# Postoperative Management After Risk-Reducing Salpingo-Oophorectomy for Hereditary Breast and Ovarian Cancer Syndrome: A Narrative Review on Balancing Oncologic Benefit and Quality of Life

## TL;DR

This paper reviews how to manage health after surgery to reduce cancer risk in women with a genetic cancer syndrome, balancing cancer prevention and quality of life.

## Contribution

The paper provides a narrative review of postoperative care strategies to balance oncologic benefits and quality of life after RRSO in HBOC patients.

## Key findings

- RRSO reduces ovarian and breast cancer risk but causes abrupt menopause with significant health consequences.
- Patients with STIC require tailored surveillance similar to ovarian cancer monitoring.
- Prophylactic salpingectomy with delayed oophorectomy may preserve ovarian function while maintaining preventive benefits.

## Abstract

Risk-reducing salpingo-oophorectomy (RRSO) is the most effective intervention for reducing ovarian cancer risk in women with hereditary breast and ovarian cancer syndrome (HBOC) associated with pathogenic BRCA1 and BRCA2 variants. RRSO has been shown to markedly reduce the risk of ovarian cancer and to confer a protective effect against breast cancer, thereby contributing to improved overall survival. However, when performed before natural menopause, RRSO induces abrupt menopause, which is associated with vasomotor symptoms, sexual dysfunction, accelerated bone loss, adverse cardiovascular changes, mood disturbances, and reduced quality of life. Recent meta-analyses have also demonstrated an increased risk of all-cause mortality among women undergoing oophorectomy before the age of 45 years without hormone replacement therapy.

Serous tubal intraepithelial carcinoma (STIC), a recognized precursor of high-grade serous carcinoma, is occasionally identified in specimens obtained during RRSO and is associated with an increased risk of subsequent primary peritoneal cancer, warranting tailored postoperative surveillance. International guidelines emphasize comprehensive management following RRSO, including symptom-directed therapies, hormone replacement therapy for eligible patients, cardiovascular and bone health monitoring, and routine breast cancer surveillance with contrast-enhanced magnetic resonance imaging. While no additional gynecologic screening is recommended for patients without STIC, those with STIC require follow-up protocols similar to ovarian cancer surveillance. Emerging evidence also supports prophylactic salpingectomy with delayed oophorectomy as a staged risk-reduction strategy that preserves ovarian function, mitigates menopause-related morbidity, and maintains preventive benefits.

This narrative review summarizes current evidence regarding the oncologic benefits and adverse health consequences of RRSO, the clinical significance of STIC, international postoperative care recommendations, and evolving preventive strategies. Individualized, multidisciplinary postoperative management is essential to optimize long-term health outcomes and quality of life in women undergoing RRSO.