Highlights
- •Understanding of the etiology and pathogenesis of ovarian cancer has significantly evolved over the past two decades.
- •Surgical prophylactic surgery has saved lives in high-risk populations of women.
- •Although the evidence-base is limited, surgical risk-reduction methods have increasingly been applied to average-risk women.
- •There are different side effect profiles associated with various types of surgical prevention strategies.
- •Current prospective trials may offer evidence for less toxic alternative prophylactic surgical options in the future.
Abstract
Given the current lack of effective screening for ovarian cancer, surgical removal
of at-risk tissue is the most successful strategy to decrease risk of cancer development.
However, the optimal timing of surgery and tissues to remove, as well as the appropriate
patients to undergo preventive procedures are poorly understood. In this review, we
first discuss the origin and precursors of ovarian epithelial carcinomas, focusing
on high-grade serous carcinomas and endometriosis-associated carcinomas, which cause
the majority of the mortality and incidence of ovarian cancer. In addition, we summarize
the implications of current understanding of specific pathogenic origins for surgical
prevention and remaining gaps in knowledge. Secondly, we review evidence from the
epidemiologic literature on the associations of various surgical prevention strategies,
including endometriosis excision, tubal procedures, and bilateral salpingo-oophorectomy,
with risk of future ovarian cancer development, as well as the short- and long-term
consequences of these strategies on women's health and quality and life. We conclude
with recommendations for surgical prevention in women with high-risk genetic mutations
and average-risk women, and a brief discussion of ongoing research that will help
clarify optimal surgical approaches that balance risk-reduction with maintenance of
women's quality of life.
Keywords
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Article info
Publication history
Published online: August 06, 2018
Accepted:
August 2,
2018
Received:
July 13,
2018
Identification
Copyright
© 2018 Published by Elsevier Inc.
