A prospective cohort study in JAMA Surgery provides updated actuarial estimates of ovarian cancer risk for women with BRCA mutations who have not had risk-reducing surgery. The analysis of more than 5,700 carriers found that a BRCA1 carrier who deferred bilateral salpingo-oophorectomy (BSO) until age 50 still faced a 23.9% lifetime risk of ovarian cancer. By age 75, residual risk fell to 8.4% for BRCA1 carriers and 3.7% for BRCA2 carriers.
The authors, led by Vasily Giannakeas of Sinai Health System in Toronto, said the estimates exceed those from earlier studies and support individualized counseling about BSO timing. They noted that for older women in good health, residual risk is sufficiently high to justify considering preventive surgery, particularly for BRCA1 carriers. However, the decision should weigh comorbidities, life expectancy, surgical risks, and quality-of-life effects of early menopause.
An accompanying commentary by Kara Long and colleagues at Memorial Sloan Kettering pointed to interval salpingectomy with delayed oophorectomy as a promising alternative that may reduce tubo-ovarian cancer risk while preserving fertility and avoiding surgical menopause, with two large trials ongoing. Experts from Moffitt Cancer Center added that risk decreases after menopause but never reaches zero, so risk-reducing surgery remains the standard of care even for patients presenting later in life.