Timing of Oophorectomy in Ovarian Cancer

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Evidence supporting recommendations for the appropriate age to proceed with prophylactic oophorectomy remain unclear. Robert A. Burger, MD, notes that prophylactic oophorectomy is typically done at the completion of childbearing or age 35, whichever comes later, in individuals who carry the BRCA1 germline mutation. Physicians typically recommend age 40 for women with BRCA2 mutations, as the median age of diagnosis in women with BRCA2 mutations who do not undergo risk-reducing surgery is age 40. James Tate Thigpen, MD, mentions that strong consideration to a prophylactic salpingo-oophorectomy should be given to anyone who tests positive for a BRCA mutation by age 40.

Burger and Warner K. Huh, MD, agree that no studies have demonstrated a mathematical equation that determines the exact time an early intervention affords protection, and the decision remains individualized for each patient. Michael J. Birrer, MD, points out that clinicians do not have all the data needed to make an individualized decision at this time. It is still uncertain how specific types of mutations impact the disease course and how modifiers within each individual affect how that mutation manifests itself. Until these aspects are uncovered, states Birrer, clinicians cannot effectively individualize care.