Skip to main content

Advertisement

SpringerLink
Log in

The consequences of risk reducing salpingo-oophorectomy: the case for a coordinated approach to long-term follow up post surgical menopause

  • Original Article
  • Published:
Familial Cancer Aims and scope Submit manuscript

Abstract

Women with germline mutations in BRCA1 and BRCA2 genes have significantly increased lifetime risks of breast and ovarian cancer. To manage both the ovarian and breast cancer risks the current recommendation is undergo a risk reducing salpingo-oophorectomy (RRSO) prior to natural menopause. To date, studies have focussed on quality of life and sexual dysfunction in women who undergo RRSO, but few have reported on the wider physical consequences. We performed a questionnaire study in women with BRCA 1 or 2 gene mutations known to the Peter MacCallum Familial Cancer Centre. We gathered information about ovarian surgery, ongoing follow-up, management of risk factors including osteoporosis, and current severity of menopausal symptoms. Two hundred and nineteen women were surveyed. One hundred and forty-three of 157 responding participants (91 %) reported having RRSO. Sixty one were pre-menopausal at RRSO. Post surgical follow-up rates were generally low, and a minority of women reported recent bone density imaging or pharmaceutical prevention or treatment of osteoporosis. Menopausal symptoms appeared generally mild. No significant differences in symptom severity were observed in women who underwent a pre-menopausal RRSO compared to RRSO after natural menopause. These data indicate that a formalised follow-up protocol is necessary to optimally manage the consequences of a RRSO.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Ford D, Easton DF, Bishop DT, Narod SA, Goldgar DE (1994) Risks of cancer in BRCA1-mutation carriers. Breast cancer linkage consortium. Lancet 343(8899):692–695

    Article  PubMed  CAS  Google Scholar 

  2. Antoniou A, Pharoah PD, Narod S, Risch HA, Eyfjord JE, Hopper JL, Loman N, Olsson H, Johannsson O, Borg A, Pasini B, Radice P, Manoukian S, Eccles DM, Tang N, Olah E, Anton-Culver H, Warner E, Lubinski J, Gronwald J, Gorski B, Tulinius H, Thorlacius S, Eerola H, Nevanlinna H, Syrjakoski K, Kallioniemi OP, Thompson D, Evans C, Peto J, Lalloo F, Evans DG, Easton DF (2003) Average risks of breast and ovarian cancer associated with BRCA1 or BRCA2 mutations detected in case Series unselected for family history: a combined analysis of 22 studies. Am J Hum Genet 72(5):1117–1130

    Article  PubMed  CAS  Google Scholar 

  3. Antoniou AC, Rookus M, Andrieu N, Brohet R, Chang-Claude J, Peock S, Cook M, Evans DG, Eeles R, Nogues C, Faivre L, Gesta P, van Leeuwen FE, Ausems MG, Osorio A, Caldes T, Simard J, Lubinski J, Gerdes AM, Olah E, Furhauser C, Olsson H, Arver B, Radice P, Easton DF, Goldgar DE (2009) Reproductive and hormonal factors, and ovarian cancer risk for BRCA1 and BRCA2 mutation carriers: results from the international BRCA1/2 carrier cohort study. Cancer Epidemiol Biomarkers Prev 18(2):601–610

    Article  PubMed  CAS  Google Scholar 

  4. Hennessy BT, Coleman RL, Markman M (2009) Ovarian cancer. Lancet 374(9698):1371–1382

    Article  PubMed  CAS  Google Scholar 

  5. McGuire V, Jesser CA, Whittemore AS (2002) Survival among U.S. women with invasive epithelial ovarian cancer. Gynecol Oncol 84(3):399–403

    Article  PubMed  Google Scholar 

  6. Hermsen BB, Olivier RI, Verheijen RH, van Beurden M, de Hullu JA, Massuger LF, Burger CW, Brekelmans CT, Mourits MJ, de Bock GH, Gaarenstroom KN, van Boven HH, Mooij TM, Rookus MA (2007) No efficacy of annual gynaecological screening in BRCA1/2 mutation carriers; an observational follow-up study. Br J Cancer 96(9):1335–1342

    PubMed  CAS  Google Scholar 

  7. Evans DG, Gaarenstroom KN, Stirling D, Shenton A, Maehle L, Dorum A, Steel M, Lalloo F, Apold J, Porteous ME, Vasen HF, van Asperen CJ, Moller P (2009) Screening for familial ovarian cancer: poor survival of BRCA1/2 related cancers. J Med Genet 46(9):593–597

    Article  PubMed  CAS  Google Scholar 

  8. Finch A, Beiner M, Lubinski J, Lynch HT, Moller P, Rosen B, Murphy J, Ghadirian P, Friedman E, Foulkes WD, Kim-Sing C, Wagner T, Tung N, Couch F, Stoppa-Lyonnet D, Ainsworth P, Daly M, Pasini B, Gershoni-Baruch R, Eng C, Olopade OI, McLennan J, Karlan B, Weitzel J, Sun P, Narod SA (2006) Salpingo-oophorectomy and the risk of ovarian, fallopian tube, and peritoneal cancers in women with a BRCA1 or BRCA2 mutation. JAMA 296(2):185–192

