Systematic review of acceptability, cardiovascular, neurological, bone health and HRT outcomes following risk reducing surgery in BRCA carriers

Faiza Gaba, Ranjit Manchanda* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Citations (Scopus)


Primary surgical prevention in the form of risk-reducing salpingo-oophorectomy (RRSO) is the most effective option and the gold standard for ovarian cancer (OC) risk-reduction, particularly given the absence of an effective national OC screening programme. However, premenopausal RRSO leads to premature surgical menopause with detrimental long-term health sequelae particularly in women who do not/are unable to take hormone replacement therapy (HRT). HRT uptake in women undergoing pre-menopausal oophorectomy appears low and is dependent on informed counselling, the safety of HRT and efficacy in mitigating the health sequelae of premature menopause. Acceptance of a central role for the fallopian tube in OC etiopathogenesis, coupled with the detrimental consequences of premature menopause, has led to the attractive proposal of early-salpingectomy with delayed oophorectomy as an alternative OC surgical prevention strategy in premenopausal women who have completed childbearing but decline or wish to delay RRSO. The successful implementation of risk reducing surgery for OC prevention depends on the acceptability of surgery to both, recipients (e.g. BRCA1/BRCA2 carriers) and intervention deliverers (healthcare professionals/researchers). Acceptability is also informed by an understanding of health outcomes following risk reducing surgery and the safety of HRT. It is therefore vital to understand the effects of surgery on important health outcomes such as cardiovascular health, neurological function and bone health. We present a comprehensive review of acceptability, the selected health outcomes mentioned above and HRT safety following risk reducing surgery.

Original languageEnglish
Pages (from-to)46-65
Number of pages20
JournalBest Practice & Research Clinical Obstetrics & Gynaecology
Early online date13 May 2020
Publication statusPublished - May 2020

Data Availability Statement

Supplementary data to this article can be found online at


  • BRCA1 Protein/genetics
  • BRCA2 Protein/genetics
  • Bone Density/physiology
  • Female
  • Genetic Predisposition to Disease
  • Heterozygote
  • Hormone Replacement Therapy
  • Humans
  • Mutation
  • Ovarian Neoplasms/genetics
  • Ovariectomy/adverse effects
  • Salpingectomy/adverse effects
  • Salpingo-oophorectomy/adverse effects


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