New Hope for BRCA+ Women: Prophylactic Salpingectomy with Delayed Oophorectomy (PSDO) for Ovarian Cancer Prevention

After Rachel Belkin had breast cancer, she found out she was BRCA1+. Because of this gene mutation, she has a high risk of getting ovarian cancer. She had surgery to remove her fallopian tubes to decrease her ovarian cancer risk.

Oophorectomy for Ovarian Cancer Prevention in BRCA1+ Young Breast Cancer SurvivorPhoto byRachel K. Belkin

BRCA Gene Mutation: Decreasing Ovarian Cancer Risk with Fallopian Tube Removal - Prophylactic Salpingectomy with Delayed Oophorectomy (PSDO)

Breast Cancer Diagnosis and BRCA Testing

After her breast cancer diagnosis in 2009, Rachel underwent BRCA testing, which revealed that she carried the BRCA1 gene mutation associated with an increased risk of breast and ovarian cancers.

Specifically, she tested positive for the BRCA1 187 del AG mutation, which can significantly elevate her likelihood of developing these cancers. Given her history of bilateral mastectomy and chemotherapy for breast cancer, Rachel recognized the importance of reducing her ovarian cancer risk. As such, she made it a priority to explore options for minimizing that risk.

BRCA and Increased Ovarian Cancer Risk 

Due to the lack of reliable ovarian cancer screening methods, women with the BRCA gene mutation face a difficult decision in terms of risk reduction. While options for surveillance exist, such as monitoring the CA125 tumor marker and undergoing regular ultrasounds, they are not always effective.

For women like Rachel, who are at high risk of developing ovarian cancer, oophorectomy (removal of the ovaries) is the most effective risk-reducing measure. However, many doctors recommend that this procedure is performed around age 40.

Despite its effectiveness, bilateral oophorectomy before natural menopause can result in several negative outcomes, including cardiovascular disease, cognitive impairment, bone problems, emotional and sexual difficulties, and an increased risk of premature death. These risks can be daunting and may cause anxiety for women considering the procedure.

Ovarian Cancer May Start in the Fallopian Tubes

Recent research has suggested that ovarian cancer may actually originate in the fallopian tubes, prompting doctors to consider salpingectomy (fallopian tube removal) for ovarian cancer prevention in premenopausal women.

One clinical research study at M.D. Anderson Cancer Center in Houston, Texas, known as the Prophylactic Salpingectomy With Delayed Oophorectomy trial, was recruiting participants to compare ovarian cancer screening, risk-reducing salpingo-oophorectomy (RRSO), and prophylactic salpingectomy with delayed oophorectomy (PSDO).

After careful consideration and personal research, Rachel decided to participate in this fallopian tube removal option for BRCA+ women. She felt that her body was like a ticking time bomb, and at 37 years old, waiting until age 40+ to reduce her risk of ovarian cancer was too daunting. Additionally, she was not ready to face the issues associated with surgical menopause that could come with bilateral oophorectomy.

Rachel's Laparoscopic Prophylactic Salpingectomy with Delayed Oophorectomy (PSDO) 

In September 2015, Rachel and her husband traveled to Houston for pre-op appointments and testing ahead of her prophylactic salpingectomy surgery at MD Anderson Cancer Center. After receiving confirmation that everything was normal, her surgery was scheduled for the following day. Rachel arrived at the center at 6:30 am on September 15, and after waiting in the waiting room for some time, was given a room. The medical team inserted an IV and administered a scopolamine transdermal patch behind her ear to prevent nausea. Around 9:15 am, Rachel was wheeled into surgery and given anesthesia.

Rachel Belkin at M.D. Anderson Cancer CenterPhoto byRachel K. Belkin

Recovery After Her Fallopian Tubes Were Removed

Rachel experienced a complication during her laparoscopic salpingectomy. Her small intestine swelled during surgery, which caused her doctor and a gastroenterologist to carefully check her whole small intestine for any punctures. After a thorough examination, they found no injuries. Despite the surgery being scheduled for 1.5 hours, it lasted for 3 hours due to the intestinal problem.

Typically, a laparoscopic salpingectomy is an outpatient procedure, but Rachel had to spend the night at the hospital due to complications. Her doctor wanted to monitor her overnight to ensure that she did not experience any further intestinal problems.

Pain After the Laparoscopic Salpingectomy for Ovarian Cancer Risk Reduction

After her surgery, Rachel reported a pain level of around 3 out of 10, and her stomach was bloated and gassy due to the surgical air. She was informed prior to surgery to expect a lot of gas after the procedure.

However, Rachel experienced some annoying side effects from the anesthesia or scopolamine patch. Unfortunately, her scopolamine patch remained on for a few days until she complained to her doctor upon returning to Austin. She experienced blurry vision, especially up close, and had difficulty with reading and texting for almost a week.

Rachel also felt nauseous, lightheaded, and dizzy for a period of time.

Recovery After About a Week After Laparoscopic Salpingectomy

Rachel reports that she is almost feeling back to normal after her surgery. She was able to drive recently, although she is still experiencing some weakness and slight nausea. As part of her post-surgery recovery, Rachel is following some restrictions, such as not lifting more than 10 pounds for six weeks, and not doing abdominal exercises and Pilates until six weeks after the surgery. After four weeks, she will be able to resume running.

Pictures of Laparoscopic Salpingectomy After Surgery

Rachel shared some pictures of her stomach with steristrips after the laparoscopic salpingectomy. The photos show four incisions, whereas typically, the procedure only requires three incisions - two for fallopian tube removal and one for the camera. However, due to Rachel's intestinal issues, the surgeon had to make an extra incision to check her bowels and small intestine.

Pictures of Recovery After Laparoscopic Salpingectomy After Surgery - Four Days After Laparoscopic Prophylactic Salpingectomy Fallopian TubePhoto byRachel K. Belkin

Summary

Ovarian cancer is a serious and often deadly disease that affects many women worldwide. With recent research suggesting that ovarian cancer may actually start in the fallopian tubes, doctors are now recommending salpingectomy for ovarian cancer prevention in premenopausal women.

Rachel's personal experience with this procedure provides valuable insights into the process and the recovery period.

It is important for women to be aware of their options for ovarian cancer prevention and to discuss them with their doctors. While the recovery period may have its challenges, the long-term benefits of preventive surgery cannot be overstated. By staying informed and proactive about their health, women can take important steps towards reducing their risk of ovarian cancer and achieving optimal health and well-being.

Recovery after Fallopian Tube Removal for Ovarian Cancer PreventionPhoto byRachel K. Belkin

As a young breast cancer survivor in Austin, Texas, Rachel Belkin is an advocate for breast cancer patients and serves as a member of the Advisory Council for the Breast Cancer Resource Center CDC Young Survivor Project.

This article was produced and syndicated by Rachel K. Belkin.