Ovarian cancer leads to more deaths than all other gynecologic cancers combined. In the general population, the risk of ovarian cancer is 1.4%. In contrast, a woman with a deleterious BRCA1 gene mutation has a 30% to 40% chance of developing ovarian
Table 4-5. Ovarian Cancer Risk Reduction: Surgery in Women with BRCA Mutations
Investigation Surgery Odds Ratio 95% CI
Rebbeck et al24 Prophylactic BSO 0.04 0.01-0.16
Kauff et al25 Prophylactic BSO 0.15 0.02-1.31
Rutter et al26 Prophylactic BSO 0.29 0.12-0.73
Rutter et al26 BTL/hysterectomy 0.67 0.38-1.18
BSO, bilateral salpingo-oophorectomy; BTL, bilateral tubal ligation.
Table 4-6. Summary of Ovarian Cancer Risk Reduction
Intervention Odds Ratio
Oral contraceptives general population Oral contraceptives high-risk population Prophylactic BSO general population Prophylactic BSO high-risk population BTL/hysterectomy general population BTL/hysterectomy high-risk population
BSO, bilateral salpingo-oophorectomy; BTL, bilateral tubal ligation. Data from references 5, 15, 19, 20, 24, 26.
300 surgeries to prevent 1 case
cancer in her lifetime. Currently, an effective screening test for ovarian cancer is not available. Chemoprevention for ovarian cancer with oral contraceptive pills appears to be beneficial in both the general population and in women with a high risk of ovarian cancer. Prophylactic oophorectomy has only a modest impact on reducing ovarian cancer rates in the general population. In contrast, bilateral salpingo-oophorectomy in the high-risk group significantly decreases the risk of developing an ovarian malignancy. For patients who are unfortunately found to have occult cancers at the time of this surgery, this procedure most likely represents intervention at an earlier stage than would be expected. Although prophylactic surgery may be effective in the high-risk group, it does result in surgical menopause. Improvements in screening and chemoprevention would be welcomed.
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