    Article  PubMed  CAS  Google Scholar 

  9. Kauff ND, Domchek SM, Friebel TM, Robson ME, Lee J, Garber JE, Isaacs C, Evans DG, Lynch H, Eeles RA, Neuhausen SL, Daly MB, Matloff E, Blum JL, Sabbatini P, Barakat RR, Hudis C, Norton L, Offit K, Rebbeck TR (2008) Risk-reducing salpingo-oophorectomy for the prevention of BRCA1- and BRCA2-associated breast and gynecologic cancer: a multicenter, prospective study. J Clin Oncol 26(8):1331–1337

    Article  PubMed  Google Scholar 

  10. Rebbeck TR, Kauff ND, Domchek SM (2009) Meta-analysis of risk reduction estimates associated with risk-reducing salpingo-oophorectomy in BRCA1 or BRCA2 mutation carriers. J Natl Cancer Inst 101(2):80–87

    Article  PubMed  CAS  Google Scholar 

  11. Domchek SM, Friebel TM, Singer CF, Evans DG, Lynch HT, Isaacs C, Garber JE, Neuhausen SL, Matloff E, Eeles R, Pichert G, Van t’veer L, Tung N, Weitzel JN, Couch FJ, Rubinstein WS, Ganz PA, Daly MB, Olopade OI, Tomlinson G, Schildkraut J, Blum JL, Rebbeck TR (2010) Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality. JAMA 304(9):967–975

    Article  PubMed  CAS  Google Scholar 

  12. Metcalfe KA, Birenbaum-Carmeli D, Lubinski J, Gronwald J, Lynch H, Moller P, Ghadirian P, Foulkes WD, Klijn J, Friedman E, Kim-Sing C, Ainsworth P, Rosen B, Domchek S, Wagner T, Tung N, Manoukian S, Couch F, Sun P, Narod SA (2008) International variation in rates of uptake of preventive options in BRCA1 and BRCA2 mutation carriers. Int J Cancer 122(9):2017–2022

    Article  PubMed  CAS  Google Scholar 

  13. Skytte AB, Gerdes AM, Andersen MK, Sunde L, Brondum-Nielsen K, Waldstrom M, Kolvraa S, Cruger D (2010) Risk-reducing mastectomy and salpingo-oophorectomy in unaffected BRCA mutation carriers: uptake and timing. Clin Genet 77(4):342–349

    Article  PubMed  CAS  Google Scholar 

  14. Fry A, Busby-Earle C, Rush R, Cull A (2001) Prophylactic oophorectomy versus screening: psychosocial outcomes in women at increased risk of ovarian cancer. Psychooncology 10(3):231–241

    Article  PubMed  CAS  Google Scholar 

  15. Elit L, Esplen MJ, Butler K, Narod S (2001) Quality of life and psychosexual adjustment after prophylactic oophorectomy for a family history of ovarian cancer. Fam Cancer 1(3–4):149–156

    Article  PubMed  CAS  Google Scholar 

  16. Tiller K, Meiser B, Gould L, Tucker K, Dudding T, Franklin J, Friedlander M, Andrews L (2005) Knowledge of risk management strategies, and information and risk management preferences of women at increased risk for ovarian cancer. Psychooncology 14(4):249–261

    Article  PubMed  CAS  Google Scholar 

  17. Madalinska JB, Hollenstein J, Bleiker E, van Beurden M, Valdimarsdottir HB, Massuger LF, Gaarenstroom KN, Mourits MJ, Verheijen RH, van Dorst EB, van der Putten H, van der Velden K, Boonstra H, Aaronson NK (2005) Quality-of-life effects of prophylactic salpingo-oophorectomy versus gynecologic screening among women at increased risk of hereditary ovarian cancer. J Clin Oncol 23(28):6890–6898

    Article  PubMed  Google Scholar 

  18. Madalinska JB, van Beurden M, Bleiker EM, Valdimarsdottir HB, Hollenstein J, Massuger LF, Gaarenstroom KN, Mourits MJ, Verheijen RH, van Dorst EB, van der Putten H, van der Velden K, Boonstra H, Aaronson NK (2006) The impact of hormone replacement therapy on menopausal symptoms in younger high-risk women after prophylactic salpingo-oophorectomy. J Clin Oncol 24(22):3576–3582

    Article  PubMed  Google Scholar 

  19. Fang CY, Cherry C, Devarajan K, Li T, Malick J, Daly MB (2009) A prospective study of quality of life among women undergoing risk-reducing salpingo-oophorectomy versus gynecologic screening for ovarian cancer. Gynecol Oncol 112(3):594–600

    Article  PubMed  Google Scholar 

  20. Hadjidakis D, Kokkinakis E, Sfakianakis M, Raptis SA (1999) The type and time of menopause as decisive factors for bone mass changes. Eur J Clin Invest 29(10):877–885

