Surgery to remove healthy ovaries and fallopian tubes — called prophylactic or risk-reducing salpingo-oophorectomy — reduces the risk of breast cancer in women with a BRCA1 or BRCA2 mutation in the first 5 years after surgery. The age at which a woman has the surgery seems to affect risk reduction more in women with a BRCA1 mutation than in women with a BRCA2 mutation.
The research was published online on Feb. 25, 2021, by JAMA Oncology. Read the abstract of “Association of Risk-Reducing Salpingo-Oophorectomy With Breast Cancer Risk in Women With BRCA1 and BRCA2 Pathogenic Variants.”
Genetic mutations linked to breast cancer
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.
The average woman’s risk of developing breast cancer in her lifetime is about 13%. According to the National Cancer Institute (NCI), women with a BRCA1 mutation have between a 55% and 72% lifetime risk of developing breast cancer and women with a BRCA2 mutation have a 45% to 69% lifetime risk of developing breast cancer.
Men with these mutations also have an increased risk of breast cancer, especially if the BRCA2 gene is affected, and possibly of prostate cancer.
About 5% to 10% of breast cancers are thought to be hereditary, meaning the cancer is linked to mutations in genes passed from parent to child.
You are substantially more likely to have a genetic mutation linked to breast cancer if:
- You have blood relatives (grandmothers, mother, sisters, aunts) on either your mother's or father's side of the family who had breast cancer diagnosed before age 50.
- There is both breast and ovarian cancer on the same side of the family or in a single individual.
- You have a relative(s) with triple-negative breast cancer.
- There are other cancers in your family in addition to breast, such as prostate, melanoma, pancreatic, stomach, uterine, thyroid, colon, and/or sarcoma.
- Women in your family have had cancer in both breasts.
- You are of Ashkenazi Jewish (Eastern European) heritage.
- You are Black and have been diagnosed with breast cancer at age 35 or younger.
- A man in your family has had breast cancer.
- There is a known breast cancer gene mutation in your family.
Risk-reducing ovary and fallopian tube removal
Women who are at high risk for breast cancer and/or ovarian cancer because they have a BRCA mutation may choose to have their healthy breasts and/or ovaries removed. The ovaries are the body’s main source of the hormones estrogen and progesterone, and the fallopian tubes connect the ovaries to the uterus. Risk-reducing salpingo-oophorectomy surgery means that both ovaries and fallopian tubes are removed before any cancer is detected in them.
It’s important to know that this surgery is a serious choice that can have a considerable impact on your life. Ovary removal takes away your ability to have children and reduces the amount of estrogen produced by the body. The sudden loss of estrogen can cause a range of side effects, such as hot flashes, depression, difficulty sleeping, and lessened sex drive. Estrogen loss may also affect bone and heart health.
It's also important to know that this risk-reducing surgery doesn’t guarantee that cancer won’t develop.
Still, research suggests that removing the healthy ovaries and fallopian tubes can reduce the risk of dying from breast cancer by about 56% in women at very high risk.
But research on how much removing the ovaries and fallopian tubes reduces the risk of ever developing breast cancer in BRCA mutation carriers has had mixed results. Early research assumed that any reduction in breast cancer risk stayed constant each year after the surgery. More recent research suggests that the reduction in breast cancer risk may change or level out over time. The researchers who did this study wanted to look more closely at the links between risk-reducing salpingo-oophorectomy and lower breast cancer risk in women with a BRCA1 or BRCA2 mutation and see how any reduction in risk changed as time passed.
