Prophylactic salpingectomy and delayed oophorectomy as an alternative for BRCA mutation carriers

Obstet Gynecol. 2013 Jan;121(1):14-24. doi: 10.1097/aog.0b013e3182783c2f.


Objective: Prophylactic bilateral salpingo-oophorectomy is advised for women with BRCA mutations, but there are adverse consequences of premature menopause. The majority of BRCA-associated ovarian cancers appear to arise in the fallopian tube; therefore, salpingectomy may be an alternative to bilateral salpingo-oophorectomy. We compared the costs and benefits of salpingectomy with bilateral salpingo-oophorectomy among BRCA mutation carriers.

Methods: We developed a Markov Monte Carlo simulation model to compare three strategies for risk reduction in women with BRCA mutations: 1) bilateral salpingo-oophorectomy; 2) bilateral salpingectomy; and 3) bilateral salpingectomy with delayed oophorectomy. Net health benefits were measured in years-of-life expectancy and quality-adjusted life-year expectancy, and the primary outcome was the incremental cost-effectiveness ratio. The model estimated the number of future breast and ovarian cancers and cardiovascular deaths attributed to premature menopause with each strategy.

Results: Bilateral salpingo-oophorectomy was associated with the lowest cost and highest life expectancy compared with the other two strategies. When quality-of-life measures were included, salpingectomy followed by delayed oophorectomy yielded the highest quality-adjusted life expectancy with incremental cost-effectiveness ratios of $37,805 and $89,680 per quality-adjusted life-year for BRCA1 and BRCA2, respectively, relative to salpingectomy alone. Bilateral salpingo-oophorectomy yielded the lowest number of future breast and ovarian cancers compared with the other two strategies.

Conclusion: Bilateral salpingo-oophorectomy offers the greatest risk reduction for breast and ovarian cancer among BRCA mutation carriers. However, when considering quality-adjusted life expectancy, bilateral salpingectomy with delayed oophorectomy is a cost-effective strategy and may be an acceptable alternative for those unwilling to undergo bilateral salpingo-oophorectomy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Breast Neoplasms / economics
  • Breast Neoplasms / genetics
  • Breast Neoplasms / prevention & control*
  • Computer Simulation
  • Female
  • Genes, BRCA1*
  • Genes, BRCA2*
  • Humans
  • Mammaplasty / economics
  • Markov Chains
  • Mastectomy / methods
  • Middle Aged
  • Models, Biological
  • Mutation
  • Ovarian Neoplasms / economics
  • Ovarian Neoplasms / genetics
  • Ovarian Neoplasms / prevention & control*
  • Ovariectomy / methods*
  • Quality of Life
  • Quality-Adjusted Life Years
  • Risk Reduction Behavior
  • Salpingectomy / methods*
  • Treatment Outcome