BRCA variants and risk-reducing surgery for ovarian cancer

The genes help repair DNA. A harmful inherited change, passed down in families through either parent, makes that repair less reliable, which raises cancer risk over a lifetime. It does not guarantee cancer, and most people who carry a variant never develop ovarian cancer, but the risk is clearly above that in the general population.

Cancer Research UK points out that most cancers are not hereditary. Even so, inheriting a faulty gene explains a proportion of ovarian cancers, and Cancer Research UK lists BRCA1 or BRCA2, RAD51C, RAD51D, BRIP1 and PALB2 as the genes involved, along with Lynch syndrome. BRCA variants also raise breast cancer risk, which is discussed separately by the genetics team.

The NHS advises speaking to a GP about genetic testing when ovarian cancer runs in the family. Referral to a clinical genetics service is based on the pattern of cancers in relatives, such as ovarian cancer at any age, breast cancer at a young age or several related cancers on one side of the family. Anyone diagnosed with ovarian cancer is normally offered a test.

Genetic counselling comes before and after a test. It covers what a result could mean for you and your relatives, insurance and employment questions, and how you might feel. A result can be positive, negative or uncertain, and family members may be offered testing for a known variant.

Risk-reducing salpingo-oophorectomy removes both fallopian tubes and both ovaries, usually by keyhole surgery with a day or short hospital stay. Because many ovarian cancers are now thought to begin at the end of the fallopian tubes, as Macmillan explains, removing the tubes is central to the operation.

The NHS notes it is still possible to get ovarian cancer after the ovaries are removed, since the disease can affect the tubes or the peritoneum. Tissue is examined after removal for any hidden early cancer. A hysterectomy is not routinely part of the operation, though may be done for other reasons or in Lynch syndrome.

Removing the ovaries before the natural menopause causes menopausal symptoms immediately, including hot flushes, night sweats, vaginal dryness and low mood, as the NHS menopause pages describe. Bone and heart health also deserve attention if surgery is done young.

Many carriers are offered hormone replacement therapy to relieve symptoms and protect bones until the usual age of menopause, after a discussion of the benefits and risks given their personal and family history. The balance differs from person to person, particularly where breast cancer risk is relevant.

Ovarian cancer has no reliable screening test for carriers, so surgery is the main way to reduce risk. Some people and teams discuss removing the tubes first and the ovaries later, which is not yet standard practice and is offered in research settings. Hormonal contraception also lowers ovarian cancer risk, as Cancer Research UK notes, though BRCA carriers should discuss it alongside breast cancer risk.

The decision is personal and not urgent for most people. It involves family planning, menopause tolerance and psychological readiness. The genetics team, gynaecology and sometimes an endocrinologist and counsellor support it, and a support charity can put you in touch with others who have faced it.