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Salpingo-oophorectomy decreased risk for breast, ovarian, fallopian tube cancers in BRCA1/2 carriers

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Risk-reducing salpingo-oophorectomy was associated with a 50% reduction in the risk for breast cancer and an 80% reduction in the risk for ovarian and fallopian tube cancers in women with BRCA1 or BRCA2 mutations, according to data from a newly published meta-analysis.

To help physicians and women optimize cancer prevention strategies, researchers conducted a fixed-effects meta-analysis to summarize the extent of cancer risk reduction among BRCA1/2 mutation carriers who have undergone risk-reducing salpingo-oophorectomy.

Using PubMed, the researchers identified 10 studies that examined breast or gynecologic cancer outcomes in mutation carriers.

According to the researchers, risk-reducing salpingo-oophorectomy was related to a statistically significant, clinically important reduction in the risk for breast cancer among BRCA1/2 mutation carriers (HR=0.49, 95% CI, 0.37-0.65). The researchers observed similar reductions for BRCA1 (HR=0.47; 95% CI, 0.35-0.64) and BRCA2 (HR=0.47; 95% CI, 0.26-0.84) mutation carriers.

Risk-reducing salpingo-oophorectomy was also associated with a major reduction in the risk for ovarian or fallopian tube cancers among BRCA1/2 mutation carriers (HR=0.21; 95% CI, 0.12-0.39). The researchers were unable to estimate risk reductions for ovarian and fallopian tube cancers separately in BRCA1 vs. BRCA2 carriers due to insufficient data.

In an accompanying editorial, Mark H. Greene, MD, and Phuong L. Mai, MD, Clinical Genetics Branch, division of cancer epidemiology and genetics at the National Cancer Institute, addressed the knowledge obtained from risk-reducing salpingo-oophorectomy.

“The article by Rebbeck et al provides an opportunity to reflect on what we have learned from introducing ‘prophylactic oophorectomy’ into the management of women whose families have multiple cases of breast or ovarian cancer, a practice which long predated the discovery of BRCA1/2,” they wrote. “The more accurate post-RRSO cancer risk estimates provided by Rebbeck et al constitute another important improvement in the management of high-risk women.”

J Natl Cancer Inst. 2009;101:80-87.