Prophylactic Salpingo-Oophorectomy (Ovary/Tube Removal)

This page is for people with a BRCA1 or BRCA2 variant who are thinking about having their ovaries and tubes removed to lower cancer risk. It explains the numbers, the timing, and the main cost: early menopause.

Risk-reducing salpingo-oophorectomy removes both ovaries and both fallopian tubes. It is usually done laparoscopically, through small cuts. The tubes come out because NCI says many tumors once called ovarian high-grade serous cancer may start in the tube lining.

• Lifetime ovarian cancer risk is about 39% to 58% with a BRCA1 variant and 13% to 29% with BRCA2. In the general population it is about 1.1%.
• This surgery cuts ovarian and fallopian tube cancer risk by roughly 90%.
• Cancer of the abdominal lining (primary peritoneal cancer) has been reported rarely after the surgery.
• Does the surgery also lower breast cancer risk? NCI reports a nearly 50% lower risk of later breast cancer in studies, though results differ by gene.

One reason it is offered despite what it costs: NCI says there is no evidence that screening finds ovarian cancer early. That covers CA-125 blood tests and transvaginal ultrasound.

NCI gives the usual timing as age 35 to 40 for BRCA1 and 40 to 45 for BRCA2). Ask how your family history and plans for children fit these ages.

Timing is the hardest part of this decision. The risk you are cutting rises with age. The cost of surgical menopause falls with age. So earlier surgery prevents more cancer, at the price of more years without ovarian hormones. Later surgery does the reverse. Family history often shifts the target, above all how old your relatives were at diagnosis.

Some researchers are studying removing the tubes first and the ovaries later. We could not confirm details in an NCI source, so ask your team about it.

If you have not yet gone through menopause, this surgery brings it on at once rather than over years. That matters:

• Hot flashes and night sweats — reported by roughly 41% to 61% of women afterwards
• Sleep disruption, mood changes, difficulty concentrating
• Vaginal dryness, and changes in sexual desire and comfort
• Loss of bone density over time
• Higher cardiovascular risk when surgery happens well before natural menopause
• Permanent loss of fertility

NCI notes that these harms may be lessened with hormone replacement. Whether it suits you depends on your own history, including any breast cancer. Have that conversation before surgery, not after.

The tissue is examined. The tubes and ovaries are checked by a pathologist after surgery. Ask in advance what happens if anything unexpected is found, so it is not a shock.

Your uterus is a separate question. This operation does not include hysterectomy. Some people have reasons to consider it at the same time. Many do not. Ask why it is, or is not, being proposed for you.

NCI reports about a 90% lower ovarian cancer risk. NCI's genetics summary says risk-reducing salpingo-oophorectomy has been shown to improve overall survival in people carrying a BRCA1 or BRCA2 pathogenic variant, without putting a figure on it. The costs are just as real, and they land in daily life rather than on a chart.

Some people decide quickly. That is common if you are near the recommended age range, have finished having children, or have watched ovarian cancer in your family. Others take much longer, especially if they are younger, still deciding about children, or dreading menopause. Taking longer is a legitimate choice. Just keep the decision open, and set a date to revisit it, so it does not quietly drop off the list.

• NCI — Ovarian, Fallopian Tube, and Primary Peritoneal Cancer Prevention (PDQ®)
• NCI — Genetics of Breast and Gynecologic Cancers (PDQ®), Health Professional Version
• NCI — BRCA Gene Changes: Cancer Risk and Genetic Testing