Indications for Risk Reducing Bilateral Salpingectomy-Oophorectomy (BSO)

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Women with a pathogenic variant in BRCA1:
    • Have a lifetime cumulative ovarian cancer risk of 44% (95% CI 36% to 53%)
  • The NCCN guidelines recommend:
    • Risk-reducing bilateral salpingectomy-oophorectomy (BSO), for women who have completed childbearing:
      • Be performed by age 35 to 40 in BRCA1 patients
    • Of note, hysterectomy at the time of BSO is not routinely recommended
  • There is a lack of data to support survival benefit to ovarian cancer screening
  • Pelvic MRI serves no role in screening for ovarian cancers
  • For high-risk patients who decline or defer BSO:
    • Screening is typically offered and includes transvaginal ultrasound and cancer antigen (CA) 125 every six months beginning at age 30 or 5 to 10 years before the earliest age of first diagnosis of ovarian cancer in the family:
      • This screening strategy appears most effective with use of longitudinal algorithms as opposed to a single cutoff for CA 125
  • There is no current effective chemoprevention option for risk-reduction in ovarian cancer, though research is underway
  • References
    • Kuchenbaecker KB, Hopper JL, Barnes DR, et al. Risks of breast, ovarian, and contralateral breast cancer for BRCA1 and BRCA2 mutation carriers. JAMA. 2017;317(23):2402-2416.
    • National Comprehensive Cancer Network. Genetic/familial high risk assessment: breast and ovarian, Version 1.2020 https://www.nccn.org/professionals/physician_gls/pdf/genetics_bop.pdf Accessed February 23, 2020.
    • Menon U, Karpinskyj C, Gentry-Maharaj A. Ovarian cancer prevention and screening. Obstet Gynecol. 2018;131(5):909-927.
    • Kathawala RJ, Kudelka A, Rigas B. The chemoprevention of ovarian cancer: the need and the options. Curr Pharmacol Rep. 2018;4(3):250-260.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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