    Article  PubMed  CAS  Google Scholar 

  21. Rocca WA, Bower JH, Maraganore DM, Ahlskog JE, Grossardt BR, de Andrade M, Melton LJ III (2007) Increased risk of cognitive impairment or dementia in women who underwent oophorectomy before menopause. Neurology 69(11):1074–1083

    Article  PubMed  CAS  Google Scholar 

  22. Rivera CM, Grossardt BR, Rhodes DJ, Brown RD Jr, Roger VL, Melton LJ III, Rocca WA (2009) Increased cardiovascular mortality after early bilateral oophorectomy. Menopause 16(1):15–23

    Article  PubMed  Google Scholar 

  23. Domchek SM, Rebbeck TR (2007) Prophylactic oophorectomy in women at increased cancer risk. Curr Opin Obstet Gynecol 19(1):27–30

    Article  PubMed  Google Scholar 

  24. Rocca WA, Grossardt BR, de Andrade M, Malkasian GD, Melton LJ III (2006) Survival patterns after oophorectomy in premenopausal women: a population-based cohort study. Lancet Oncol 7(10):821–828

    Article  PubMed  Google Scholar 

  25. Cohen JV, Chiel L, Boghossian L, Jones M, Stopfer JE, Powers J, Rebbeck TR, Nathanson KL, Domchek SM (2011) Non-cancer endpoints in BRCA1/2 carriers after risk-reducing salpingo-oophorectomy Familial Cancer. doi:10.1007/s10689-011-9480-8

  26. Schneider HP, Heinemann LA, Rosemeier HP, Potthoff P, Behre HM (2000) The Menopause Rating Scale (MRS): comparison with Kupperman index and quality-of-life scale SF-36. Climacteric 3:50–58

    Article  PubMed  CAS  Google Scholar 

  27. Heinemann LA, Potthoff P, Schneider HP (2003) International versions of the Menopause Rating Scale (MRS). Health Qual Life Outcomes 1:28

    Article  PubMed  Google Scholar 

  28. Antill Y, Reynolds J, Young MA, Kirk J, Tucker K, Bogtstra T, Wong S, Dudding T, Di Iulio J, Phillips KA (2006) Risk-reducing surgery in women with familial susceptibility for breast and/or ovarian cancer. Eur J Cancer 42(5):621–628

    Article  PubMed  Google Scholar 

  29. Rebbeck TR, Friebel T, Wagner T, Lynch HT, Garber JE, Daly MB, Isaacs C, Olopade OI, Neuhausen SL, van ‘t Veer L, Eeles R, Evans DG, Tomlinson G, Matloff E, Narod SA, Eisen A, Domchek S, Armstrong K, Weber BL (2005) Effect of short-term hormone replacement therapy on breast cancer risk reduction after bilateral prophylactic oophorectomy in BRCA1 and BRCA2 mutation carriers: the PROSE study group. J Clin Oncol 23(31):7804–7810

    Article  PubMed  CAS  Google Scholar 

  30. Kotz K, Alexander JL, Dennerstein L (2006) Estrogen and androgen hormone therapy and well-being in surgically postmenopausal women. J Womens Health (Larchmt) 15(8):898–908

    Article  Google Scholar 

  31. Hickey M, Saunders C, Partridge A, Santoro N, Joffe H, Stearns V (2008) Practical clinical guidelines for assessing and managing menopausal symptoms after breast cancer. Ann Oncol 19(10):1669–1680

    Article  PubMed  CAS  Google Scholar 

  32. Chapman JS, Powell CB, McLennan J, Crawford B, Mak J, Stewart N, Chen LM (2011) Surveillance of survivors: follow-up after risk-reducing salpingo-oophorectomy in BRCA 1/2 mutation carriers. Gynecol Oncol 122:339–343

    Article  PubMed  Google Scholar 

  33. Campfield Bonadies D, Moyer A, Matloff ET (2011) What I wish I’d known before surgery: BRCA carriers’ perspectives after bilateral salipingo-oophorectomy. Fam Cancer 10(1):79–85. doi:10.1007/s10689-010-9384-z

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This project was supported by funding from Irene Pletka.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Familial Cancer Centre, Peter MacCallum Cancer Centre, Level 3, 10 St Andrews Place, East Melbourne, VIC, 3002, Australia

    Carmel Pezaro, Paul James, Joanne McKinley, Mary Shanahan, Mary-Anne Young & Gillian Mitchell

  2. Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, 3010, Australia

    Paul James & Gillian Mitchell

Authors
  1. Carmel Pezaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paul James
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joanne McKinley
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mary Shanahan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mary-Anne Young
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gillian Mitchell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gillian Mitchell.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pezaro, C., James, P., McKinley, J. et al. The consequences of risk reducing salpingo-oophorectomy: the case for a coordinated approach to long-term follow up post surgical menopause. Familial Cancer 11, 403–410 (2012). https://doi.org/10.1007/s10689-012-9527-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10689-012-9527-5

Keywords

Search

Navigation