Prophylactic Surgery

Prophylactic surgery in HBOC syndrome includes prophylactic bilateral mastectomy and/or complete bilateral salpingo-oophorectomy (including the entire fallopian tubes and infundibulopelvic ligaments). Prophylactic bilateral mastectomy with reconstruction option is the safest measure for prevention of breast cancer. In BRCA-mutation carriers, prophylactic bilateral mastectomy was associated with an 85-100% risk reduction for breast cancer.

In HBOC syndrome, prophylactic oophorectomy is recommended at age 35 or after childbearing is com-pleted.[3] Among mutation carriers, prophylactic oopho-rectomy has been shown to reduce the risk of breast and ovarian cancer by 53-68% and 85-96%, respectively. Ten to fifteen percent of women with BRCA1 or BRCA2 mutations who underwent prophylactic oophorectomy were found to have occult ovarian carcinoma.[16] A residual risk of primary peritoneal carcinoma and peritoneal carcinomatosis has been documented in 2-11% of women who undergo prophylactic oophorectomy.1-17-1 The majority of women (86.4%) who had prophylactic oophorecto-my were satisfied because surgery effectively reduced their anxiety about ovarian cancer, with the benefit of anxiety reduction outweighing the potential adverse events of surgery.[18]

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