Projected Benefit of Bilateral Salpingo-Oophorectomy by Age in BRCA Carriers.

BRCA1/2

Pathogenic BRCA1 and BRCA2 variants, with residual ovarian cancer risk projected by life table according to current age and age at salpingo-oophorectomy

Women carrying a BRCA1 or BRCA2 variant face a high lifetime risk of ovarian cancer and are often advised to undergo preventive bilateral salpingo-oophorectomy (BSO), recommended at age 35 for BRCA1 and 45 for BRCA2 carriers; some choose to delay it until menopause, and there is no standard upper age beyond which surgery is no longer advised. This international prospective cohort, recruited between 1995 and 2024 across 24 centres, followed 4,286 BRCA1 and 1,427 BRCA2 carriers aged 30 to 74 years at baseline, with both ovaries intact and no prior ovarian cancer, over a mean follow-up of 4.4 years (SD 3.9), during which 249 ovarian cancers occurred. A life table analysis based on age-specific ovarian cancer incidence and competing mortality rates estimated the lifetime risk at 55.0% (95% CI 48.8-61.9) for BRCA1 and 24.1% (15.1-36.6) for BRCA2 carriers. For a 30-year-old BRCA1 carrier whose BSO is delayed to age 50, the projected residual risk is 23.9% (95% CI 20.7-27.4); at age 75, the estimated residual risk is 8.4% (1.7-22.7) for BRCA1 and 3.7% (0.1-22.7) for BRCA2. The authors conclude that the residual risk for older women in good health is high enough to consider preventive surgery.

Synthesis written by Geno'X. For the full original abstract, please refer to the source publication.

This addresses a real consultation question, the age up to which salpingo-oophorectomy should be offered: for a 30-year-old BRCA1 carrier, delaying it to age 50 leaves a projected residual risk of 23.9% (95% CI 20.7-27.4), an estimate precise enough that a prolonged wait should not be taken lightly. At age 75, however, the values are life table projections rather than observations, with very wide intervals (1.7-22.7% for BRCA1, 0.1-22.7% for BRCA2) on a mean follow-up of 4.4 years: they point in the direction the authors take without allowing an upper age limit to be set. The abstract quantifies residual ovarian cancer risk, not the net benefit of surgery, which still has to be weighed against its own effects in each patient.

Analysis by Dr Thibaut Benquey