THE ROLE OF PROPHYLACTIC OOPHORECTOMY IN CANCER PREVENTION

Prophylactic oophorectomy is presently the only effective method of ov arian cancer prevention. This study reviews current data on how prophy lactic oophorectomy (PO) should be used in different risk groups. It i s estimated that 7% of ovarian cancer patients have positive family hi story, of which 3-9% may end up having hereditary cancer syndromes. Wo men in direct genetic lineage of family cancer syndromes may have up t o 50% lifetime risk of ovarian cancer. Because of such a high risk, PO is indicated for women with familial cancer syndromes after childbear ing or the age of 35-40 at the latest. Most women with positive family history of ovarian cancer do not have one of the recognized hereditar y cancer syndromes. However, women with one or two affected relatives do have an increased lifetime risk of ovarian cancer from a baseline o f 1.6 to 5-7%. This risk is ndt high enough to warrant PO recommendati on for a large number of women. After being properly informed and the patient still desires surgical prevention (i.e., cancer phobia), PO th en becomes an indicated procedure. In women without family history of ovarian cancer, the role of PO remains controversial. The decision of PO as a concurrent procedure to other indicated gynecologic surgeries should depend on the individual patient and her ability to comply with lifelong estrogen replacement therapy. (C) 1994 Academic Press, Inc.