Hereditary cancer conditions
BRCA1 and BRCA2
Inherited changes in the BRCA1 and BRCA2 genes are associated with an increased risk of ovarian, fallopian tube and breast cancer.
Women with these genetic changes may be advised to consider risk-reducing removal of their fallopian tubes and ovaries once they have completed their families. The recommended timing depends on the specific gene, age, family history and individual circumstances.
Hysterectomy is not routinely required for women with BRCA1 or BRCA2 genetic changes. However, some women may choose to have their uterus removed at the same time as their fallopian tubes and ovaries, depending on their individual circumstances, other gynaecological conditions and preferences.
Lynch syndrome
Lynch syndrome is an inherited condition associated with an increased risk of endometrial (uterine), bowel and certain other cancers, including ovarian cancer.
Risk-reducing hysterectomy is generally recommended, with timing influenced by age, completion of family (if relevant) and the specific genetic change. Removal of both fallopian tubes and ovaries is also commonly offered at the time of hysterectomy. The decision is individualised according to the gene involved, age, menopausal status and personal circumstances.
Other hereditary cancer genes
Changes in other genes, including BRIP1, RAD51C and RAD51D, can also increase ovarian cancer risk. Recommendations for risk-reducing surgery depend on the gene involved and the individual's estimated risk.
Genetic assessment and counselling
A family history of breast, ovarian, uterine or bowel cancer may indicate an inherited cancer predisposition, particularly when several relatives are affected or cancers occur at younger ages.
Genetic testing and counselling are generally coordinated through a familial cancer service or appropriately qualified genetics specialist.
If an inherited genetic change is identified, specialist consultation can help determine whether risk-reducing surgery is appropriate and when it should be considered.
Risk-reducing surgery
Risk-reducing surgery aims to substantially lower the likelihood of developing certain gynaecological cancers before cancer occurs.
Risk-reducing salpingo-oophorectomy involves removal of both fallopian tubes and ovaries. It is an established strategy for reducing ovarian and fallopian tube cancer risk in women with certain inherited genetic changes.
Risk-reducing hysterectomy involves removal of the uterus and cervix. It is generally recommended for women with Lynch syndrome and may also be considered by some women with BRCA1 or BRCA2 genetic changes, depending on their circumstances.
Salpingectomy with delayed oophorectomy involves removing the fallopian tubes initially while retaining the ovaries until a later operation. This approach may delay the onset of surgical menopause, but it has not yet been established as providing equivalent cancer protection to removal of the fallopian tubes and ovaries together.
The international TUBA-WISP II clinical trial is investigating the safety of this alternative approach in women with an increased inherited risk of ovarian cancer. Participation may be available to eligible patients at participating centres, and this option can be discussed during consultation.
Surgery can often be performed using minimally invasive laparoscopic or robotic techniques.
Planning surgery and managing menopause
The decision to proceed with surgery involves balancing cancer risk reduction against the potential effects of treatment.
Removal of both ovaries before natural menopause causes immediate menopause and permanently affects fertility. This can result in menopausal symptoms and longer-term effects on bone and cardiovascular health.
Menopausal hormone therapy may be appropriate for many women following risk-reducing surgery, depending on their medical history and individual circumstances.
Shaun discusses the timing and extent of surgery, fertility considerations, menopausal consequences and available management options to support informed decision-making.
Common questions
If I have a BRCA gene change, will I definitely develop ovarian cancer?
No. An inherited genetic change increases cancer risk but does not mean cancer will definitely develop. The degree of risk varies according to the gene involved and other individual factors.
Can ovarian cancer be detected early with regular ultrasound or blood tests?
Unfortunately, there is no reliable screening test for ovarian cancer, even in women with an inherited increased risk. Regular pelvic ultrasound and CA-125 blood tests have not been shown to reliably detect ovarian cancer early.
Do I need a hysterectomy if I have a BRCA1 or BRCA2 gene change?
Not necessarily. Hysterectomy is not routinely recommended solely because of a BRCA1 or BRCA2 genetic change. However, some women choose to have a hysterectomy at the same time as risk-reducing removal of their fallopian tubes and ovaries. This decision takes into account other gynaecological conditions, menopausal hormone therapy considerations and individual preferences.
Does risk-reducing surgery completely eliminate cancer risk?
No. Removal of the fallopian tubes and ovaries substantially reduces the risk of ovarian and fallopian tube cancer, but a small residual risk of primary peritoneal cancer remains.
Do I need a referral?
Yes. A referral from your GP or specialist is needed for a Medicare rebate. Please address this to Dr Shaun McGrath at Arc Specialist Care.
Further information and support
Seeing us in Brisbane
Ask your GP or specialist for a referral to Dr Shaun McGrath at Arc Specialist Care, then call us to book.
This information is general in nature and does not replace individual medical advice. Recommendations regarding genetic assessment and risk-reducing surgery depend on your individual circumstances.