Skip to main content
SpringerLink
Log in

Risk-Reducing Salpingo-oophorectomy (RRSO)

  • Chapter
  • First Online:
Hereditary Breast and Ovarian Cancer

  • 499 Accesses

Abstract

Risk-reducing salpingo-oophorectomy (RRSO) is performed for the primary prevention of ovarian cancer in patients with hereditary breast–ovarian cancer (HBOC) syndrome. When HBOC is diagnosed without ovarian cancer, surveillance is performed using transvaginal ultrasound and serum CA125 assessment, and chemoprophylaxis is administered using oral contraceptives (OCs) or low-dose estrogen–progestin (LEP); however, RRSO is the most reliable treatment for ovarian cancer prevention. While RRSO is expected to gain popularity, due attention must be paid to the fact that this procedure is not easy to perform. Performing RRSO requires a deep understanding of the biological and anatomical characteristics of the structures surrounding ovarian cancer, paying attention to important points while performing surgical procedures, and taking precautions to facilitate pathology examination; moreover, a thorough understanding of gynecologic oncology and female reproductive medicine, such as treatment for surgical menopause, is required. Furthermore, following RRSO, minute ovarian cancers, which cannot be identified on preoperative evaluation, and occult cancers, which are serous tubal intraepithelial carcinoma (STIC) lesions of the fallopian tubes, can become apparent. To detect occult cancer, pathological examination is inadequate in cases of benign disease, and it is important to proceed with the sectioning and extensively examining the fimbriated end (SEE-FIM) protocol in collaboration with pathologists. Moreover, for RRSO to perform its original role, which is primary prevention, it should be kept in mind to introduce the procedure at the end of childbirth between the age of 35 and 40 years, as recommended in the guidelines, and at an appropriate time based on the earliest age of ovarian cancer onset among individuals in the patient’s family. To provide the maximum benefit to patients with HBOC, individuals involved in the care of such patients must deepen their knowledge not only in their own field of expertise but also in genetic medicine and incorporate this knowledge into routine medical care.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kuchenbaecker KB, Hopper JL, Barnes DR, Phillips KA, Mooij TM, Roos-Blom MJ, et al. Risks of breast, ovarian, and contralateral breast cancer for BRCA1 and BRCA2 mutation carriers. JAMA. 2017;317(23):2402–16.

    Article  CAS  PubMed  Google Scholar 

  2. Iodice S, Barile M, Rotmensz N, Feroce I, Bonanni B, Radice P, et al. Oral contraceptive use and breast or ovarian cancer risk in BRCA1/2 carriers: a meta-analysis. Eur J Cancer. 2010;46(12):2275–84.

    Article  CAS  PubMed  Google Scholar 

  3. Anothaisintawee T, Wiratkapun C, Lerdsitthichai P, Kasamesup V, Wongwaisayawan S, Srinakarin J, et al. Risk factors of breast cancer: a systematic review and meta-analysis. Asia Pac J Public Health. 2013;25(5):368–87.

    Article  PubMed  Google Scholar 

  4. Gierisch JM, Coeytaux RR, Urrutia RP, Havrilesky LJ, Moorman PG, Lowery WJ, et al. Oral contraceptive use and risk of breast, cervical, colorectal, and endometrial cancers: a systematic review. Cancer Epidemiol Biomark Prev. 2013;22(11):1931–43.

    Article  Google Scholar 

  5. Mørch LS, Skovlund CW, Hannaford PC, Iversen L, Fielding S, Lidegaard Ø. Contemporary hormonal contraception and the risk of breast cancer. N Engl J Med. 2017;377(23):2228–39.

    Article  PubMed  Google Scholar 

  6. Ichida M, Kataoka A, Tsushima R, Taguchi T. No increase in breast cancer risk in Japanese women taking oral contraceptives: a case-control study investigating reproductive, menstrual and familial risk factors for breast cancer. Asian Pac J Cancer Prev. 2015;16(9):3685–90.

    Article  PubMed  Google Scholar 

  7. Kawai M, Minami Y, Kuriyama S, Kakizaki M, Kakugawa Y, Nishino Y, et al. Reproductive factors, exogenous female hormone use and breast cancer risk in Japanese: the Miyagi cohort study. Cancer Causes Control. 2010;21(1):135–45.

    Article  PubMed  Google Scholar 

  8. Buys SS, Partridge E, Black A, Johnson CC, Lamerato L, Isaacs C, et al. Effect of screening on ovarian cancer mortality: the prostate, lung, colorectal and ovarian (PLCO) cancer screening randomized controlled trial. JAMA. 2011;305(22):2295–303.

