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Risk-reducing salpingo-oophorectomy for BRCA carriers | CION Cancer Clinics
Risk-reducing salpingo-oophorectomy removes both fallopian tubes and both ovaries before any cancer has been found, in a woman who carries a faulty BRCA1 or BRCA2 gene. It sharply lowers the chance of ovarian cancer, which no scan reliably catches early. Guidelines suggest it between about 35 and 40 for BRCA1 and 40 and 45 for BRCA2, once childbearing is complete. This page explains what it does and what to ask. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What is risk-reducing salpingo-oophorectomy?
- What the operation does, and what it does not
- From gene result to follow-up
- Surgery and watchful monitoring, compared
- Three things families say, and what is actually true
- What to ask, and what this page cannot settle
- Common questions about risk-reducing ovary removal
The short answer
What is risk-reducing salpingo-oophorectomy?
It is an operation to remove both ovaries and both fallopian tubes before any cancer has been found, in a woman who carries a faulty BRCA1 or BRCA2 gene. It is done because that gene fault carries a high lifetime chance of ovarian cancer, and there is no reliable test that catches ovarian cancer early.
Why the tubes come out too
Many of the cancers once called ovarian are now known to begin in the far end of the fallopian tube. Removing the ovaries alone would leave that tissue behind. So the operation is always both, and the long name on your letter, bilateral salpingo-oophorectomy, simply means both tubes and both ovaries.
Why it is offered at a particular age
The chance of ovarian cancer in gene carriers is low in the twenties and climbs through the late thirties and forties. Guidelines therefore suggest between about 35 and 40 for BRCA1 and about 40 and 45 for BRCA2, once childbearing is complete. Those are ranges, not deadlines, and your family history moves them.
Who it is not for
It is not offered to a woman who has not had a gene test, however strong her family history feels. It is not usually offered in the twenties, because the risk is still low and the cost of early menopause is high. And it is not a treatment for a cancer that has already been found; that is a different operation with a different plan.
This page cannot tell you whether or when to have the operation. It tells you what the team weighs, so you can ask the right questions.What to expect
What the operation does, and what it does not
Being clear about both sides is the point of the appointment where it is discussed.
It greatly lowers ovarian cancer risk
With the ovaries and tubes gone, the chance of cancer starting in them falls by around 80%. A small risk remains from the lining of the abdomen, which is made of similar cells, and that is why follow-up continues after surgery.
It does not remove breast cancer risk
Breast screening carries on as before. Removing the ovaries before the menopause may lower breast cancer risk a little in some carriers, but it is not a substitute for breast surveillance or for a separate decision about breast surgery.
It causes menopause at once
If you have not yet reached the menopause, it begins the day of surgery. Hormone replacement is usually offered to carriers who have not had breast cancer, until the age of natural menopause, and it softens most of the effects.
If you have had breast cancer, hormone replacement is usually not advised, and the plan is different.It ends natural fertility
Once both ovaries are gone, natural pregnancy is no longer possible. If children are still wanted, the timing of the operation is set around that, or eggs and embryos are frozen before it.
Not sure whether this applies to you?
Ask an oncologistThe pathway
From gene result to follow-up
-
Genetic counselling
The counsellor explains what your particular gene fault means, how the risk changes with age, and which relatives may want testing. This is where the surgery is first raised, usually well before any date.
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The decision appointment
A surgical oncologist or gynaecological oncologist goes through the risks of the operation against the risk of waiting. Bring your partner or the family member who will support you. Ask about hormone replacement and fertility here.
-
Tests before surgery
Usually a scan of the pelvis, a blood test called CA-125, and the ordinary fitness checks before an anaesthetic. These check that nothing has already started.
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The operation
Nearly always keyhole, through a few small cuts, taking around an hour. Most women go home the next day. The tubes and ovaries are sent whole for a very careful examination.
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The pathology report
Because the tubes are examined so closely, a very early change is occasionally found. Your surgeon goes through the report with you even when it is normal, which it usually is.
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Follow-up for life
Hormone replacement is reviewed, bones and heart are watched, and breast screening continues. Ask who is responsible for each, because they often sit with different doctors.
Side by side
Surgery and watchful monitoring, compared
Risk-reducing surgery
Monitoring with scans and blood tests
Lowers the chance of ovarian cancer sharply
Does not lower the chance; tries to catch it, and often catches it late
Causes immediate menopause if before it
Hormones and fertility are untouched
One operation, then lifelong follow-up
Scans and blood tests every few months, indefinitely
Recommended by guidelines once childbearing is complete
Offered as a bridge for women not yet ready for surgery
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Commonly believed
Three things families say, and what is actually true
"Regular scans will catch it early, so why
operate?"