About the study
The study included 876 families with a known BRCA mutation:
- 498 families (2,650 people) had a BRCA1 mutation
- 378 families (1,925 people) had a BRCA2 mutation
Of the 2,650 people with a BRCA1 mutation:
- 924 (34.9%) were diagnosed with breast cancer
- 182 (6.9%) were diagnosed with ovarian cancer
- 166 had risk-reducing salpingo-oophorectomy; 28 women who had the surgery were diagnosed with breast cancer; the average age at the time of surgery was 44.5 years
- the average age at first breast cancer diagnosis was 44.2 years
Of the 1,925 people with a BRCA2 mutation:
- 715 (37.1%) were diagnosed with breast cancer
- 62 (3.2%) were diagnosed with ovarian cancer
- 144 had risk-reducing salpingo-oophorectomy; 8 women who had the surgery were diagnosed with breast cancer; the average age at the time of surgery was 46.9 years
- the average age at first breast cancer diagnosis was 47.9 years
The researchers looked to see if the timing of risk-reducing salpingo-oophorectomy affected a woman’s risk of breast cancer.
The researchers found that the cumulative risk of breast cancer for women with a BRCA1 mutation who didn’t have risk-reducing surgery was 61% by age 70 compared to 12.1% for women who didn’t have a BRCA1 mutation.
The researchers also found that the timing of the surgery affected the reduction in risk.
If a woman with a BRCA1 mutation had risk-reducing salpingo-oophorectomy:
- at age 30, her risk of breast cancer was 48.2% by age 70
- at age 40, her risk of breast cancer was 49.7% by age 70
- at age 50, her risk of breast cancer was 52.8% by age 70
The researchers also found that the cumulative risk of breast cancer for women with a BRCA2 mutation who didn’t have risk-reducing surgery was 54% by age 70 compared to 10.3% for women who didn’t have a BRCA2 mutation.
If a woman with a BRCA2 mutation had risk-reducing salpingo-oophorectomy:
- at age 30, her risk of breast cancer was 53.5% by age 70
- at age 40, her risk of breast cancer was 52.7% by age 70
- at age 50, her risk of breast cancer was 51.7% by age 70
So the age when a woman had risk-reducing salpingo-oophorectomy didn’t seem to affect breast cancer risk in women with a BRCA2 mutation, but it did affect breast cancer risk in women with a BRCA1 mutation.
The researchers also looked to see if the reduction in breast cancer risk after risk-reducing salpingo-oophorectomy was different in two time periods:
- 5 years after surgery
- more than 5 years after surgery
They found differences based on the type of mutation the women had:
- For women with a BRCA1 mutation, the reduction in risk was spread out over a longer time period, leveling out about 10 years after surgery.
- For women with a BRCA2 mutation, the reduction in risk leveled out about 5 to 6 years after surgery.
“Although the primary indication for [risk-reducing salpingo-oophorectomy] is the prevention of [ovarian cancer], assessing its association with [breast cancer] risk is critical to guide clinical decision-making and the timing of such a decision. Our results suggest a reduced [breast cancer] risk associated with [risk-reducing salpingo-oophorectomy] in women carrying BRCA1 and BRCA2 pathogenic variants, but the association with cumulative risk was stronger among women carrying BRCA1 pathogenic variants,” the researchers concluded.
What this means for you
If you know you have a BRCA mutation, you may be considering taking steps to keep your risks of breast and ovarian cancer as low as they can be. There are many lifestyle choices you can make, including:
- maintaining a healthy weight
- exercising regularly
- limiting or avoiding alcohol
- eating nutritious food
- never smoking
You also may be considering risk-reducing surgery to remove your ovaries and fallopian tubes. As this study shows, the amount of risk reduction you get depends on the type of BRCA mutation you have. If you have a BRCA1 mutation, your age at the time of the surgery will likely also affect how much your risk of breast cancer is lowered.
Prophylactic surgery decisions require a great deal of thought, patience, and discussion with your doctors, genetic counselor, and family over time — along with a tremendous amount of courage. Take the time you need to consider these options, and make decisions that feel comfortable to you and are best for your unique situation.
For more information, visit the Breastcancer.org Prophylactic Ovary Removal page.
Written by: Jamie DePolo, senior editor
Reviewed by: Brian Wojciechowski, M.D., medical adviser
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