Risk-reducing surgery for women at high risk of epithelial ovarian cancer

Key content The lifetime risk of ovarian cancer in the general population is 1.4% but women with hereditary ovarian cancer syndromes have a lifetime probability ashighas 25–60%for developing epithelial ovarian cancer. Screening has not been found to be associated with a statistically significant reduction in mortality from ovarian cancer and cannot be routinely recommended even for women at high risk. Serum CA125 levels are only elevated in 50–60% of stage I ovarian cancers and interval cancers may develop between screening visits. Studies show a 4–20% risk of finding an occult malignancy at the time of risk-reducing bilateral salpingo-oophorectomy. Studies support the efficacy of risk-reducing bilateral salpingo-oophorectomy in significantly reducing the risk of gynaecological and breast cancer in women who carry BRCA1 or BRCA2 mutations. Women undergoing risk-reduction bilateral salpingooophorectomy should be counselled about the effects of early menopause and the available management options including hormone replacement therapy.