Society of Gynecologic Oncology Recommendations for the Prevention of Ovarian Cancer

Abstract

Early detection of epithelial ovarian carcinoma through screening and symptom detection has failed to reduce mortality from this lethal malignancy. The only available strategy likely to reduce mortality from this cancer is prevention. This review summarizes evidence that implementation of several prevention strategies can substantially reduce mortality from ovarian cancer. Potential strategies recommended by the Society of Gynecologic Society that can reduce the risk of ovarian cancer are discussed. Recommendations are based on analysis of the current literature. • A key aim of preventive strategies is to identify and treat women at hereditary increased risk of ovarian cancer. • There has been increasing evidence in the past decade that most type 2 serous ovarian cancers arise from neoplastic progression of epithelial cells in the fallopian tube. With the current assumption that the fallopian tubes are the potential source of high-grade serous cancer in women with and without known genetic mutations, many gynecologic surgeons believe that risk reduction in both women at high risk or average risk may be achieved by opportunistic salpingectomy. • Salpingectomy should be considered for average-risk women undergoing hysterectomy, elective pelvic surgery, and sterilization techniques at the completion of childbearing. Salpingectomy can also be considered at the completion of childbearing in women at increased genetic risk of ovarian cancer who refuse to have salpingo-oophorectomy. • Oral contraceptives reduce the risk of both types 1 and 2 ovarian cancer and are considered safe for carriers of the BRCA1 and BRCA2 mutation. These drugs are also effective for reducing risk in women with an average risk of ovarian cancer. • Another prevention strategy, tubal ligation, has been associated with a reduction in ovarian cancer in both high-risk women as well as the general population. • The most proven method for preventing ovarian cancer in women with a deleterious BRCA1 or BRCA2 mutation is risk-reducing salpingo-oophorectomy (RRSO). Following RRSO, a 70% to 85% reduction in ovarian cancer has been reported. • Women at inherited increased risk of ovarian cancer or who have this cancer should be offered genetic counseling to assess their risk. Individualized genetic counseling is followed by elective genetic testing, which should include BRCA1 and BRCA2. Despite clear evidence of benefit from counseling, about 50% of women with ovarian cancer seen at academic centers and 80% in a community setting are not referred for genetic counseling. • The majority of high-grade serous cancers have precursor lesions in the fallopian tube, and salpingectomy is presumed to reduce the incidence of type 2 ovarian cancer. However, there are no data showing a reduction in ovarian cancer risk with opportunistic salpingectomy among either women at inherited risk or those at average risk.