Health Library Should I Have My Ovaries Removed to Prevent Ovarian Cancer?From Healthwise

This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

The average woman has a 1 or 2 in 100 chance of getting ovarian cancer in her lifetime. That means that for every 100 women, 1 or 2 will get ovarian cancer sometime during their lives and 98 or 99 will not.

But those odds don't apply to women who have a strong family history of ovarian cancer. (Family history means having relatives with the disease.) For these women, the chances of getting ovarian cancer are much higher. A few of these women have also inherited a certain gene change, called a BRCA gene change (say "BRAH-kuh"). Their chances of getting ovarian cancer are very high.

An operation to remove the ovaries is called an oophorectomy (say "oh-uh-fuh-REK-tuh-mee"). Women who are at very high risk for ovarian cancer may decide to have this surgery to lower their risk. Consider the following when making your decision:

• You can't begin to make a decision about having this surgery until you find out more about how high your risk is for ovarian cancer. Your doctor will help you find this out by talking to you about your medical history and your family history. You may also talk with a genetic counselor, an expert in helping people find out about their cancer risks.
• If you are not at high risk for cancer, having your ovaries removed to prevent cancer is not recommended.
• Your decision will depend on how high your risk is estimated to be, as well as your health, your age, and your personal feelings.
• Having the ovaries removed greatly lowers a woman's chances of getting ovarian cancer. The fallopian tubes are removed at the same time. This is another place where cancer can start.¹
• It's possible to get cancer even after your ovaries have been removed.
• Without your ovaries, you cannot get pregnant and have children. And having the ovaries removed causes you to begin menopause.
• For many women who have inherited a BRCA gene change, doctors recommend removing the ovaries as a way to help prevent cancer.^{2, 3} Most women do not have this rare gene change.
• Sometimes women think their risk is higher than it really is. So it's important to work with your doctor or genetic counselor to understand how high your risk may be.

How do you know if you are at high risk for ovarian cancer?

You can't begin to decide whether to have surgery until you have an estimate of how high your risk is. If you don't know whether you are at high risk, talk to your doctor. A genetic counselor can also help you.

Your risk depends on your medical history and your family history. For example, having one relative with ovarian cancer means you are more likely than average to get it. But if you have more than one relative with this cancer, your chances of getting it are much higher, and you may want to talk to a genetic counselor. See who is at high risk for ovarian cancer.

To understand how a family history of ovarian cancer can affect your chances of getting it, look at the numbers below. It’s important to remember that everyone’s case is different, and these numbers may not show what will happen in your case.

• Out of 100 average women, 1 or 2 will get ovarian cancer.
• That risk goes up to 4 or 5 out of 100 for women with one family member who has had ovarian cancer. The risk is 7 out of 100 for women with two relatives who have had it. And if at least two first-degree relatives (meaning mother, sister, or daughter) have had ovarian cancer, the risk is 25 to 50 out of 100.⁴
• The risk also goes up for women who inherit a BRCA gene change. Out of 100 women who inherit the BRCA1 gene change, 20 to 60 will get ovarian cancer. Out of 100 women who inherit the BRCA2 gene change, 10 to 35 will get ovarian cancer.⁵

  Should I have a BRCA gene test?

What are the benefits of having your ovaries removed?

Studies show that surgery may lower your chances of getting ovarian cancer by 85% to 95%.

This means that it may lower your risk of ovarian cancer so that you have the same or only slightly higher risk than the average woman. The numbers below may help you understand.

What are the risks of having your ovaries removed?

• When your ovaries are removed, you can no longer have children.
• Without your ovaries, you will go into early menopause. Menopause often has symptoms like hot flashes and vaginal dryness. It also raises your risk for heart disease and osteoporosis. Although many women in menopause take hormone therapy to keep from having symptoms like hot flashes, hormone therapy is not recommended if you are trying to prevent ovarian and breast cancer.
• Removing the ovaries does not always prevent cancer. Sometimes a woman already has cancer before the operation but doesn't know it because she has no symptoms. And the cancer cells may already have begun to spread outside the ovaries. In that case, removing the ovaries will not remove all of the cancer cells. Cancer can also start in the abdominal cavity after the ovaries are removed, but this is rare.
• A recent study estimated that women who have their ovaries removed before age 45 live longer when they take estrogen replacement.
• One recent study showed that women younger than 45 who have their ovaries removed and who do not take replacement therapy are more likely than other women to die of heart disease, mental disorders, or diseases of the nervous system.⁶

What other choices do I have?

