A new large-scale retrospective study suggests that bilateral salpingo-oophorectomy (BSO), the surgical removal of both ovaries and fallopian tubes, significantly reduces ovarian cancer risk in women carrying BRCA1 or BRCA2 genetic mutations.
The study by Hassan et al., analyzing electronic health records of 3,423 women aged 20–75 years diagnosed with breast cancer as their first malignancy between 1995 and 2019, found that BSO reduced ovarian cancer risk by 80% and significantly improved overall (HR 0.52) and breast cancer-specific survival (BRCA1: HR 0.62; BRCA2: HR 0.48) in BRCA1 and BRCA2 mutation carriers. BSO also lowered the risk of second non-breast cancers (HR 0.59) without increasing the risk of cardiovascular disease, stroke, depression, or contralateral breast cancer. However, uptake was notably lower among Black and Asian women and those from more socioeconomically deprived areas, underscoring disparities in access to this preventive intervention.
Women with BRCA1 and BRCA2 pathogenic variants face a significantly elevated lifetime risk of breast and ovarian cancer—by age 80, the risk of breast cancer ranges from 45% to 72%, and for ovarian cancer from 11% to 44%. Among those already diagnosed with breast cancer, the subsequent risk of ovarian cancer is estimated at 33% for BRCA1 and 12% for BRCA2 carriers. BSO remains the only proven intervention to reduce ovarian cancer risk and is recommended between ages 35–40 for BRCA1 and 40–45 for BRCA2 carriers.
A similar study by Bommel et al. reinforced the association between BRCA mutations and elevated risks of breast and ovarian cancers, further supporting the role of surgical prevention strategies. Additionally, the Tubal Ligation and Oophorectomy (TUBA) study compared risk-reducing salpingectomy (RRS) with risk-reducing salpingo-oophorectomy (RRSO) and found that RRS was associated with better menopause-related quality of life (QoL) outcomes, especially in the first year after surgery, when compared to those undergoing RRSO even with hormone replacement therapy (HRT). However, by three years post-surgery, these differences in QoL became less pronounced.
The present study is the first to use large-scale population-based electronic health records and genetic data to evaluate the long-term outcomes of BSO in BRCA1 and BRCA2 mutation carriers with a personal history of breast cancer. It also provides insights into disparities in BSO uptake. These findings underscore the need for personalized counselling and shared decision-making in this high-risk group, as the risk-benefit profile of BSO differs from that of the general population. Healthcare providers can use these insights to guide informed decisions about preventive interventions and work toward addressing inequities in access to life-saving care. Additionally, the study emphasizes the importance of improving awareness, education, and support systems to help women at high genetic risk for breast and ovarian cancers make informed healthcare choices.
A new large-scale retrospective study suggests that bilateral salpingo-oophorectomy (BSO), the surgical removal of both ovaries and fallopian tubes, significantly reduces ovarian cancer risk in women carrying BRCA1 or BRCA2 genetic mutations.
References
- Hassan H, Allen I, Rahman T, Allen S, Knott C, Huntley C, et al. Long-term health outcomes of bilateral salpingo-oophorectomy in BRCA1 and BRCA2 pathogenic variant carriers with personal history of breast cancer: a retrospective cohort study using linked electronic health records. The Lancet Oncology [Internet]. 2025 May 7 [cited 2025 May 13];0(0). Available from: https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(25)00156-1/fulltext
- Van Bommel MHD, Steenbeek MP, Inthout J, Van Garderen T, Harmsen MG, Arts-De Jong M, et al. Salpingectomy With Delayed Oophorectomy Versus Salpingo-Oophorectomy in BRCA1/2 Carriers: Three-Year Outcomes of a Prospective Preference Trial. BJOG: An International Journal of Obstetrics & Gynaecology. 2025;132(6):782–94.