    Article  CAS  PubMed  Google Scholar 

  9. Evans DG, Gaarenstroom KN, Stirling D, Shenton A, Maehle L, Dørum A, et al. Screening for familial ovarian cancer: poor survival of BRCA1/2 related cancers. J Med Genet. 2009;46(9):593–7.

    Article  CAS  PubMed  Google Scholar 

  10. Rebbeck TR, Kauff ND, Domchek SM. Meta-analysis of risk reduction estimates associated with risk-reducing salpingo-oophorectomy in BRCA1 or BRCA2 mutation carriers. J Natl Cancer Inst. 2009;101(2):80–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Eleje GU, Eke AC, Ezebialu IU, Ikechebelu JI, Ugwu EO, Okonkwo OO. Risk-reducing bilateral salpingo-oophorectomy in women with BRCA1 or BRCA2 mutations. Cochrane Database Syst Rev. 2018;8(8):Cd012464.

    PubMed  Google Scholar 

  12. Heemskerk-Gerritsen BA, Seynaeve C, van Asperen CJ, Ausems MG, Collée JM, van Doorn HC, et al. Breast cancer risk after salpingo-oophorectomy in healthy BRCA1/2 mutation carriers: revisiting the evidence for risk reduction. J Natl Cancer Inst. 2015;107(5)

    Google Scholar 

  13. Domchek SM, Friebel TM, Singer CF, Evans DG, Lynch HT, Isaacs C, et al. Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality. JAMA. 2010;304(9):967–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Rebbeck TR, Lynch HT, Neuhausen SL, Narod SA, Van't Veer L, Garber JE, et al. Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations. N Engl J Med. 2002;346(21):1616–22.

    Article  PubMed  Google Scholar 

  15. Finch A, Beiner M, Lubinski J, Lynch HT, Moller P, Rosen B, et al. Salpingo-oophorectomy and the risk of ovarian, fallopian tube, and peritoneal cancers in women with a BRCA1 or BRCA2 mutation. JAMA. 2006;296(2):185–92.

    Article  CAS  PubMed  Google Scholar 

  16. Sherman ME, Piedmonte M, Mai PL, Ioffe OB, Ronnett BM, Van Le L, et al. Pathologic findings at risk-reducing salpingo-oophorectomy: primary results from gynecologic oncology group trial GOG-0199. J Clin Oncol. 2014;32(29):3275–83.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Donnez O, Squifflet J, Marbaix E, Jadoul P, Donnez J. Primary ovarian adenocarcinoma developing in ovarian remnant tissue ten years after laparoscopic hysterectomy and bilateral salpingo-oophorectomy for endometriosis. J Minim Invasive Gynecol. 2007;14(6):752–7.

    Article  PubMed  Google Scholar 

  18. Cass I, Walts A, Karlan BY. Does risk-reducing bilateral salpingo-oophorectomy leave behind residual tube? Gynecol Oncol. 2010;117(1):27–31.

    Article  PubMed  Google Scholar 

  19. Kauff ND, Barakat RR. Risk-reducing salpingo-oophorectomy in patients with germline mutations in BRCA1 or BRCA2. J Clin Oncol. 2007;25(20):2921–7.

    Article  CAS  PubMed  Google Scholar 

  20. Powell CB, Chen LM, McLennan J, Crawford B, Zaloudek C, Rabban JT, et al. Risk-reducing salpingo-oophorectomy (RRSO) in BRCA mutation carriers: experience with a consecutive series of 111 patients using a standardized surgical-pathological protocol. Int J Gynecol Cancer. 2011;21(5):846–51.

    Article  PubMed  Google Scholar 

  21. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology. Ovarian cancer including fallopian tube cancer and primary peritoneal cancer, ver1. 2020. Accessed Sep 30, 2020.

    Google Scholar 

  22. Practice Bulletin No ACOG. 103: hereditary breast and ovarian cancer syndrome. Obstet Gynecol. 2009;113(4):957–66.

    Article  Google Scholar 

  23. Segev Y, Iqbal J, Lubinski J, Gronwald J, Lynch HT, Moller P, et al. The incidence of endometrial cancer in women with BRCA1 and BRCA2 mutations: an international prospective cohort study. Gynecol Oncol. 2013;130(1):127–31.

    Article  CAS  PubMed  Google Scholar 

  24. Segev Y, Rosen B, Lubinski J, Gronwald J, Lynch HT, Moller P, et al. Risk factors for endometrial cancer among women with a BRCA1 or BRCA2 mutation: a case control study. Familial Cancer. 2015;14(3):383–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Shu CA, Pike MC, Jotwani AR, Friebel TM, Soslow RA, Levine DA, et al. Uterine cancer after risk-reducing Salpingo-oophorectomy without hysterectomy in women with BRCA mutations. JAMA Oncol. 2016;2(11):1434–40.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Havrilesky LJ, Moss HA, Chino J, Myers ER, Kauff ND. Mortality reduction and cost-effectiveness of performing hysterectomy at the time of risk-reducing salpingo-oophorectomy for prophylaxis against serous/serous-like uterine cancers in BRCA1 mutation carriers. Gynecol Oncol. 2017;145(3):549–54.

