Medical Oncologist
CION Cancer Clinics
RAD51C and ovarian risk: why surgery is discussed | CION Cancer Clinics
Surgery comes up for RAD51C carriers because the fault raises ovarian cancer risk and the ovaries cannot be screened reliably. Removing the ovaries and tubes lowers that risk sharply. Because RAD51C ovarian cancers tend to appear later, the conversation usually starts in the mid to late forties. This page explains why, what the other options are, and what each choice changes. At CION Cancer Clinics, our oncologists explain what a gene result means for you and your family, and plan the checks that follow.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
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On this page
- Why do doctors bring up surgery for RAD51C carriers?
- What are the options for managing ovarian risk?
- How do women usually reach a decision?
- The words you will hear, in plain language
- What changes if you have surgery, and what if you wait?
- What this page cannot tell you
- Four things women tell us about this surgery, and what is true
- Common questions about RAD51C and ovarian surgery
The short answer
Why do doctors bring up surgery for RAD51C carriers?
Because a RAD51C fault raises the risk of ovarian cancer, and there is no reliable way to catch ovarian cancer early with scans or blood tests. Removing the ovaries and fallopian tubes is the one step known to lower that risk substantially. It is raised as an option to consider, usually from the mid to late forties, not as an instruction.
Why checks cannot do the job instead
For breast risk, regular scans can find a cancer while it is small. The ovaries sit deep in the pelvis, and ovarian cancer often spreads before it causes symptoms or shows on a scan. Ultrasound and the CA-125 blood test have both been tried as screening, and neither has proved good enough to rely on.
Why the timing differs from BRCA1
Ovarian cancers linked to RAD51C mostly appear after the menopause. That gives carriers more time than BRCA1 carriers have. Many women can finish having children, and even reach a natural menopause, before the question becomes pressing.
Why it is rarely a decision made alone
In many families here, a husband, a mother or an adult child is part of the choice, and sometimes the one paying for it. Surgery may also mean travel from a district and time away from work or home. It helps to bring the people who will support you to the counselling session, so everyone hears the same explanation at the same time.
Surgery is one option among several. The wider choices are set out on our page about ways to reduce hereditary cancer risk.The choices
What are the options for managing ovarian risk?
There is no single right answer. Each option trades one thing against another.
Removing the ovaries and tubes
The option with the strongest evidence. It lowers ovarian cancer risk sharply. If done before a natural menopause, it brings on the menopause straight away.
Usually discussed with
- A gynaecological oncologist
- Your genetic counsellor
- A doctor who can advise on menopause
Removing the tubes first
Many ovarian cancers are now thought to start in the fallopian tube. Removing the tubes first and the ovaries later delays the menopause. This approach is still being studied and is not yet standard care.
Waiting, and staying alert
Some women choose to wait, especially while still young. That is a reasonable choice while risk is low, as long as the plan is reviewed regularly and new symptoms are reported quickly.
Report these if they last
- Bloating most days
- Feeling full quickly after eating
- Pain in the lower tummy or pelvis
- Needing to pass urine more often
The contraceptive pill
The pill lowers ovarian cancer risk in the general population and in BRCA carriers. Evidence in RAD51C carriers specifically is limited. It may help while surgery is being put off, but it is not a replacement.
Not sure whether this applies to you?
Ask an oncologistThinking it through
How do women usually reach a decision?
Understand your own risk
Your counsellor adjusts the average figures for your age and your family history. A mother or sister with ovarian cancer usually brings the conversation forward.
Think about children
After the ovaries are removed, pregnancy with your own eggs is no longer possible. If your family is not complete, say so early, so timing can be planned around it.
Talk about the menopause
Surgery before a natural menopause brings on hot flushes, sleep changes and bone thinning. Hormone replacement is usually possible if you have not had breast cancer.
Choose a time, or a date to review
Some women book surgery. Others agree to revisit the question each year. Both are legitimate outcomes of a good conversation.
In the clinic
The words you will hear, in plain language
- Risk-reducing salpingo-oophorectomy
- Removal of both fallopian tubes and both ovaries to lower cancer risk. Usually done by keyhole surgery.
- Fallopian tube
- The narrow tube that carries an egg from the ovary to the womb. Many ovarian cancers are now thought to begin here.
- Surgical menopause
- A menopause that starts suddenly because the ovaries have been removed, rather than gradually with age.
- Hormone replacement therapy
- Medicine that replaces the hormones the ovaries used to make. It eases menopause symptoms and protects the bones.
- CA-125
- A blood test that can rise with ovarian cancer, but also with many harmless conditions. It is not reliable enough for screening.
- Primary peritoneal cancer
- A rare cancer of the lining of the abdomen that behaves like ovarian cancer. A small risk of it remains after surgery.
