New clinical guidelines to support women after surgery to reduce ovarian cancer risk

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Image credit: Becca Tapert, Unsplash

The first evidence-based clinical guidelines for managing women’s health before and after surgery to reduce the risk of ovarian cancer have been developed by an international team of researchers, offering better health and wellbeing outcomes for women.

Published in the International Journal of Obstetrics and Gynaecology, the scoping review provides new recommendations for supporting women with a high risk of developing ovarian cancer who undergo Risk-Reducing Salpingo-oophorectomy (RRSO) surgery.

RRSO surgery involves the removal of fallopian tubes and ovaries in women with pathogenic variants in the BRCA1/2 gene to reduce their risk of ovarian cancer, but this surgery can adversely affect women’s short and long-term health in various ways.

Lead author Professor Martha Hickey, Chair of Obstetrics and Gynaecology at the Royal Women’s Hospital, said around one in 450 women carry BRCA1/2 variants, and that a growing number of women are considering RRSO surgery.

“Women at high risk of ovarian cancer can be offered RRSO before the age of menopause, and although potentially life-saving, RRSO may induce symptoms that negatively affect quality of life and impair long-term health,” Professor Hickey said.

“Despite the efficacy of RRSO for reducing ovarian caner risk, the procedure causes permanent infertility and may cause menopausal symptoms, mood and sleep disturbances, sexual difficulties and elevated risk of long-term health problems such as osteoporosis and cardiovascular disease.”

Professor Hickey and the team conducted an extensive scoping review, and developed the first international consensus clinical guidelines for managing high-risk women before and after RRSO, from preoperative counselling to long-term disease prevention.

Professor Hickey said the guidelines will translate into better health outcomes for these women.

“We recommend that women are informed about these possible effects prior to surgery and have the opportunity to discuss available treatments after RRSO. Clinicians need to generate an individualised plan for post-operative care,” Professor Hickey said.

“Having effectively reduced their ovarian cancer risk, these women should then be able to enjoy a long and healthy life – and optimising their health and wellbeing after RRSO is an essential aspect of their care.”

The new recommendations include:

  • Counselling before undergoing RRSO surgery
  • Discussion about the positives and negatives of concurrent hysterectomy at the time of RRSO
  • Management of vasomotor symptoms – hot flushes and night sweats - following RRSO in women, including women with breast cancer
  • Safe and effective vasomotor symptoms treatments
  • Active management of sleep and mood disturbance after RRSO
  • Management of sexual and genitourinary symptoms after RRSO
  • Lifestyle and pharmacological interventions to prevent cardiovascular and bone disease after RRSO