Most BRCA Carriers With Breast Cancer Undergo Ovary Removal Within Two Years

Women who carry an inherited mutation in the BRCA1 or BRCA2 genes face a sharply elevated lifetime risk of ovarian cancer on top of their breast cancer diagnosis, and surgical removal of the ovaries and fallopian tubes remains the only prevention strategy shown to work. A new retrospective study from a German hereditary cancer center now offers one of the first detailed pictures of when, in real-world practice, breast cancer patients actually undergo this operation. Among 148 patients with germline BRCA-mutated breast cancer treated at the Hereditary Breast and Ovarian Cancer Center of University Hospital Erlangen between 2012 and 2024, 101 patients, or 68.2 percent, underwent risk-reducing salpingo-oophorectomy, and the median time from breast cancer surgery to the preventive operation was 16.0 months.

The timing analysis, published in Archives of Gynecology and Obstetrics, used Kaplan-Meier estimation to calculate the probability of remaining free of the operation after breast surgery. At six months, 93 percent of patients had not yet undergone salpingo-oophorectomy, with a 95 percent confidence interval of 0.88 to 0.97. By twelve months that figure had fallen to 0.58 (95 percent CI 0.50 to 0.68), and by twenty-four months to 0.39 (95 percent CI 0.31 to 0.49). In other words, most patients who eventually had the surgery did so within the first two years after their breast cancer diagnosis, a window that matters enormously for counseling women who must weigh ovarian cancer prevention against recovery from breast cancer treatment.

The cohort itself reflects the biology of hereditary breast cancer. Slightly more than half of the patients, 60.8 percent, carried a BRCA1 mutation and 39.2 percent a BRCA2 mutation. The mean age at breast cancer diagnosis was 47.1 years, and 73.6 percent of tumors were detected at UICC stage I or II. Nearly half of the patients, 47.9 percent, had triple-negative breast cancer, a subtype strongly associated with inherited BRCA1 mutations, while 38.4 percent had hormone receptor-positive, HER2-negative disease and 8.9 percent had HER2-positive tumors. Twenty patients, or 13.5 percent, were younger than 35 at diagnosis, the age threshold at which German and international guidelines begin recommending the preventive operation for BRCA1 carriers.

The study also stratified its timing analysis by whether guidelines would have recommended the surgery at the date of breast surgery. Group A comprised BRCA1 carriers aged 35 or older and BRCA2 carriers aged 40 or older, for whom the operation was recommended; group B comprised younger carriers for whom it was not yet advised. Among patients with a recommendation, the twelve-month operation-free probability was 0.52 (95 percent CI 0.43 to 0.63) and the twenty-four-month figure 0.34 (95 percent CI 0.26 to 0.45). For those in whom surgery was not yet recommended, the corresponding probabilities were 0.87 (95 percent CI 0.74 to 1.00) at twelve months and 0.59 (95 percent CI 0.42 to 0.84) at twenty-four months. Even younger patients, the authors note, generally underwent the procedure later but still within internationally recommended timeframes.

Why does the timing matter so much? Without risk-reducing surgery, the ovarian cancer risk in this population is far from trivial. The authors cite a prospective cohort study of BRCA1-mutated breast cancer patients reporting a cumulative ovarian cancer risk of 14.9 percent over fifteen years of breast cancer follow-up, and 5.1 percent for BRCA2 carriers. Other data show a ten-year ovarian cancer risk after stage I to II germline BRCA-mutated breast cancer of 12.7 percent for BRCA1 and 6.8 percent for BRCA2 carriers. Because breast cancer survival has improved substantially in recent years, more mutation carriers now live long enough for these second primary cancers to become clinically relevant.

The protective effect of the operation itself is well documented in prior research. A 2002 study by Kauff and colleagues reported a significant reduction in breast and ovarian cancer risk among carriers undergoing the procedure, with a hazard ratio of 0.25 (95 percent CI 0.08 to 0.74), and a meta-analysis by Rebbeck and colleagues found an ovarian cancer risk reduction with a hazard ratio of 0.21 (95 percent CI 0.12 to 0.39). In a prospective multicenter cohort of 2,482 BRCA1 or BRCA2 mutation carriers, women with prior breast cancer who underwent the operation had an ovarian cancer hazard ratio of 0.14 (95 percent CI 0.04 to 0.59), along with lower all-cause mortality (HR 0.30; 95 percent CI 0.17 to 0.52). More recently, Blondeaux and colleagues in 2025 reported significantly better overall survival in germline BRCA-mutated breast cancer patients undergoing the surgery (HR 0.58; 95 percent CI 0.48 to 0.71).