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Side by side
What changes if you have surgery, and what if you wait?
After surgery
While waiting
Ovarian cancer risk falls sharply
Ovarian risk stays raised and rises with age
Menopause begins, if it had not already
Natural hormones continue
No further pregnancy with your own eggs
Fertility is unchanged
Breast checks still continue
Breast checks continue, symptoms reported quickly
Being straight with you
What this page cannot tell you
It cannot tell you whether or when to have surgery. That decision belongs to you, made with a gynaecological oncologist and a genetic counsellor who know your age, your family history and your plans. What your specific variant means is a question for the counsellor who ordered the test.
It cannot describe the operation in detail
How the surgery is done, the recovery and the risks of the operation itself are for the surgeon to explain. Ask for that conversation separately, and bring someone with you if you can.
Who this does not apply to
If your report shows a RAD51C variant of uncertain significance, surgery should not be offered on the strength of it. The same is true if RAD51C was found only in a tumour and not in your blood. Men who carry RAD51C do not face this decision, but their daughters and sisters may.
Commonly believed
Four things women tell us about this surgery, and what is true
"If I carry RAD51C, I have to have the operation now."
Ovarian risk linked to RAD51C rises later in life. Most women have time to think, to finish their family and to choose a date that suits them.
"A scan every six months is just as good."
It is not. No scan or blood test has been shown to find ovarian cancer early enough to be relied on. Checks can reassure, but they cannot replace a plan.
"The womb has to come out as well."
RAD51C does not raise the risk of womb cancer. Removing the womb is sometimes offered for other reasons, and you can ask whether it is needed in your case.
"After surgery, I will never need another check."
Surgery lowers ovarian risk but does not touch breast risk. Breast checks continue, and a small risk of cancer in the lining of the abdomen remains.
Questions we are asked
Common questions about RAD51C and ovarian surgery
At what age is surgery usually discussed?
Guidelines generally suggest thinking about it from the mid to late forties, later than for BRCA1 or BRCA2. A close relative with ovarian cancer at a younger age can bring that earlier. Your counsellor will say what fits your family.
Does removing the ovaries lower breast cancer risk too?
The evidence for that is unclear in RAD51C carriers, and you should not count on it. Breast checks carry on as planned after surgery. Your breast plan is separate and should be written down alongside the surgical one.
Can I take hormone replacement after surgery?
Usually yes, if you have not had breast cancer. Replacing hormones until the age of a natural menopause protects the bones and heart and eases symptoms. If you have had breast cancer, other ways to manage symptoms are discussed.
Should I freeze my eggs first?
If your family is not complete and surgery is being planned, egg or embryo freezing is worth asking about. Because RAD51C risk rises later, many women can complete their family first without freezing. A fertility specialist can advise.
What happens to the removed tissue?
It is examined closely under a microscope. Very occasionally, a tiny early cancer is found that no scan had shown. If that happens, your team will explain the next steps. In most women the tissue is clear.
Is this surgery covered by insurance or government schemes?
It depends on the policy or scheme, and cover for preventive surgery varies. Ask your insurer in writing before booking, and ask whether Aarogyasri or Ayushman Bharat applies in your case. Our team can help you check.
My mother had ovarian cancer. Should I test first or plan surgery first?
Test first. If your mother's fault is known, a test for that exact fault will show whether you carry it. If you do not, your ovarian risk returns to that of the general population and surgery is not needed for this reason.
Who should I talk to about this decision?
A genetic counsellor to explain the risk, and a gynaecological oncologist to explain the operation. Many women also want a partner or an adult child in the room. The CION helpline can arrange both conversations.
Your Specialists
Meet CION's oncologists. Bring your family history or genetic report to them.
Our medical oncologists see people with a strong family history of cancer, arrange genetic counselling and testing where it fits, and plan the checks that follow.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
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Sources
- National Cancer Institute — Ovarian, Fallopian Tube, and Primary Peritoneal Cancer Prevention (PDQ)–Patient Version
- NCCN — Genetic/Familial High-Risk Assessment: Breast, Ovarian, Pancreatic, and Prostate
- National Cancer Institute — Genetics of Breast and Gynecologic Cancers (PDQ)–Health Professional Version
- MedlinePlus Genetics — RAD51C gene
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
RAD51C mutation: which cancers and what riskThe size of the risk behind this decisionHRT after risk-reducing ovary removalManaging the menopause surgery brings onOvarian surveillance: why it works poorlyWhy scans cannot stand in for surgeryWays to reduce hereditary cancer riskEvery option, weighed side by side
Talk to us
Weighing up surgery and not sure where to start?
We can arrange a conversation with a genetic counsellor and a gynaecological oncologist, so you hear the risk and the options from both sides. One helpline serves every CION centre.