Prophylactic Risk-Reducing Salpingo-Oophorectomy in Women with BRCA1 or BRCA2 Mutations: A Systematic Review and Meta-Analysis

Introduction & Objective: Prophylactic risk-reducing Salpingooophorectomy (RRSO) refers to surgical removal of both fallopiantubes and ovaries in women not thought to have cancer prior to surgical procedure but have a high lifetime risk. Despite previous studies, the role of RRSO in reducing breast and High-grade Serous Cancer (HGSC) of ovarian, tubal and peritoneal origin are uncertain. This study assesses benefits and harms of prophylactic RRSO in women with BRCA1 or BRCA2 mutations. Method: We searched Cochrane Central Register of Controlled Trials, MEDLINE /Embase Ovid and trial registries, and abstracts with no language restrictions up to July 2017. We included non-randomized trials that used statistical adjustment analyses comparing RRSO versus no RRSO in women without a previous/coexisting gynecological malignancy and in women with a Risk-reducing Mastectomy (RRM). We extracted data and performed meta-analyses of Hazard Ratios (HR) for time-to-event variables and Risk Ratios (RR) for dichotomous outcomes, with 95% Confidence Intervals (CI). We used ROBINS-I ‘Risk of bias’ assessment tool and quantified inconsistency using I2 statistic. We used random-effects models.