The Erlangen study also examined what the surgery actually finds. Among the 101 patients who underwent risk-reducing salpingo-oophorectomy during breast cancer follow-up, three were diagnosed with occult high-grade serous ovarian carcinoma, detected when the removed specimens were examined according to the SEE-FIM protocol, a standardized pathological procedure designed to avoid missing early carcinomas. Two of these patients had the operation seven months after breast surgery and one more than fifteen years later. Tumor stages were FIGO IA, IC and IIIA. All underwent laparotomy, and the patient with stage IIIA disease subsequently received a poly(ADP-ribose) polymerase inhibitor. None experienced a breast or ovarian cancer relapse by the December 2024 data cut-off. This detection rate of roughly three percent aligns with the wider literature, in which occult carcinomas are found in approximately one to five percent of procedures, and with Finch and colleagues’ identification of 46 invasive carcinomas among 1,390 mutation carriers.

Ovarian cancer also appeared among patients who did not have the surgery. Of 47 patients who did not undergo risk-reducing salpingo-oophorectomy, seven developed ovarian cancer: two before their breast cancer diagnosis, one synchronously, and four afterward. In the four patients who developed ovarian cancer during breast cancer follow-up, diagnosis came between 91 and 449 months after breast cancer. One of these patients received only palliative systemic treatment for FIGO IVA disease, underscoring the stakes of the prevention decision. The authors conclude that because survival after breast cancer continues to improve, the risk of a subsequent ovarian cancer remains clinically relevant, and the operation should continue to be offered and discussed in accordance with current guidelines even in the context of a breast cancer diagnosis.

The findings come with important caveats that the authors themselves lay out in detail. The study is retrospective and single-center, so selection bias cannot be excluded, since patients who chose the operation may differ systematically from those who did not. Missing or incomplete data, differing follow-up times and confounding factors may have affected the results, and ascertainment bias likely led to underreporting, for example when patients had surgery at other institutions. The relatively small cohort precluded meaningful inferential statistics, so the data were analyzed predominantly descriptively, and the authors consider the risk of statistical error substantial. For the Kaplan-Meier analysis, 21 patients were excluded for missing time-to-surgery data and others for testing performed outside a defined window around breast surgery, leaving 125 patients in the timing analysis. Data were also collected in Germany only, where adnexal ultrasound screening for ovarian cancer is not recommended and only risk-reducing surgery is reimbursed, a more directive counseling environment that should be considered when interpreting the results.

Within those limits, the study provides the first real-world data on the median interval between breast cancer surgery and the preventive operation, information the authors describe as valuable for genetic counseling and shared decision-making. Current guidelines recommend offering the procedure from age 35 in BRCA1 carriers and age 40 in BRCA2 carriers, but they give no specific recommendation on timing relative to breast cancer treatment, a gap this single-center cohort begins to fill. The operation is not without costs: it triggers immediate menopause in premenopausal women, which can substantially affect quality of life and sexual well-being, and effects on bone health and cardiovascular risk have been described, although large registry analyses have not consistently shown increased cardiovascular risk. An alternative under investigation, bilateral salpingectomy with delayed oophorectomy, is being tested in the TUBA-WISP II trial with results still pending. For now, the Erlangen data suggest that in everyday clinical practice, most carriers with breast cancer who take up the surgery do so early, within roughly a year and a half of their breast operation.

Subject of Research: Timing and uptake of risk-reducing salpingo-oophorectomy in patients with germline BRCA-mutated breast cancer

Article Title: Risk-reducing salpingo-oophorectomy in patients with gBRCA-mutated breast cancer

Article References: Amann, N., Wagner, K., Ziegler, P., Krückel, A., Brückner, L., Gocke, J., Müller, C., Runz, C., Heindl, F., Hack, C. C., Emons, J., Fasching, A. P., Beckmann, W. M., & Hörner, M. (2026). Risk-reducing salpingo-oophorectomy in patients with gBRCA-mutated breast cancer. Archives of Gynecology and Obstetrics, 313(1), Article 278. https://doi.org/10.1007/s00404-026-08581-2

Image Credits: AI Generated

DOI: 10.1007/s00404-026-08581-2

Keywords: BRCA1, BRCA2, breast cancer, ovarian cancer, risk-reducing salpingo-oophorectomy, hereditary breast and ovarian cancer, Kaplan-Meier analysis, genetic counseling, retrospective study, cancer prevention, Risk-reducing, salpingo-oophorectomy