Back to Cancer Australia's website

Cancer Australia

Select a guideline

Recommendations for management of

Statements of evidence

Below are the statements of evidence on which the recommendations are based.

For women at high/potentially high risk of ovarian cancer, including BRCA1 and BRCA2 mutation carriers and those with Lynch Syndrome.
Gynaecological cancer risk for women with BRCA1/2 mutations or Lynch Syndrome 
In women with a BRCA1/2 mutation, there is an increased risk of cancer in the fallopian tubes and ovary IV NBOCC5
In women with Lynch Syndrome, there is an increased risk of cancer of the uterus and ovaries IV NBOCC5
Gynaecological and breast cancer risk following RRSO
Risk-reducing salpingo-oophorectomy provides a substantial risk reduction in developing ovarian and fallopian tube cancers in BRCA1/2 mutation carriers. III-2

Rebbeck 20093

Domchek 2010a12

Risk-reducing salpingo-oophorectomy before the age of 50 provides a risk reduction for developing breast cancer in BRCA1/2 mutation carriers. III-2

Rebbeck 20093

Domchek 2010a12

There is no apparent increase in risk of breast cancer in BRCA1/2 mutation carriers, unaffected by breast cancer, who take short-term HRT after RRSO performed before the age of 50 compared to those who do not take HRT. III-2 Rebbeck 200514
Occult cancers have been detected in the fallopian tubes and ovaries at RRSO.  

Rabban 2009b15

Hirst 200916

Callahan 200717

Domchek 2010a12

Finch 2006a18 & 2006b19

Olivier 200420

Primary peritoneal carcinoma may occur despite risk-reducing surgery but is uncommon. III-2

Domchek 2010a12 Domchek 200621

Kauff 200822

Finch 2006a18

Limited data are available for the efficacy of risk-reducing surgery in women with Lynch Syndrome. III-2 Schmeler 200613
Survival/life expectancy
In women with a BRCA1/2 mutation, RRSO is associated with a significant reduction in all-cause mortality (including breast and ovarian cancer-specific mortality). III-2 Domchek 2010a12
Symptoms associated with RRSO
Symptoms from RRSO are mainly associated with surgically-induced menopause III-2

Fang 200923

Benshushan 200924

Women with surgically-induced menopause more commonly report night sweats, sleep disturbance, hot flushes, and decreased libido and have significantly more severe vasomotor symptoms than women who go through natural menopause.     III-2 Benshushan 200924
Use of HRT for menopausal symptoms
HRT is effective in the management of most menopausal symptoms following RRSO. III-2 Madalinska 2006 14
Quality of life following RRSO  
There is evidence of reduced cancer worry following RRSO, but there is no consistent evidence on the effect on quality of life following RRSO  

De Leeuw 200825

Madalinska 200526

RRSO technique and pathology assessment
Attending a specialist gynaecologic oncologist for risk-reducing gynaecological surgery is more likely to result in adequate surgery and pathological examination III-2 Kiely 201127
The ovarian and fallopian tube tissue should be examined appropriately with specimens cut through at no more than 3mm intervals, and all tissue processed and embedded with at least one section cut from each block IV Rabban 200915
The fallopian tube-peritoneal junction is a potential site of carcinogenesis   Seidman 201128
Cost-effectiveness of risk-reducing strategies   
Bilateral salpingo-oophorectomy and combined bilateral salpingo-oophorectomy and mastectomy are the most cost-effective risk-reducing strategies for women with a BRCA1/2 gene mutation.  Surveillance and mastectomy alone are the least cost-effective strategies.  Modelling study Anderson 200629
Use of the oral contraceptive pill 
Use of the oral contraceptive pill reduces rates of ovarian cancer in BRCA1/2 mutation carriers, with greater reductions with increasing duration of use.  III-2 Antoniou 200930McLaughlin
Whittemore 200432
In women with BRCA1/2 mutations the risk of breast cancer with OCP use is uncertain III-2 Narod 200233
Tubal ligation
While there is evidence of reduced risk of ovarian cancer after tubal ligation in the general population, the association between tubal ligation and risk of ovarian cancer is not clear in high-risk women. III-2

Antoniou 200930 McLaughlin 200731

Rutter 200334

Surveillance strategies for women at high risk
Evidence shows that ultrasound or CA125, singly or in combination, is not effective in detecting early ovarian cancer in women at high or potentially high risk of ovarian cancer.   NBOCC7
There is no evidence for the use of gynaecological surveillance after risk-reducing surgery for women at high risk    
Communication about risk 
Risk perception and knowledge are improved following genetic counselling   Braithwaite 200635
Decision making
Use of a decision aid or shared decision-making, compared to a general educational pamphlet about risk-reducing strategies, reduces decisional conflict improves knowledge and increases satisfaction with the decision. II

Tiller 200536 Armstrong 200537

van Roosmalen 200438

Published using CeCC Docbook Manager