Prophylactic surgery and other strategies for reducing the risk of familial ovarian cancer.

The goal of a cancer prevention program is to improve the mortality rates of patients. No risk-reduction strategy is proven to reduce mortality rates of women at increased risk for ovarian cancer. Methods of ovarian cancer surveillance are unproven in high-risk women. According to some studies, the use of oral contraceptives in high-risk women reduces ovarian cancer risk. Prophylactic salpingo-oophorectomy is the most effective method of cancer risk reduction in women at high risk for ovarian cancer. However, women who undergo prophylactic salpingo-oophorectomy remain at risk for primary peritoneal cancer. A minority of women with BRCA1 and BRCA2 mutations are diagnosed with occult cancer at the time of surgical prophylaxis. Surgical prophylaxis should include complete removal of the fallopian tubes and ovaries, procurement of peritoneal cytology, and thorough evaluation of the tubes and ovaries by an expert pathologist. Beginning at age 30 years, women with BRCA1 and BRCA2 germline mutations should have an annual or semiannual screening, consisting of serum CA-125 measurement and transvaginal ultrasound, until the completion of childbearing. After the completion of childbearing and by age 40 years, women should undergo prophylactic salpingo-oophorectomy.