The two methods currently available to reduce the risk of ovarian cancer are using oral contraceptives or undergoing risk-reducing (prophylactic) surgery to remove the ovary and fallopian tubes.
Oral contraceptives (birth control pills) have been shown to reduce the risk of ovarian cancer by 30 to 60 percent. The longer a woman uses oral contraceptives, the greater the protection. This protection also continues for many years after the pills were last taken.
However, oral contraceptives have been linked to breast cancer and may be associated with other health risks. Physicians in the Ovarian Cancer Screening and Prevention Program can help you decide if taking oral contraceptives to reduce your risk of ovarian cancer makes sense for you.
Memorial Sloan Kettering researchers have established the value of risk-reducing, or prophylactic, salpingo-oophorectomy — removal of the ovaries and fallopian tubes before ovarian cancer has been diagnosed — as a way to prevent breast and ovarian cancers in women who are at high risk of this disease because of mutations in the BRCA genes. Women who opt for this surgery will no longer be able to have children. Such therapy has been shown to decrease the risk of ovarian and related cancers (such as those developing in the fallopian tube and peritoneal or abdominal cavity) by 85 to 90 percent.1 2 Additionally, if this surgery is done prior to menopause, it can reduce the risk of breast cancer by 40 to 70 percent.
Women with genetic risk factors for ovarian cancer may wish to consider surgery to remove their ovaries and fallopian tubes.
Most salpingo-oophorectomy operations can be performed on an outpatient basis, using a minimally invasive procedure known as laparoscopy. During this procedure, a thin, tube-like instrument with a camera on its tip (a laparoscope) is inserted through the abdominal wall. Guided by the camera's highly magnified image, surgery is performed through surgical ports using tiny instruments. Our specially trained surgeons may also use an advanced robotic device to assist him or her during the salpingo-oophorectomy operation.
One study has shown that the prophylactic removal of the ovaries and fallopian tubes may provide a different benefit for women who carry a genetic mutation in the BRCA2 gene than for those who have a BRCA1 mutation. In the study, none of the women carrying the BRCA2 mutation who had the surgery developed ovarian cancer, while women carrying the BRCA1 mutation who had the surgery decreased their risk of developing ovarian or related cancers by 85 percent.3
Risk-reducing surgery gives profound protection against ovarian and related cancers in women carrying either BRCA1 or BRCA2 mutations. Women with BRCA2 mutations who chose surgery also reduced their risk of developing breast cancer by 72 percent. However, women with BRCA1 mutations only reduced their risk of breast cancer by 39 percent. Additional research is underway to better understand why the results of the procedure differ in BRCA1 and BRCA2 carriers.
The decision to have a risk-reducing salpingo-oophorectomy is usually made after genetic counseling and possibly testing for mutations that may put a woman at risk for ovarian cancer. Because a woman cannot have children after this procedure, our investigators have initiated a study to learn more about the decision process leading up to surgery. Our researchers also want to find out more about the feelings associated with being at risk for ovarian cancer, and why or why not a woman opts for risk-reducing surgery.
N. D. Kauff, J. M. Satagopan, M. E. Robson, L. Scheuer, M. Hensley, C. A. Hudis, N. A. Ellis, J. Boyd, P. I. Borgen, R. R. Barakat, L. Norton, M. Castiel, K. Nafa, and K. Offit, “Risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 mutation,” New England Journal of Medicine 346(21), 2002: 1609-15. [PubMed Abstract]
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. Risk-reducing salpingo-oophorectomy for the prevention of BRCA1- and BRCA2-associated breast and gynecologic cancer: a multicenter, prospective study. J Clin Oncol. 2008 Mar 10;26(8):1331-7. Epub 2008 Feb 11. [PubMed Abstract]
2006 ASCO Abstract: N. D. Kauff, S. M. Domchek, T. M. Friebel, J. B. Lee, R. Roth, M. E. Robson, R. R. Barakat, L. Norton, K. Offit, T. R. Rebbeck, and the PROSE Study Group, “Multi-center prospective analysis of risk-reducing salpingo-oophorectomy to prevent BRCA-associated breast and ovarian cancer,” Journal of Clinical Oncology, 2006 ASCO Annual Meeting Proceedings Part I. 24 (18S), 2006: 1003.