Being at higher risk for ovarian cancer does not mean you will definitely get ovarian cancer. For this reason, some women choose not to have surgery. If you decide not to have surgery, you can consider two other options:

• Birth control pills. Studies have found that taking birth control pills for more than 5 years lowers the average woman's chances of getting ovarian cancer. The results are not clear on the use of birth control pills in women who have BRCA gene changes.
• Extra checkups and testing. The goal here would be to find any cancer as early as possible, when the chances of treating it successfully are higher.

There is no evidence that having regular tests helps women live longer by finding ovarian cancer early. Still, experts recommend that women who have inherited a BRCA gene change and have not had their ovaries removed have the following tests at least once a year, starting at age 35:³

• Transvaginal ultrasound. Ultrasound uses sound waves to make a picture of your organs and other body parts. A small handheld device called a transducer is passed back and forth over the area in question. In a transvaginal ultrasound, the transducer fits into a woman's vagina. The test is used to look for tumors in and around the ovaries.
• CA-125 blood test. CA-125 is a protein. A higher-than-normal amount of this protein can mean that cancer is present. The test is usually used to check how well treatment for ovarian cancer is working or to see if ovarian cancer has returned.

Women who have inherited a BRCA1 gene change (not a BRCA2 gene change) may want to start having these regular tests as early as age 25.³

If you need more information, see the topic Ovarian Cancer.

Your choices are:

• Have surgery to remove your ovaries and fallopian tubes.
• Don't have surgery, and consider other options (doing nothing, having regular checkups and testing, or taking birth control pills).

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about having your ovaries removed. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

*NA=Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have your ovaries removed to prevent ovarian cancer.

Check the box below that represents your overall impression about your decision.

Return to the topic Ovarian Cancer.

Citations

1. American Cancer Society (2006). American Cancer Society's Detailed Guide: Can Ovarian Cancer Be Prevented? Available online: http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_Can_ovarian_cancer_be_prevented_33.asp.

2. National Comprehensive Cancer Network and American Cancer Society (2007). Genetic/Familial High-Rsk Assessment: Breast and Ovarian, version 1.2007. Available online: http://www.nccn.org/professionals/physician_gls/PDF/genetics_screening.pdf.

3. National Cancer Institute (2007). Genetics of Breast and Ovarian Cancer (PDQ)—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/genetics/breast-and-ovarian/healthprofessional.

4. Ozols RF, et al. (2005). Epithelial ovarian cancer. In WJ Hoskins et al., eds., Principles and Practice of Gynecologic Oncology, 4th ed., chap. 25, pp. 895–987. Philadelphia: Lippincott Williams and Wilkins.

5. Karlan BY, et al. (2005). Ovarian cancer, peritoneal carcinoma, and fallopian tube carcinoma. In VT DeVita Jr et al., eds., Cancer: Principles and Practice of Oncology, 7th ed., vol. 1, pp. 1364–1397. Philadelphia: Lippincott Williams and Wilkins.

6. Rocca WA, et al. (2006). Survival patterns after oophorectomy in premenopausal women: a population-based cohort study. Lancet Oncology, 7(10): 821–828.

Other Works Consulted

• Kauff ND, et al. (2002). Risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 mutation. New England Journal of Medicine, 346(21): 1609–1615.

• National Cancer Institute (2007). Ovarian Cancer (PDQ): Prevention—Patient Version. Available online: http://www.cancer.gov/cancerinfo/pdq/prevention/ovarian/patient.

• Rebbeck TR, et al. (2002). Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations. New England Journal of Medicine, 346(21): 1616–1622.

• Samuel JC, Ollila DW (2005–2006). Prophylaxis and screening options: Recommendations for young women with BRCA mutations. Breast Disease, 23: 31–35.

• Wooster R, Weber BL (2003). Breast and ovarian cancer. New England Journal of Medicine, 348(23): 2339–2347.

Author:	Cynthia Tank	Last Updated: August 31, 2007
Medical Review:	Joy Melnikow, MD, MPH - Family Medicine Ross Berkowitz, MD - Obstetrics and Gynecology
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