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PubMed This is a summary of 16 peer-reviewed journal articles Updated
Oncology · Hereditary Breast and Ovarian Cancer Syndrome

Does Ovary Removal Reduce BRCA Breast Cancer Risk?

At a Glance

Removing your ovaries (RRSO) is highly effective for preventing ovarian cancer, but its impact on breast cancer is smaller than once thought. It does not significantly lower breast cancer risk for BRCA1 carriers, though it may offer some protection for BRCA2 carriers if done before menopause.

In this answer

3 sections

01

Why the Medical Guidance Changed

02

How the Benefit Differs by Mutation

03

Surgical Menopause and Hormone Replacement Therapy (HRT)

For many years, doctors believed that removing the ovaries and fallopian tubes (a surgery called risk-reducing salpingo-oophorectomy, or RRSO) significantly lowered a BRCA mutation carrier’s risk of developing breast cancer. However, recent, higher-quality research has changed this thinking. While RRSO remains the most effective way to prevent ovarian and fallopian tube cancers [1][2], its impact on breast cancer risk is much smaller than originally thought and depends heavily on which gene mutation you carry. For women with a BRCA1 mutation, RRSO likely does not lower breast cancer risk [3][4]. For women with a BRCA2 mutation, the surgery may still offer some breast cancer protection, especially if performed before menopause [5][3].

Why the Medical Guidance Changed

In the past, studies suggested that having your ovaries removed could cut your breast cancer risk by up to 50%. However, researchers later discovered that these early studies contained a statistical flaw known as “immortal time bias” [6][7]. Simply put, this bias occurs when the years a woman lived before having the surgery were mistakenly counted as a benefit of the surgery itself. When newer studies looked at the data using more accurate methods, they found that the protective effect against breast cancer was either very small or non-existent [8]. Because of this, the primary medical reason to have an RRSO today is to prevent ovarian and fallopian tube cancer, not breast cancer [9][4].

Doctors generally recommend an RRSO between ages 35 and 40 for BRCA1 carriers, and between ages 40 and 45 for BRCA2 carriers [10][11]. Because RRSO may not protect against breast cancer, your breast cancer risk must be managed separately through options like intensive screening (such as alternating mammograms and breast MRIs) or a risk-reducing mastectomy.

How the Benefit Differs by Mutation

The effect of ovary removal on breast cancer risk varies depending on whether you have a BRCA1 or BRCA2 mutation. This difference likely exists because BRCA1 breast cancers are typically estrogen receptor-negative (so removing estrogen-producing ovaries doesn’t stop them), while BRCA2 breast cancers are more often estrogen receptor-positive.

  • BRCA1 Carriers: Current evidence shows that RRSO does not significantly lower the risk of developing breast cancer for those with a BRCA1 mutation [5][12].
  • BRCA2 Carriers: For BRCA2 carriers, some studies show that removing the ovaries can lower breast cancer risk, particularly if the surgery is done before age 50 (before natural menopause) [5][3]. The protection may also become more apparent several years after the procedure [3].

Surgical Menopause and Hormone Replacement Therapy (HRT)

Removing the ovaries before natural menopause will cause immediate surgical menopause. Many women worry that taking Hormone Replacement Therapy (HRT) (medications that replace the hormones your ovaries stopped making) to manage these symptoms might increase their breast cancer risk, undoing any potential benefits of the surgery. Fortunately, research shows that taking HRT after an RRSO does not negatively impact your breast cancer risk [13][14].

In fact, HRT is often recommended for young women until they reach the age of natural menopause (around age 50) to help protect bone and heart health, as well as to improve quality of life [15][16].

Important note: This safety information applies to women who have not had breast cancer. If you are a breast cancer survivor—particularly of estrogen receptor-positive (ER+) breast cancer—HRT is typically not recommended, and you should talk to your oncologist about non-hormonal ways to manage menopause symptoms.

Common questions in this guide

Does removing my ovaries lower my risk of breast cancer if I have a BRCA1 mutation?
Current evidence shows that having your ovaries removed does not significantly lower your risk of developing breast cancer if you are a BRCA1 carrier. Because of this, your breast cancer risk must be managed separately through intensive screening or a risk-reducing mastectomy.
Can ovary removal prevent breast cancer for BRCA2 carriers?
For women with a BRCA2 mutation, removing the ovaries may still offer some protection against breast cancer. This benefit is most likely if the surgery is performed before you reach natural menopause, typically before age 50.
Why did doctors previously say ovary removal cuts breast cancer risk in half?
Older studies contained a statistical error called immortal time bias, which mistakenly counted the years a woman lived before her surgery as a benefit of the surgery itself. When newer research corrected this flaw, they found the breast cancer benefit is actually much smaller or non-existent.
Is it safe to take hormone replacement therapy (HRT) after having my ovaries removed?
Yes, if you have not had breast cancer, taking HRT after preventive ovary removal is considered safe and does not negatively impact your breast cancer risk. It is often recommended for young women until the age of natural menopause to protect bone and heart health.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Based on my specific mutation (BRCA1 or BRCA2), how will removing my ovaries affect my personal breast cancer risk?
  2. 2.What breast screening schedule should I follow, given that an RRSO might not significantly lower my breast cancer risk?
  3. 3.What is the recommended age for me to undergo an RRSO to maximize my protection against ovarian cancer?
  4. 4.Is Hormone Replacement Therapy (HRT) safe given my personal medical history, and what are my options if I cannot take hormones?
  5. 5.Do you recommend I consider a risk-reducing mastectomy as an additional strategy to lower my breast cancer risk?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

Related questions

How Do PARP Inhibitors Work for BRCA-Mutated Cancers?Can Tamoxifen Lower Breast Cancer Risk in BRCA Carriers?How Much Does Mastectomy Reduce Breast Cancer Risk?How to Find an Expert in Hereditary Breast & Ovarian CancerHow Do I Prepare a Family Cancer History for Genetics?Is HRT Safe After Ovary Removal for BRCA Carriers?What is the Difference Between BRCA1 and BRCA2 Mutations?Do I Meet the NCCN Criteria for BRCA Genetic Testing?What Causes PARP Inhibitor Resistance in BRCA Cancers?What is a VUS (Variant of Uncertain Significance) in BRCA?What is Cascade Testing for BRCA and HBOC Mutations?What Is the Male Breast Cancer Risk for BRCA Carriers?What is the BRCA Mutation Rate in Ashkenazi Jews?What Age Should BRCA Carriers Have Ovaries Removed?What Is My Pancreatic Cancer Risk with a BRCA Mutation?What Genes Besides BRCA Cause Breast & Ovarian Cancer?When Should BRCA Carriers Start Breast Cancer Screening?Which Specialists Treat Hereditary Breast & Ovarian Cancer?Why is Platinum Chemo Effective for BRCA Cancers?

References

References (16)
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This page provides educational information about RRSO and BRCA mutations. Always consult your genetic counselor or oncologist regarding your personal cancer risk and preventive surgery options.

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