fathers — have a much higher-than-average risk of developing breast cancer and/or ovarian cancer.
About 5% to 10% of breast cancers are thought to be hereditary, meaning the cancer is linked to genetic mutations passed from parent to child.
People with a BRCA1 mutation are more likely to be diagnosed with triple-negative breast cancer, which is often more aggressive than breast cancer that is hormone receptor-positive. Breast cancer in people with a BRCA1 or BRCA2 mutation is also more likely to recur (come back in the same or opposite breast).
Removing the ovaries and fallopian tubes preventively
Because having a BRCA mutation increases the risk of ovarian cancer in addition to breast cancer, many doctors recommend women with a BRCA1 or BRCA2 mutation have preventive surgery to remove the healthy ovaries and fallopian tubes, whether they’ve been diagnosed with breast cancer or not.
The ovaries are the body’s main sources of the hormones estrogen and progesterone, and so removing them can reduce the risk for developing breast, ovarian, and fallopian tube cancer, as well as peritoneal cancer (cancer of the lining of the abdominal cavity).
Earlier studies have shown that preventively removing the ovaries and fallopian tubes in women with a BRCA1 mutation who were diagnosed with breast cancer was linked to a lower risk of dying from breast cancer.
About the study
This small, Italian study included 480 women who had surgery to remove early-stage breast cancer between 1972 and 2019. All the women had a BRCA1 or BRCA2 mutation:
290 women had a BRCA1 mutation
190 women had a BRCA2 mutation
It’s important to know that although the women in the study had breast cancer surgery starting in 1972, genetic testing wasn’t available until 1996. It’s unclear from the study when the women had genetic testing, but it seems that some of them must have genetic testing a number of years after they had breast cancer surgery.
All the women received a recommendation to have the other healthy breast – called prophylactic mastectomy – as well as their healthy ovaries and fallopian tubes removed, but not all did:
97 women with a BRCA1 mutation and 66 women with a BRCA2 mutation had prophylactic mastectomy
186 women with a BRCA1 mutation and 114 women with a BRCA2 mutation had their ovaries and fallopian tubes removed
Half the women were followed for more than 16.5 years and half were followed for a shorter time.
During follow-up, among the 290 women with a BRCA1 mutation:
49 had a recurrence in the same breast
83 developed cancer in the other breast
77 developed a second primary cancer, including 58 ovarian cancers
28 died from breast cancer
32 died from ovarian cancer
10 died from a second primary cancer that wasn’t ovarian cancer
one died from something besides cancer
215 were alive and cancer free at the last follow-up check
Among the 190 women with a BRCA2 mutation:
29 had a recurrence in the same breast
46 developed cancer in the other breast
35 developed a second primary cancer, including 19 ovarian cancers
23 died from breast cancer
eight died from ovarian cancer
three died from a second primary cancer that wasn’t ovarian cancer
three died from something besides cancer
145 were alive and cancer free at the last follow-up check
Overall, 62.5% of the women had prophylactic ovary and fallopian tube surgery about 51 months after mastectomy. Doctors found ovarian cancer during prophylactic surgery in six of the women. All six women were alive and cancer free at the last follow-up check.
Among the 300 women who had prophylactic ovary and fallopian tube surgery:
16 died from breast cancer
seven died from a second primary cancer
one died from something other than cancer
276 women were alive at the last follow-up check and 268 were cancer free
At the last follow-up check, the researchers found that women who had prophylactic ovary and fallopian tube surgery were 60% more likely to be alive than women who didn’t have the surgery. This difference was statistically significant, which means that it was likely due to the difference in whether or not they had these surgeries and not just because of chance.
The link between prophylactic ovary and fallopian tube surgery and better overall survival was especially strong for:
women with a BRCA1 mutation
women diagnosed with triple-negative breast cancer
women diagnosed with invasive ductal carcinoma
Prophylactic ovary and fallopian surgery was NOT linked to a lower risk of developing cancer in the other breast or to a lower risk of dying from breast cancer.
“We conclude that for patients carrying a BRCA1 or BRCA2 variant undergoing breast cancer surgery, [prophylactic salpingo-oophorectomy] should be performed as early as possible, particularly for those with the BRCA1 variant, to reduce overall mortality,” the researchers wrote.
What this means for you
The results of this study are very good news for women with a BRCA1 or BRCA2 mutation who’ve been diagnosed with breast cancer: Having your healthy ovaries and fallopian tubes removed can improve your overall survival.
Still, there are some things to keep in mind:
Since this study started, the medicine Lynparza (chemical name: olaparib) was approved by the U.S. Food and Drug Administration (FDA) to treat early-stage, HER2-negative breast cancer with a BRCA1 or BRCA2 mutation with a high risk of recurrence that had already been treated with chemotherapy. Research shows that treating this type of breast cancer with Lynparza can reduce the risk of death by 10% to 15%. It’s unclear how much Lynparza and preventive ovary and fallopian tube removal could work together to improve overall survival.
Prophylactic ovary and fallopian tube surgery is a serious choice that can have a large impact on your life. Removing the ovaries takes away your ability to have children and reduces the amount of estrogen in your body. The sudden, sharp drop in estrogen brings on early menopause, which can cause a range of side effects, including hot flashes, insomnia, and loss of libido. Low estrogen levels also can affect your bone health and heart health. It’s important to know that this prophylactic surgery doesn’t guarantee that cancer won’t develop.
The researchers who did this study recommended that women with a BRCA mutation who’ve been diagnosed with breast cancer have prophylactic ovary and fallopian tube surgery as soon as possible. Still, other doctors recommend a more individualized approach, taking into account a woman’s age and other health conditions, the characteristics of the breast cancer, and the cancer’s response to chemotherapy before breast cancer surgery, if that treatment was given.
Together, you and your doctor can decide if and when prophylactic surgery is right for your unique situation.
Updated on August 7, 2025