    Article  PubMed  Google Scholar 

  27. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology. Genetic/Familial high-risk assessment: breast, Ovarian, and Pancreatic, ver1. 2020. Accessed Sep 30, 2020.

    Google Scholar 

  28. Gaba F, Manchanda R. Systematic review of acceptability, cardiovascular, neurological, bone health and HRT outcomes following risk reducing surgery in BRCA carriers. Best Pract Res Clin Obstet Gynaecol. 2020;65:46–65.

    Article  PubMed  Google Scholar 

  29. Reitsma W, de Bock GH, Oosterwijk JC, Bart J, Hollema H, Mourits MJ. Support of the ‘fallopian tube hypothesis’ in a prospective series of risk-reducing salpingo-oophorectomy specimens. Eur J Cancer. 2013;49(1):132–41.

    Article  PubMed  Google Scholar 

  30. Zakhour M, Danovitch Y, Lester J, Rimel BJ, Walsh CS, Li AJ, et al. Occult and subsequent cancer incidence following risk-reducing surgery in BRCA mutation carriers. Gynecol Oncol. 2016;143(2):231–5.

    Article  PubMed  Google Scholar 

  31. Kobayashi Y, Hirasawa A, Chiyoda T, Ueki A, Masuda K, Misu K, et al. Retrospective evaluation of risk-reducing salpingo-oophorectomy for BRCA1/2 pathogenic variant carriers among a cohort study in a single institution. Jpn J Clin Oncol 2020.

    Google Scholar 

  32. Cheng A, Li L, Wu M, Lang J. Pathological findings following risk-reducing salpingo-oophorectomy in BRCA mutation carriers: a systematic review and meta-analysis. Eur J Surg Oncol. 2020;46(1):139–47.

    Article  PubMed  Google Scholar 

  33. Stuursma A, van Driel CMG, Wessels NJ, de Bock GH, Mourits MJE. Severity and duration of menopausal symptoms after risk-reducing salpingo-oophorectomy. Maturitas. 2018;111:69–76.

    Article  CAS  PubMed  Google Scholar 

  34. Vermeulen RFM, Beurden MV, Korse CM, Kenter GG. Impact of risk-reducing salpingo-oophorectomy in premenopausal women. Climacteric. 2017;20(3):212–21.

    Article  CAS  PubMed  Google Scholar 

  35. Tucker PE, Cohen PA. Review article: sexuality and risk-reducing Salpingo-oophorectomy. Int J Gynecol Cancer. 2017;27(4):847–52.

    Article  PubMed  Google Scholar 

  36. Michelsen TM, Tonstad S, Pripp AH, Tropé CG, Dørum A. Coronary heart disease risk profile in women who underwent salpingo-oophorectomy to prevent hereditary breast ovarian cancer. Int J Gynecol Cancer. 2010;20(2):233–9.

    Article  PubMed  Google Scholar 

  37. Michelsen TM, Pripp AH, Tonstad S, Tropé CG, Dørum A. Metabolic syndrome after risk-reducing salpingo-oophorectomy in women at high risk for hereditary breast ovarian cancer: a controlled observational study. Eur J Cancer. 2009;45(1):82–9.

    Article  PubMed  Google Scholar 

  38. Ozdemir S, Celik C, Görkemli H, Kiyici A, Kaya B. Compared effects of surgical and natural menopause on climacteric symptoms, osteoporosis, and metabolic syndrome. Int J Gynaecol Obstet. 2009;106(1):57–61.

    Article  PubMed  Google Scholar 

  39. Johansen N, Liavaag AH, Tanbo TG, Dahl AA, Pripp AH, Michelsen TM. Sexual activity and functioning after risk-reducing salpingo-oophorectomy: impact of hormone replacement therapy. Gynecol Oncol. 2016;140(1):101–6.

    Article  CAS  PubMed  Google Scholar 

  40. Vermeulen RFM, Beurden MV, Kieffer JM, Bleiker EMA, Valdimarsdottir HB, Massuger L, et al. Hormone replacement therapy after risk-reducing salpingo-oophorectomy minimises endocrine and sexual problems: a prospective study. Eur J Cancer. 2017;84:159–67.

    Article  CAS  PubMed  Google Scholar 

  41. Rocca WA, Bower JH, Maraganore DM, Ahlskog JE, Grossardt BR, de Andrade M, et al. Increased risk of cognitive impairment or dementia in women who underwent oophorectomy before menopause. Neurology. 2007;69(11):1074–83.