Ovarian cancer rarely shows on a scan or a blood test until it has already spread. Monitoring is offered as a bridge for women who are not yet ready for surgery, not as an equal alternative to it. Your counsellor will say this plainly.
"Once the ovaries are out, the gene no longer
matters."
The gene fault is in every cell of the body. Breast screening continues, some carriers face other cancer risks, and your children may carry the same fault. The operation deals with one risk, and an important one, not with all of them.
"Hormone tablets after this surgery will bring the
cancer risk back."
For a carrier who has not had breast cancer, hormone replacement until the usual age of menopause is generally considered safe, and it protects the bones and heart. The picture is different after a breast cancer, which is why the question is asked of your own team.
Did you know
Because so many of these cancers start in the tube, trials are testing whether removing the tubes first and the ovaries some years later can delay menopause without losing protection. It is not yet standard care, but it is a reasonable question to put to your team.
Being straight with you
What to ask, and what this page cannot settle
The decision is yours and your team's, and it turns on things this page does not know: which gene, which family history, whether you have had breast cancer, whether you want children, and how you feel about living with the risk. What it can do is give you the questions.
Questions for the counsellor
What is my own lifetime risk, given my gene and my family? At what age does it start to rise sharply? Which of my relatives should be offered testing, and how? Is there a risk of other cancers I should know about?
Questions for the surgeon
Will it be keyhole? Will the womb be left? Can I take hormone replacement afterwards, and for how long? What happens if the pathology report finds something? Who looks after my bones and heart in the years after?
If you are not ready
Saying so is allowed. Many women carry the result for a year or more before deciding. Ask what monitoring is offered meanwhile and what its honest limits are, so that the wait is a choice rather than a drift.
If you have a gene result and nobody has yet sat down with you to explain it, call the helpline. That conversation should come before any date.Questions we are asked
Common questions about risk-reducing ovary removal
At what age should a BRCA carrier have her ovaries removed?
Guidelines suggest between about 35 and 40 for BRCA1 and between about 40 and 45 for BRCA2, once childbearing is complete. A relative diagnosed young can bring that earlier. These are ranges for discussion with your counsellor and surgeon, not rules that apply to every carrier in the same way.
Does it also protect against breast cancer?
Not enough to change anything. Removing the ovaries before the menopause may lower breast cancer risk somewhat in some carriers, but breast screening continues exactly as before, and any decision about risk-reducing breast surgery is made separately with the breast team.
Will I have to take hormone replacement?
It is usually recommended, not required, for carriers who have not had breast cancer, until the age of natural menopause. It protects the bones and heart and eases flushes. If you have had breast cancer, it is generally avoided, and the plan for symptoms and bones works without it.
How long does recovery take?
The keyhole operation itself is usually a one-night stay, with most women back to light activity within a week or two. The menopause symptoms, if you were not already past it, are the longer part of recovery and are managed over months. Ask your surgeon for their own centre's typical timeline.
Can I keep my womb?
Usually yes. Removing the womb is not part of this operation unless there is a separate reason, such as a BRCA1 carrier with a family history of womb cancer, or a plan to take a particular kind of hormone replacement. Ask why if it is suggested.
What if the report finds cancer already there?
Occasionally the close examination of the tubes finds a very early change or a small cancer nobody knew about. That is the operation doing its job. Your surgeon will explain what was found and what, if anything, needs to follow. Usually the finding is at a very early stage.
Is the operation covered by insurance or Aarogyasri?
Cover for preventive surgery varies. Some cashless insurers and schemes accept it with the gene report and a specialist's letter; others treat it as elective and decline. Ask the centre to check your cover in writing before the date, and call the helpline if you are unsure what to send.
Should my sister and daughter be tested?
Close blood relatives can be offered a test for the same fault through a genetic counsellor. Each child of a carrier has a one in two chance of carrying it. Testing is usually offered in adulthood, when something can be done with the result. Ask your counsellor who in the family should be seen first.
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Sources
- National Cancer Institute — BRCA Gene Changes: Cancer Risk and Genetic Testing
- Cancer Research UK — Ovarian cancer risks and causes
- NHS — Predictive genetic tests for cancer risk genes
- NICE — Familial breast cancer: classification, care and managing breast cancer and related risks in people with a family history of breast cancer (CG164)
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
What Age to Have Risk-Reducing Ovary RemovalThe timing question in more depthOccult Cancer Found in a Preventive SpecimenWhat happens if the pathology report finds somethingFollow-Up After Risk-Reducing SurgeryWho watches what in the years afterCan You Take HRT After Ovary Removal for Cancer?Hormone replacement after surgical menopauseDeciding on Cancer SurgeryHow to weigh any operation with your team
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