What Age Should BRCA Carriers Have Ovaries Removed?

When you have a BRCA1 or BRCA2 mutation, doctors strongly recommend a surgery called a risk-reducing salpingo-oophorectomy (RRSO)—the removal of the ovaries and fallopian tubes—to drastically lower your risk of ovarian cancer ^[1]. However, the recommended age for this surgery depends on which gene mutation you carry. According to established guidelines from groups like the National Comprehensive Cancer Network (NCCN), women with a BRCA1 mutation are advised to have their ovaries removed between ages 35 and 40 ^[2][3]. For those with a BRCA2 mutation, the recommendation is typically delayed by five years, to between ages 40 and 45 ^[2][3]. This difference exists because ovarian cancer tends to develop at an earlier age in people with a BRCA1 mutation compared to those with BRCA2 ^[3][4].

Why is the timing different for BRCA1 and BRCA2?

The timeline for surgery is carefully designed to balance your risk of developing cancer against the health impacts of entering early menopause. The risk profiles for the two mutations are different:

• Earlier onset in BRCA1: In people with a BRCA1 mutation, the risk of ovarian cancer begins to rise significantly in their late 30s ^[3]. To get ahead of this risk, surgery is ideally performed by age 35, or between 35 and 40 once childbearing is complete ^[2][5].
• Later onset in BRCA2: For those with a BRCA2 mutation, research shows that ovarian cancer rarely develops before age 40 ^[3][4]. Because the cancer risk emerges later, doctors recommend waiting until ages 40 to 45 to perform the surgery ^[2][3].
• Different lifetime risks: Overall, BRCA1 mutations carry a higher lifetime risk of ovarian cancer. By age 80, the cumulative risk is approximately 44% for BRCA1 carriers, compared to about 17% for BRCA2 carriers ^[3].

It is important to note that your personal timeline can also be adjusted based on your family history. If you have a close blood relative who was diagnosed with ovarian cancer at a very young age, your medical team may recommend shifting your surgery timeline earlier to ensure you are protected.

Why is surgery the only recommended prevention?

It is natural to wonder if you can just be screened regularly for ovarian cancer instead of having major surgery that causes early menopause. Unfortunately, routine screening methods—like transvaginal ultrasounds (imaging of the reproductive organs) and checking the blood for the CA-125 tumor marker—have not been shown to catch ovarian cancer early enough to save lives ^[6][7]. Because ovarian cancer is aggressive and notoriously hard to detect in its early stages, screening is not considered a safe or viable substitute for surgery ^[8][7].

Currently, RRSO is the only proven and highly effective method to prevent high-grade serous ovarian cancer in BRCA carriers ^[1][9]. Studies consistently show that this surgery significantly reduces the risk of dying from ovarian and fallopian tube cancers ^[10][11]. While this surgery is highly effective at preventing ovarian cancer, it is important to know that a very small residual risk of developing a related condition called primary peritoneal cancer (cancer of the abdominal lining) remains even after the ovaries and tubes are removed, which is why ongoing clinical follow-up is still necessary ^[12].

Managing the Impact of Early Menopause

Having your ovaries removed before natural menopause will instantly trigger surgical menopause. This abrupt drop in hormones can bring on sudden symptoms like hot flashes and vaginal dryness, while also increasing long-term risks for bone loss (osteoporosis) and cardiovascular issues ^[13][14].

To help manage these sudden changes, your doctor will likely discuss hormone replacement therapy (HRT). Evidence indicates that for many BRCA mutation carriers—especially those who have never had breast cancer—taking HRT until the age of natural menopause (around age 50) is safe, does not increase your risk of breast cancer, and helps protect your bone and cardiovascular health ^[15][16]. For individuals who have had breast cancer or cannot safely take HRT, there are highly effective non-hormonal medications and targeted lifestyle strategies available to help manage hot flashes, protect bone density, and support heart health.

Finally, researchers now understand that the most common and aggressive type of “ovarian” cancer in BRCA carriers actually begins in the fallopian tubes, rather than the ovaries themselves ^[17]. Because of this discovery, researchers are currently investigating a two-step surgical approach. In this approach, the fallopian tubes are removed first (salpingectomy) to reduce cancer risk, delaying the removal of the ovaries (and the onset of menopause) until a later age ^[18][19]. However, because doctors are still studying whether this two-step method is as safe as removing everything at once, it is currently considered experimental and is typically only available to patients participating in clinical trials.