WOMEN with hereditary cancer syndromes face complex decisions that weigh the benefits of ovarian cancer prevention against the potential long-term risks of cardiovascular disease. A new study highlights how risk-reducing salpingo-oophorectomy (RRSO), while highly effective in preventing ovarian cancer, introduces additional health challenges due to premature surgical menopause.
For patients with pathogenic germline variants in BRCA1 and BRCA2, the lifetime risk of ovarian cancer is estimated at up to 40% and 18%, respectively. RRSO has been shown to reduce this risk by as much as 96%, making it a cornerstone of preventive care. Current clinical guidelines recommend the procedure between ages 35 and 40 years for BRCA1 carriers, and between 40 and 45 years for BRCA2 carriers, or upon completion of childbearing. Similar recommendations extend to patients with BRIP1, RAD51C, RAD51D, and PALB2 variants. As genetic testing expands, the number of women identified for such preventive surgery is expected to grow.
However, when RRSO is performed at guideline-directed ages, patients often experience menopause a decade or more earlier than average. This abrupt transition is associated with vasomotor symptoms, quality-of-life concerns, and importantly, an increased risk of cardiovascular disease. Menopause, whether natural or surgically induced, is an established risk factor for cardiovascular events in women. Given that cardiovascular disease remains the leading cause of death among women in the United States, the intersection of cancer prevention and cardiac health requires close attention.
The findings emphasize the importance of multidisciplinary care for women undergoing RRSO. Gynecologic oncologists and genetic counselors play a critical role in guiding patients through risk-reduction strategies, but ongoing cardiovascular surveillance and preventive measures should also be integrated into care plans. Tailored counseling and long-term management may help ensure that patients not only reduce their cancer risk but also maintain cardiovascular health.
This dual-risk framework underscores the need for a balanced approach in hereditary cancer management, where preventive surgery offers life-saving benefits yet necessitates vigilance for secondary health outcomes.
Reference: Keenahan L et al. Navigating dual risks: Ovarian cancer prevention and cardiovascular health in patients with hereditary cancer syndromes. Gynecologic Oncology Reports. 2025;61:101940.
