Prophylactic oophorectomy: Clinical considerations

Ovarian cancer usually remains clinically silent until it is far advanced, and is associated with significant morbidity and mortality. In view of the modest impact of adjuvant treatments on survival, much effort is devoted to early detection programs and prevention strategies. However, the usefulnes s of early detection programs remains to be established, with only one rand omized study indicating improved median survival in screened individuals. A t present, oral contraceptives and prophylactic oophorectomy are the only o ptions for prevention of ovarian cancer. Indications for prophylactic oopho rectomy either as a primary procedure, or secondary to abdominal surgery, w ill vary according to the estimated risk, and to the individual's perceptio n of that risk. Genetic screening allows better identification of pre-sympt omatic individuals who would benefit the most from prophylactic oophorectom y. Data concerning the benefit of prophylactic surgery, and the safety of e stablished or innovative hormone replacement therapies in individuals at ri sk, are encouraging. Semin. Surg. Oncol. 19:20-27, 2000. (C) 2000 Wiley-Lis s, Inc.