Among older BRCA carriers who remain in good health, the residual risk of ovarian cancer may be high enough to support consideration of preventive surgery, according to findings from a prospective cohort study reported in JAMA Surgery. Giannakeas et al also found that BRCA1 carriers who defer bilateral salpingo-oophorectomy until age 50 may face a nearly one-in-four risk of developing the disease.
Given their high lifetime risk of ovarian cancer, women with BRCA1 or BRCA2 pathogenic variants are often advised to consider preventive bilateral salpingo-oophorectomy. However, some delay surgery until menopause, and there is no established upper age at which the procedure is no longer recommended.
“Clinical decision support tools can help personalize the risk of ovarian cancer and inform decisions regarding the timing and projected benefit of bilateral salpingo-oophorectomy in BRCA carriers,” the investigators wrote.
Study Details
The investigators focused on 4,286 BRCA1 and 1,427 BRCA2 carriers aged 30 to 74 years (mean age = 42.0 years) who had both ovaries intact and no prior ovarian cancer diagnosis at baseline. Participants were recruited from 24 international centers between 1995 and 2024.
Using age-specific ovarian cancer incidence rates and competing mortality rates, the investigators conducted a life-table analysis to estimate residual lifetime ovarian cancer risk according to current age and projected age at bilateral salpingo-oophorectomy. The timing of surgery was categorized as immediate, delayed, or no bilateral salpingo-oophorectomy.
During a mean follow-up of 4.4 years, 249 incident ovarian cancers were identified.
Key Findings
For BRCA1 and BRCA2 carriers, the lifetime risks of ovarian cancer were 55.0% and 24.1%, respectively.
The projected residual ovarian cancer risk for a 30-year-old BRCA1 carrier with bilateral salpingo-oophorectomy delayed until age 50 was 23.9%. By age 75, the estimated residual ovarian cancer risk was 8.4% for BRCA1 carriers and 3.7% for BRCA2 carriers.
“These risk estimates are intended to support informed decisions between health-care providers and patients about the timing of bilateral salpingo-oophorectomy,” the investigators concluded. “These results are consistent with the current recommendations for risk-reducing bilateral salpingo-oophorectomy at age 35 years for BRCA1 and age 45 years for BRCA2 carriers.”
They added, “These findings further emphasize the importance of timely identification of BRCA1 and BRCA2 carriers in young healthy women for whom the expected benefit of bilateral salpingo-oophorectomy is greatest.”
Vasily Giannakeas, PhD, of Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, is the corresponding author of the article in JAMA Surgery.
Disclosure: The study was supported by the Canadian Institutes of Health Research, Canadian Cancer Society, Norwegian Cancer Society, and the Canada Research Chairs Program. For full disclosures of the study authors, visit jamanetwork.com.
