Women carrying BRCA1 or BRCA2 gene mutations face a significantly higher lifetime risk of developing ovarian cancer, estimated between 11-68%, compared to about 2% in the general population. Approximately 15% of ovarian cancers are associated with these genetic alterations. Bilateral salpingo-oophorectomy (RRSO), a preventive surgery to remove the fallopian tubes and ovaries, is currently the only confirmed method to substantially lower the mortality risk from ovarian cancer, reducing the likelihood of developing the disease by at least 95%. In a pioneering approach, four women, all carriers of BRCA1 or BRCA2 gene mutations and scheduled for cesarean sections, underwent a combined procedure where they delivered their babies via cesarean and simultaneously had RRSO to reduce their ovarian cancer risk. Post-surgery, all four women expressed high satisfaction with the two-in-one procedure.

This innovative approach adopted by the team at University College London (UCL, London, UK), offers a viable option for women carrying BRCA gene mutations who are undergoing cesarean sections. The four patients, aged between 40 and 45, were BRCA1 or BRCA2 gene carriers and chose cesarean delivery for reasons unrelated to their genetic risk, with no plans for more children. The surgeries were successful without any major postoperative complications, and the hospital stays were no longer than what is typical for cesarean sections alone. Although there was a theoretical risk of increased blood loss due to the combined surgery, there was no such issue in these cases. It is important to note that RRSO invariably leads to infertility. However, women who have previously harvested eggs may still pursue assisted reproductive techniques. Additionally, RRSO induces early menopause, making hormone replacement therapy advisable until the age of 51, barring contraindications like a history of breast cancer treatment.

“Offering this two-in-one surgery could prove very beneficial to other women at high risk of ovarian cancer, who would then avoid the need for separate risk-reducing surgery,” said Professor Adam Rosenthal, consultant gynecologist at UCLH. “The number of women who give birth by cesarean section is increasing around the world, as is the number of women who know they carry a gene alteration which increases their ovarian cancer risk. This means many more women may be suitable for the combined procedure.” 

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