Systematic review of management options for women with a hereditary predisposition to ovarian cancer

Objective. To develop through consensus and literature review management options for women with a hereditary predisposition to ovarian cancer, outcomes of interest were incidence of ovarian cancer, life expectancy, additional benefits of prophylactic oophorectomy, complications of surgery, and alternatives to prophylactic oophorectomy. Methods. MEDLINE, CANCERLIT, and the Cochrane Library databases were searched to September 2003 using the terms ovarian, cancer, neoplasms, prophylactic oophorectomy, ovariectomy, clinical trial, metaanalysis, and systematic review. Results. Four cohort studies (two retrospective, two prospective) examined whether prophylactic oophorectomy reduced the lifetime risk of developing ovarian cancer. All the cohort studies found that prophylactic oophorectomy reduced the lifetime risk of developing ovarian cancer; however, this risk reduction was statistically significant in only two cohort studies. The complication rate of laparoscopic surgery for prophylactic oophorectomy is low (0.22-4.0%). However, there are long-term adverse effects of prophylactic oophorectomy, most notably the onset of early menopause. Conclusions. Based on the evidence from the four cohort studies, prophylactic oophorectomy does protect against the development of ovarian cancer. (C) 2004 Elsevier Inc. All rights reserved.