BRCA1/2 mutation carriers who have completed their families are counseled regarding risk-reducing salpingo-oophorectomy (RRSO). Which statement about RRSO timing is MOST accurate for BRCA1 mutation carriers?
- A RRSO should be performed at age 35–40 years for BRCA1 and 40–45 for BRCA2 ✓
- B RRSO should be performed at age 30–35 years to prevent high-grade serous carcinoma
- C RRSO should be deferred until age 50 to avoid premature menopause-related morbidity
- D RRSO has no protective effect on breast cancer risk, only on ovarian cancer
Correct answer: A. RRSO should be performed at age 35–40 years for BRCA1 and 40–45 for BRCA2
Explanation
Current guidelines (NCCN/ACOG) recommend RRSO at 35–40 years for BRCA1 carriers (earlier onset ovarian cancer risk peaking in the 40s) and 40–45 years for BRCA2 carriers (later onset risk). Performing RRSO earlier than indicated causes premature surgical menopause with cardiovascular and bone health risks without additional ovarian cancer benefit. RRSO also reduces breast cancer risk in BRCA1 carriers by ~50% when performed premenopausally (hormonal effect).
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.