Ask An Expert: Prophylactic Oophorectomy

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Ask An Expert: Prophylactic Oophorectomy

Question:

I'm 51 and in menopause. What degree of protection from ovarian cancer would a prophylactic oophorectomy provide? My mother contracted ovarian cancer at 62, already in stage IIIc, and died one year later. Is there still a risk of developing ovarian cancer in other cells even after an oopherectomy?

Answer:

Ovarian caner is diagnosed in approximately 20,000 women annually in the United States and is responsible for about 15,000 deaths. Early detection and treatment greatly improve the prognosis, but currently available screening tools often fall short in achieving these goals. Consequently, women who are at high risk for developing ovarian cancer may consider surgical removal of their ovaries (oophorectomy) to reduce their risk of cancer.

Among all women, the lifetime risk of ovarian cancer is estimated at 1.4 percent. Most cases occur in women with no family history of the disease. Prophylactic oophorectomy is not recommended for the general population, because the risk of the procedure outweighs the anticipated benefit. Women who are perimenopausal or menopausal and undergoing pelvic surgery for other problems may consider removal of the ovaries, as the risk in this setting is lower.

About 10 percent of cases of ovarian cancer occur in women who carry a gene that predisposes them to the disease. High-risk women can be identified by reviewing family history and by blood tests for the BRCA1 and BRCA2 gene mutations. Their risk of developing ovarian cancer is as high as 20 to 40 percent. Studies suggest that prophylactic oophorectomy reduces the risk of ovarian cancer to about 5 percent in women positive for the BRCA mutations. The procedure is usually done with minimally invasive surgery using a laparoscope. Careful evaluation of all tissues is done to look for early cancer cells and, if cancer is present, additional treatment is planned.

There are several reasons why prophylactic oophorectomy does not completely eliminate the risk of ovarian cancer. Some patients may have undetected microscopic cancer that has already spread to the surrounding tissues at the time of the surgery. Other patients may have residual ovarian tissue left in place despite the surgery, either from incomplete removal of the ovary or from small clusters of ovarian tissue present outside the main ovary. Finally, the tissue that lines the entire pelvic cavity, the peritoneum, is derived from cells that are similar to ovarian cells. The peritoneum can develop a cancer that behaves just like ovarian cancer due to its similar origin.

Joan Bengtson, M.D., is assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School and a member of the Department of Obstetrics, Gynecology & Reproduction at Brigham and Women's Hospital.

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Last updated:	January 24, 2007