What Are Risk-Reducing Surgeries?

Bilateral salpingo-oophorectomy (BSO)

A bilateral salpingo-oophorectomy (BSO) is the surgical removal of a woman’s fallopian tubes and ovaries. This type of surgery is usually done laparoscopically.


A laparoscopic surgery, or laparoscopy, is when the surgeon makes small incisions on the woman’s abdomen and inserts small instruments (e.g. a camera) in order to view a woman’s pelvic organs, repair or remove tissue. This type of surgery is in contrast to a laparotomy which involves larger incision on the woman’s abdomen in order to access her abdominal cavity and perform the surgery.


On average, the surgery takes 1 hour to complete. It takes about 2-3 weeks for a woman to recover once the surgery is finished.


Once a woman’s ovaries are removed during a BSO, she is no longer able to produce eggs. Fertility is still possible in cases where the uterus is not removed and where donor eggs, previously stored eggs, or embryos are available.


Depending on the case, women can receive a BSO at any age. When possible, the National Comprehensive Cancer Network (NCCN) recommends that BRCA1/2 mutation carriers have a BSO between ages 35 and 40. Some studies suggest surgery closer to age 35 for optimal risk reduction, especially in women with inherited mutations in BRCA1 5.


  • When a woman’s ovaries are removed, she is no longer able to produce eggs. Fertility is still possible in cases where the uterus is not removed and where donor eggs, previously stored eggs, or embryos are available.
  • Women will experience surgical menopause. Surgically removing the ovaries creates a change in hormones similar to that of natural menopause. Surgical menopausal symptoms including hot flashes, cold and hot sweats, vaginal dryness and decreased sexual desire1, as well as increased risk of osteopenia, osteoporosis and heart disease2,3. These symptoms can be managed through hormone replacement therapy (HRT) in women with no personal history of breast cancer1. Younger women tend to experience these symptoms to a greater degree when compared with women in perimenopause4.
  • There is a possibility that cancer will be found during a BSO. There is a 1-12% risk of finding invasive ovarian or fallopian tube cancer in BRCA1 mutation carriers during surgery, with the greatest risk for women ages 60-645. Similarly, there is a 3-9% risk in BRCA2 mutation carriers, with the greatest risk for women ages 65-695. However, the 5-year survival rate in women with cancer found during surgery is much greater (92%) than in women with cancer diagnosed through symptoms or screening (54%)5.
  • As with any surgery, typical risks such as infection may also occur.

  • A BSO is the best available strategy in reducing risk of developing ovarian, fallopian tube and peritoneal cancer5.
  • There is a 80-90% reduction in the risk of developing ovarian cancer in BRCA1 or BRCA2 mutation carriers5,6 following a BSO. BSO also provides a similar reduction in ovarian cancer risk for women with and without a personal history of breast cancer7.
  • There is a 35-57% reduction in the risk of breast cancer in BRCA1 mutation carriers8 and 45-64% reduction in the risk of breast cancer in BRCA2 mutation carriers8,7. The greatest reduction in breast cancer risk is observed when surgery is performed before the age of 408.
  • This type of surgery has been found to lower general distress9 and perceived distress among BRCA1/2 mutation carriers10.
  • Because the surgery is performed laparoscopically and involves smaller surgical incisions, women don’t have to stay at the hospital overnight and usually experience a quicker recovery.

Bilateral Salpingectomy (BS)

A bilateral salpingectomy (BS) is a surgery that involves removing the fallopian tubes only. With this surgery, a woman’s ovaries are kept intact. Since the majority of high-grade serous ovarian cancers have been shown to originate in the fallopian tubes11,12, this surgery is being explored as an alternative risk-reduction strategy (either alone or 5-10 years before the removal of the ovaries). A bilateral salpingectomy is usually done laparoscopically.


Because a BS doesn’t remove the ovaries, fertility is preserved and a woman can still have children using her own eggs. Women are still able to conceive after this surgery through the use of in vitro fertilization (IVF). Some women have reported that having a BS can reduce risk while providing them time to think about removal of the ovaries.13


On average, the surgery takes 1 hour to complete. It takes about 2-3 weeks for a woman to recover once the surgery is finished.


  • A BS will likely will not prevent the estimated 20-30% of ovarian cancers that are thought to originate in the ovaries and not the fallopian tubes12.
  • This type of surgery has not been shown to reduce the risk of developing breast cancer13
  • There is the possibility that cancer will be found during surgery, similar to a BSO
  • As with any surgery, typical risks such as infection may also occur.

  • A BS postpones the premature menopause associated with the surgical removal of ovaries (see BSO)13.
  • A BS preserves fertility so that a woman can still have children using her own eggs.
  • Some women have reported that having a BS can reduce risk while providing them time to think about removal of the ovaries.13
  • Because the surgery is performed laparoscopically and involves smaller surgical incisions, women don’t have to stay at the hospital overnight and usually experience a quicker recovery.


  1. Finch, A. et al. The impact of prophylactic salpingo-oophorectomy on menopausal symptoms and sexual function in women who carry a BRCA mutation. Gynecol. Oncol. 121, 163–168 (2011).
  2. Rocca, W. A., Grossardt, B. R., Miller, V. M., Shuster, L. T. & Brown, R. D. Premature menopause or early menopause and risk of ischemic stroke. Menopause: The Journal of The North American Menopause Society 19, 272–277 (2012).
  3. Parker, W. H. et al. Ovarian conservation at the time of hysterectomy and long-term health outcomes in the nurses’ health study. Obstet. Gynecol. 113, 1027–1037 (2009).
  4. Fang, C. Y. et al. A prospective study of quality of life among women undergoing risk-reducing salpingo-oophorectomy versus gynecologic screening for ovarian cancer. Gynecol. Oncol. 112, 594–600 (2009).
  5. Finch, A. P. M. et al. Impact of Oophorectomy on Cancer Incidence and Mortality in Women With a BRCA1 or BRCA2 Mutation. J. Clin. Oncol. 32, 1547–53 (2014).
  6. Kauff, N. D. et al. Risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 mutation. N. Engl. J. Med. 346, 1609–1615 (2002).
  7. Domchek, S. M. et al. Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality. JAMA 304, 967–975 (2010).
  8. Eisen, A. et al. Breast cancer risk following bilateral oophorectomy in BRCA1 and BRCA2 mutation carriers: an international case-control study. J. Clin. Oncol. 23, 7491–7496 (2005).
  9. Bresser, P. J. C. et al. Who is prone to high levels of distress after prophylactic mastectomy and/or salpingo-ovariectomy? Ann. Oncol. 18, 1641–1645 (2007).
  10. Borreani, C. et al. The psychological impact of breast and ovarian cancer preventive options in BRCA1 and BRCA2 mutation carriers. Clin. Genet. 85, 7–15 (2014).
  11. Salvador, S. et al. The fallopian tube: primary site of most pelvic high-grade serous carcinomas. Int. J. Gynecol. Cancer. 19, 58–64 (2009).
  12. Tone, A. A. et al. The role of the fallopian tube in ovarian cancer. Clin. Adv. Hematol. Oncol. 10, 296–306 (2012).
  13. Greene, M. H., Mai, P. L. & Schwartz, P. E. Does bilateral salpingectomy with ovarian retention warrant consideration as a temporary bridge to risk-reducing bilateral oophorectomy in BRCA1/2 mutation carriers? Am. J. Obstet. Gynecol. 204, (2011).