    Article  CAS  PubMed  Google Scholar 

  42. Marchetti C, De Felice F, Boccia S, Sassu C, Di Donato V, Perniola G, et al. Hormone replacement therapy after prophylactic risk-reducing salpingo-oophorectomy and breast cancer risk in BRCA1 and BRCA2 mutation carriers: a meta-analysis. Crit Rev Oncol Hematol. 2018;132:111–5.

    Article  CAS  PubMed  Google Scholar 

  43. Vermeulen RFM, Korse CM, Kenter GG, Brood-van Zanten MMA, Beurden MV. Safety of hormone replacement therapy following risk-reducing salpingo-oophorectomy: systematic review of literature and guidelines. Climacteric. 2019;22(4):352–60.

    Article  CAS  PubMed  Google Scholar 

  44. Miller SM, Roussi P, Daly MB, Scarpato J. New strategies in ovarian cancer: uptake and experience of women at high risk of ovarian cancer who are considering risk-reducing salpingo-oophorectomy. Clin Cancer Res. 2010;16(21):5094–106.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Nomura H, Sekine M, Yokoyama S, Arai M, Enomoto T, Takeshima N, et al. Clinical background and outcomes of risk-reducing salpingo-oophorectomy for hereditary breast and ovarian cancers in Japan. Int J Clin Oncol. 2019;24(9):1105–10.

    Article  PubMed  Google Scholar 

  46. Hirasawa A, Masuda K, Akahane T, Tsuruta T, Banno K, Makita K, et al. Experience of risk-reducing salpingo-oophorectomy for a BRCA1 mutation carrier and establishment of a system performing a preventive surgery for hereditary breast and ovarian cancer syndrome in Japan: our challenges for the future. Jpn J Clin Oncol. 2013;43(5):515–9.

    Article  PubMed  Google Scholar 

  47. Han SA, Park SK, Ahn SH, Lee MH, Noh DY, Kim LS, et al. The Korean hereditary breast cancer (KOHBRA) study: protocols and interim report. Clin Oncol (R Coll Radiol). 2011;23(7):434–41.

    Article  Google Scholar 

  48. Lee J, Kim S, Kang E, Park S, Kim Z, Lee MH. Influence of the Angelina Jolie announcement and insurance reimbursement on Practice patterns for hereditary breast cancer. J Breast Cancer. 2017;20(2):203–7.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Ramus SJ, Song H, Dicks E, Tyrer JP, Rosenthal AN, Intermaggio MP, et al. Germline mutations in the BRIP1, BARD1, PALB2, and NBN genes in women with ovarian cancer. J Natl Cancer Inst. 2015;107(11).

    Google Scholar 

  50. Loveday C, Turnbull C, Ruark E, Xicola RM, Ramsay E, Hughes D, et al. Germline RAD51C mutations confer susceptibility to ovarian cancer. Nat Genet. 2012;44(5):475–6. author reply 6

    Article  CAS  PubMed  Google Scholar 

  51. Loveday C, Turnbull C, Ramsay E, Hughes D, Ruark E, Frankum JR, et al. Germline mutations in RAD51D confer susceptibility to ovarian cancer. Nat Genet. 2011;43(9):879–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Lilyquist J, LaDuca H, Polley E, Davis BT, Shimelis H, Hu C, et al. Frequency of mutations in a large series of clinically ascertained ovarian cancer cases tested on multi-gene panels compared to reference controls. Gynecol Oncol. 2017;147(2):375–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Norquist BM, Harrell MI, Brady MF, Walsh T, Lee MK, Gulsuner S, et al. Inherited mutations in women with ovarian carcinoma. JAMA Oncol. 2016;2(4):482–90.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan

    Yusuke Kobayashi & Daisuke Aoki

  2. Center for Medical Genetics, Keio University School of Medicine, Tokyo, Japan

    Yusuke Kobayashi

Authors
  1. Yusuke Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daisuke Aoki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yusuke Kobayashi .

Editor information

Editors and Affiliations

  1. Department of Breast Surgical Oncology, Showa University, School of Medicine, Tokyo, Japan

    Seigo Nakamura

  2. Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan

    Daisuke Aoki

  3. Department of Molecular Genetics, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan

    Yoshio Miki

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Kobayashi, Y., Aoki, D. (2021). Risk-Reducing Salpingo-oophorectomy (RRSO). In: Nakamura, S., Aoki, D., Miki, Y. (eds) Hereditary Breast and Ovarian Cancer . Springer, Singapore. https://doi.org/10.1007/978-981-16-4521-1_12

Download citation

  • DOI: https://doi.org/10.1007/978-981-16-4521-1_12

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-16-4520-4

  • Online ISBN: 978-981-16-4521-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation