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Prophylactic oophorectomy: Preventing cancer by surgically removing your ovaries
Do women have to take post-menopausal hormone therapy after oophorectomy?
Use of low-dose hormone therapy after oophorectomy is controversial. While studies have shown that use of hormone therapy after menopause may increase a woman's risk of breast cancer, other studies suggest early menopause can cause its own serious risks.
Women who undergo prophylactic oophorectomy and don't use hormone therapy up to age 45 have a higher rate of premature death, cancer, heart disease and neurological diseases. It's not clear that the higher rates of these diseases are due to low estrogen levels caused by oophorectomy, but doctors typically recommend that younger women who have surgically induced menopause consider taking low-dose hormone therapy for a short time and stopping by age 45 or 50.
Prophylactic oophorectomy may also increase your risk of memory loss and dementia. But studies show this risk may be reduced with the use of hormone therapy after surgery.
It isn't entirely clear what effect hormone therapy might have on your cancer risk. Several studies have found that short-term hormone therapy doesn't increase the risk of breast cancer in women with BRCA mutations who have undergone prophylactic oophorectomy. Ask your doctor about your particular situation. If you decide to take low-dose estrogen, plan to discontinue this treatment after age 50.
You may opt to have your uterus removed during your oophorectomy surgery, so that you can take a type of hormone therapy (estrogen only hormone therapy) that may be safer for women with a high risk of breast cancer. Discuss the benefits and risks of hysterectomy with your surgeon.
Are there alternatives to oophorectomy for preventing ovarian cancer?
Researchers are studying other ways to reduce the risk of ovarian cancer in women who have a high risk of the disease. But these other ways of preventing ovarian cancer haven't been proved to reduce risk as much as oophorectomy has. For this reason, for most women with BRCA mutations, doctors recommend oophorectomy.
But oophorectomy isn't right for every woman with a high risk of breast cancer or ovarian cancer. So talk about the alternatives with your doctor to better understand how they may affect your risk. Options include:
- Increased screening for ovarian cancer. You may choose to have ovarian cancer screening twice each year to look for early signs of cancer. Screening usually includes a blood test for cancer antigen CA 125 and an ultrasound exam of your ovaries. In theory, increased screening should be able to help doctors catch ovarian cancer at its earliest stages, but whether that's possible with current screening methods isn't clear. Screening tests are noninvasive, but there's no evidence that they save lives.
- Birth control pills. Studies suggest that taking birth control pills reduces the risk of ovarian cancer in average-risk women. Some evidence suggests birth control pills may also reduce the risk of ovarian cancer in high-risk women, such as those with BRCA mutations. There is some concern that birth control pills may increase the risk of breast cancer in this high-risk group of women. However, the benefits of reducing ovarian cancer risk seem to outweigh the small risk of breast cancer. It's generally recommended that birth control pills be used for no longer than five years.
Doesn't mastectomy offer a greater reduction in breast cancer risk?
Yes. Surgery to remove your breasts (mastectomy) may reduce your risk of breast cancer by 90 percent. As an example, if your risk of developing breast cancer at some point in your lifetime is 50 percent, a preventive mastectomy may lower your risk to 5 percent. Put another way, for every 100 women who underwent preventive mastectomy, five could be diagnosed with breast cancer at some point in their lives.
Why might a woman opt for oophorectomy over mastectomy?
Reasons a woman might choose oophorectomy over mastectomy include:
- Oophorectomy reduces your risk of two cancers. Oophorectomy reduces your risk of both breast cancer and ovarian cancer, while mastectomy reduces only the risk of breast cancer.
- There aren't many options for preventing ovarian cancer. Ovarian cancer is sometimes seen as a greater threat than breast cancer because it isn't easily detected and it may be detected at a later stage when diagnosed. There are tests, such as mammograms and breast MRIs, to detect breast cancer at an early stage in very high-risk women.
- Removing your ovaries doesn't affect your appearance. Some women are concerned about how they'll look if they have their breasts removed. Oophorectomy won't affect your appearance.
These benefits have to be balanced against the risks of oophorectomy and the early menopause that occurs as a result.
What questions should you ask your doctor?
The decision to have prophylactic oophorectomy is a challenging and difficult one with no clearly right or wrong answer. It comes down to a personal choice you alone can make, but advice from a genetic counselor, a breast health specialist or a gynecologic oncologist can help you make a more informed decision.
Questions to ask your doctor or other health care provider include:
- What is my risk of breast cancer?
- What is my risk of ovarian cancer?
- What are my options to lower my risk of breast cancer?
- What are my options to lower my risk of ovarian cancer?
- What are the benefits and risks of each option?
- What are some good sources of information about reducing my cancer risk?
- How much time can I take to research my options and make a decision?
- If I decide that prophylactic oophorectomy isn't right for me right now, can I change my mind later?
- What advice would you give your friend or family member if she were in my situation?
Determining whether prophylactic oophorectomy is right for you — and when it might be right for you — depends on your individual risk of cancer and how aggressive you want to be in your cancer prevention efforts.
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- Muto MG. Risk reducing salpingo-oophorectomy in women at high risk of epithelial ovarian cancer. http://www.uptodate.com/home/index.html. Accessed Feb. 24, 2011.
- Tirona MT, et al. Prevention of breast cancer (part II): Risk reduction strategies. Cancer Investigation. 2010;28:1070.
- Rebbeck TR, et al. Meta-analysis of risk reduction estimates associated with risk-reducing salpingo-oophorectomy in BRCA1 or BRCA2 mutation carriers. Journal of the National Cancer Institute. 2009;101:80.
- Parker WH, et al. Effect of bilateral oophorectomy on women's long-term health. Women's Health. 2009;5:565.
- Rocca WA, et al. Oophorectomy, menopause, estrogen treatment and cognitive aging: Clinical evidence for a window of opportunity. Brain Research. 2011;1379:188.
- Shuster LT, et al. Premature menopause or early menopause: Long-term health consequences. Maturitas. 2010;65:161.
- Pruthi S, et al. Identification and management of women with BRCA mutations or hereditary predisposition for breast and ovarian cancer. Mayo Clinic Proceedings. 2010;85:1111.
- Rebbeck TR, et al. Effect of short-term hormone replacement therapy on breast cancer risk reduction after bilateral prophylactic oophorectomy in BRCA1 and BRCA1 mutation carriers: The PROSE study group. Journal of Clinical Oncology. 2005;31:7804.
- Eisen A, et al. Hormone therapy and the risk of breast cancer in BRCA1 mutation carriers. Journal of the National Cancer Institute. 2008;100:1361.
- Milne RL, et al. Oral contraceptive use and risk of early-onset breast cancer in carriers and noncarriers of BRCA1 and BRCA2 mutations. Cancer Epidemiology, Biomarkers & Prevention. 2005;14:350.
- Haile RW, et al. BRCA1 and BRCA2 mutation carriers, oral contraceptive use and breast cancer before age 50. Cancer Epidemiology, Biomarkers & Prevention. 2006;15:1863.
- Pruthi S (expert opinion). Mayo Clinic, Rochester, Minn. March 2, 2011.
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