Risk reducing surgery

What is risk reducing surgery?

Risk reducing surgery is a surgical procedure that’s used to reduce the risk of developing gynaecological cancer, particularly ovarian cancer. 

Who should have risk reducing surgery?

BRCA1/2 mutation

If you’ve been diagnosed with a BRCA1 or BRCA2 gene mutation, you have the option of a surgical procedure called a risk-reducing bilateral salpingo-oophorectomy (rrBSO) to reduce the risk of developing epithelial ovarian and fallopian tube cancer. This risk reducing surgery includes removal of both  fallopian tubes and ovaries. 

This procedure reduces the risk of ovarian cancer by over 80%. Unfortunately, there’s still a risk of developing primary peritoneal cancer, which is a variant of ovarian cancer.

Lynch syndrome

If you’ve been diagnosed with Lynch syndrome, you have an increased risk of developing endometrial cancer as well as ovarian cancer. You have the option of risk reducing surgery to remove the uterus as well as both fallopian tubes and ovaries. 

What is the risk of gynaecological cancer due to genetic mutations?

Mutation Lifetime risk ovarian cancer
BRCA1 35-46%
BRCA2 13-23%
Lynch syndrome 38% ovarian cancer
71% endometrial cancer

What’s involved in risk reducing surgery?

Risk reducing surgery is done by laparoscopic or keyhole surgery in the majority of cases. 

BRCA1/2 mutation

The extent of surgery depends on the nature of the genetic mutation. If you carry the BRCA1 or BRCA2 gene mutation, the minimum surgery required includes removal of both fallopian tubes and ovaries and taking a sample from the lining of the uterus, called curettings. 

We may consider a hysterectomy during this surgical procedure, if there’s any other gynaecological pathology or to simplify the hormone replacement after your surgery. In fact, there’s growing evidence of the possibility of increased risk of uterine cancer with BRCA1/2 gene mutations. 

Lynch syndrome

If you’ve been diagnosed with Lynch syndrome, it’s recommended to remove the uterus, both fallopian tubes and ovaries to reduce your risk of endometrial cancer as well as ovarian cancer.

When should risk reducing surgery be performed?

If you carry the BRCA1/2 gene mutation, a risk-reducing bilateral salpingo-oophorectomy (rrBSO) is recommended between the ages of 35 to 40 if you’ve completed childbearing. Alternatively, the decision will be made based on the age of onset of ovarian cancer in your family. 

If you carry the BRCA2 gene mutation, you can delay this procedure until you’re 40 or 45. 

Who should perform risk reducing surgery?

A referral to a gynaecological oncologist is strongly recommended to give you the opportunity to discuss this surgery. Dr Vivek Arora has 20+ years’ experience performing risk reducing surgery and prioritises offering compassionate care in a supportive environment. 

What are the risks of risk reducing surgery?

Apart from the surgical risks associated with any procedure, risk reducing surgery results in loss of fertility and surgical menopause. Women are likely to experience side effects related to menopause.

Can I receive hormone replacement after risk reducing surgery?

In most cases, women can receive hormone replacement after risk reducing surgery. As your Gynaeocological Oncologist, I make it a priority to have a detailed discussion to talk about risks and benefits of hormone therapy, including the risk of breast cancer and other medical issues. 

Why can’t I have regular ultrasounds for ovarian cancer screening?

Unfortunately, there’s currently no reliable method available to screen for ovarian cancer. Ultrasounds or blood tests, even when carried out regularly, have proven unreliable in picking up ovarian cancer at an early stage. 

Risk reducing surgery is the single most reliable option to reduce the risk of ovarian and endometrial cancers.

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