A 45-year-old woman has a 12 cm left ovarian mass with a smooth wall, serous fluid, and no internal septations on ultrasound. CA-125 is 18 U/mL. Her sister had ovarian cancer at age 50. BRCA testing reveals BRCA1 mutation. Which best describes the recommended management?

• A Laparoscopic left cystectomy and await pathology
• B Annual surveillance with CA-125 and ultrasound
• C Immediate laparotomy and full staging
• D Risk-reducing bilateral salpingo-oophorectomy (RRBSO) after counselling ✓

Explanation

BRCA1 mutation carriers have a lifetime ovarian cancer risk of 39–46%. Current NCCN and ASCO guidelines recommend risk-reducing bilateral salpingo-oophorectomy (RRBSO) for BRCA1 carriers between ages 35–40 years (or upon completion of childbearing). At age 45, RRBSO is the standard recommendation. The current simple cyst (low RMI, normal CA-125) can be managed at the time of RRBSO. Surveillance alone is insufficient given the high lifetime risk conferred by BRCA1.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.