Oophorectomy (ovary removal surgery)

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Prophylactic oophorectomy: Preventing cancer by surgically removing your ovaries

Prophylactic oophorectomy (oh-oaf-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) 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?

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Illustration of the female reproductive system Female reproductive system

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 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. High-risk women age 35 and older who 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's risk of being diagnosed with breast cancer at some point in her lifetime is 60 percent, 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 90 percent or more. As an example, if a woman's risk of being diagnosed with ovarian cancer at some point in her lifetime is 30 percent, oophorectomy could reduce her risk to 3 percent. Put another way, for every 100 women just like her, 30 could be expected to be diagnosed with ovarian cancer without oophorectomy. And three 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 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 are the complications that can come from 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. Your doctor may recommend bone mineral density testing to look for bone loss. Some women may need to take medication to prevent or treat osteoporosis.
  • 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 high cholesterol and 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.

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References
  1. Isaacs C, et al. Options for women with a genetic predisposition to breast and ovarian cancer. http://www.uptodate.com/home/index.html. Accessed Feb. 3, 2009.
  2. Muto MG. Risk reducing salpingo-oophorectomy in women at high risk of epithelial ovarian cancer. http://www.uptodate.com/home/index.html. Accessed Feb. 3, 2009.
  3. Pavelka CJ, et al. Hereditary ovarian cancer - Assessing risk and prevention strategies. Obstetrics and Gynecology Clinics of North America. 2007;34:651.
  4. Oseni T, et al. An overview of the role of prophylactic surgery in the management of individuals with a hereditary cancer predisposition. Surgical Clinics of North America. 2008;88:739.
  5. Jatoi I, et al. Management of women who have a genetic predisposition for breast cancer. Surgical Clinics of North America. 2008;88:845.
  6. Can ovarian cancer be prevented? American Cancer Society. http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_Can_ovarian_cancer_be_prevented_33.asp. Accessed Feb. 6, 2009.
  7. Gulati AP, et al. The clinical management of BRCA1 and BRCA2 mutation carriers. Current Oncology Reports. 2008;10:47.
  8. Valea FA, et al. Oophorectomy and ovarian cystectomy. http://www.uptodate.com/home/index.html. Accessed Feb. 3, 2009.
  9. Shuster LT, et al. Prophylactic oophorectomy in pre-menopausal women and long-term health - a review. Menopause International. 2008;14:111.
  10. Rocca WA, et al. Survival patterns after oophorectomy in premenopausal women: A population-based cohort study. Lancet Oncology. 2006;7:821.
  11. Pruthi S (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 12, 2009.

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April 10, 2009

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