Less May Be Better: Surgery to Reduce Ovarian Cancer Risk May Improve Quality of Life

In order to reduce their risk of ovarian cancer, it is recommended that women with an inherited BRCA gene mutation have surgery to remove their ovaries before natural menopause. For women who have completed child-bearing, current guidelines recommend removal of the ovaries and fallopian tubes (also called risk-reducing salpingo-oophorectomy or RRSO) between ages 35-40 for those with an inherited BRCA1 mutation and ages 40-45 for those with an inherited BRCA2 mutation.

However, risk-reducing removal of the ovaries at these ages causes early menopause and may lead to menopause-related side effects. Short-term side effects may include hot flashes, sleep disturbances and impaired sexual function, while long-term side effects may be the risk of heart disease, osteoporosis and cognitive impairment.

There is growing evidence that the most common type of ovarian cancer usually begins in the fallopian tubes. This knowledge shift regarding where ovarian cancer begins has led to the possibility that risk-reducing removal of the fallopian tubes (called risk-reducing salpingectomy or RRS), followed later by removal of the ovaries, may lower cancer risk, while postponing menopause and its associated side effects.

The TUBA study is the first study to look at women with BRCA mutations who have had a RRS or a RRSO, to determine what the impact was on their menopause-related quality of life. Participants in the TUBA study who had a RRS only reported a better quality of life and sexual functioning than those who chose a RRSO. This was true whether participants took hormone therapy or not, although using hormone therapy improved some aspects of sexual functioning.

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