Prophylactic oophorectomy: Preventing cancer by surgically removing your ovaries
Prophylactic oophorectomy (o-of-uh-REK-tuh-me) significantly reduces your odds of developing breast cancer and ovarian cancer if you're at high risk. Weigh the pros and cons of this cancer-prevention option.By Mayo Clinic Staff
Women with BRCA1 or BRCA2 gene mutations have a significantly increased risk of developing breast cancer and ovarian cancer. Several options are available for reducing the risk of cancer in these women.
One option is preventive (prophylactic) bilateral oophorectomy — the surgical removal of the ovaries. Although removing your ovaries is usually performed to reduce the risk of ovarian cancer, oophorectomy can also reduce the risk of breast cancer.
What is oophorectomy?
In an oophorectomy, a surgeon removes both your ovaries — the almond-shaped organs on each side of your uterus. Your ovaries contain eggs and secrete the hormones that control your reproductive cycle.
Removing your ovaries greatly reduces the amount of the hormones estrogen and progesterone circulating in your body. This surgery can halt or slow breast cancers that need these hormones to grow.
Women with BRCA gene mutations usually also have their fallopian tubes removed at the same time (salpingo-oophorectomy) since they have an increased risk of fallopian tube cancer as well.
Who can consider prophylactic oophorectomy?
Prophylactic oophorectomy is usually reserved for women with a significantly increased risk of breast cancer and ovarian cancer due to an inherited mutation in the BRCA1 or BRCA2 gene — two genes linked to breast cancer, ovarian cancer and other cancers. Women who have inherited mutations and have completed childbearing are the best candidates for this surgery.
Prophylactic oophorectomy may also be recommended if you have a strong family history of breast cancer and ovarian cancer but no known genetic alteration. It might also be recommended if you have a strong likelihood of carrying the gene mutation based on your family history but choose not to proceed with genetic testing.
How much can oophorectomy reduce the risk of cancer?
If you have a BRCA mutation, a prophylactic oophorectomy can reduce your:
Breast cancer risk by up to 50 percent in premenopausal women. As an example, if a woman with a high risk of breast cancer had a 60 percent chance of being diagnosed with breast cancer at some point in her lifetime, bilateral oophorectomy could reduce her risk to 30 percent.
Put another way, for every 100 women just like her, 60 could be expected to be diagnosed with breast cancer without oophorectomy. And 30 would be expected to be diagnosed with breast cancer after oophorectomy.
Ovarian cancer risk by 80 to 90 percent. As an example, if a woman with a high risk of ovarian cancer had a 30 percent chance of being diagnosed with ovarian cancer at some point in her lifetime, oophorectomy could reduce her risk to 6 percent, assuming an 80 percent risk reduction.
Put another way, for every 100 women just like her, 30 could be expected to be diagnosed with ovarian cancer without oophorectomy. And six would be expected to be diagnosed with ovarian cancer after oophorectomy.
In studies, the risk of breast cancer and ovarian cancer varies. And your individual risk of breast cancer and ovarian cancer varies depending on many factors, including your family history, your lifestyle choices and other strategies you're using to reduce your risk of cancer. For some women, oophorectomy may offer great reduction in risk. For other women, the risks of surgery and the potential side effects may not be worth the reduction in cancer risk.
What are the risks of oophorectomy?
Oophorectomy is a generally safe procedure that carries a small risk of complications, including infection, intestinal blockage and injury to internal organs. The risk of complications depends on how the procedure is performed.
But more concerning is the impact of losing the hormones supplied by your ovaries. In women who have yet to undergo menopause, oophorectomy causes early menopause. Early menopause carries many risks, including:
- Bone thinning (osteoporosis). Removing your ovaries reduces the amount of bone-building estrogen your body produces. This may increase your risk of a broken bone.
- Discomforts of menopause. Hot flashes, vaginal dryness, sexual problems, sleep disturbance and sometimes cognitive changes are problems for some women during menopause. Removing your ovaries doesn't mean you'll immediately have these problems, but it does mean that any menopausal symptoms you develop will occur earlier and are more likely to reduce your quality of life than if they occurred during natural menopause.
- Increased risk of heart disease. Your risk of heart disease may increase if you have your ovaries removed.
- Lingering risk of cancer. Prophylactic oophorectomy doesn't completely eliminate your risk of breast cancer or ovarian cancer. A type of cancer that looks and acts identical to ovarian cancer can develop after the ovaries and fallopian tubes are removed. The risk of this type of cancer, called primary peritoneal cancer, is low — much lower than the lifetime risk of ovarian cancer if the ovaries remain intact.
Prophylactic oophorectomy might relieve much of your anxiety about developing either disease, but this type of surgery can also take an emotional toll on you. Even if you didn't plan on having children, you might mourn the loss of your fertility. Or you may, like some, have a strong sense of femininity tied to your fertility and reproductive cycle.
April 14, 2014
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