Study Examines Ovarian Cancer Risk in BRCA Carriers
New analysis may help personalize timing of preventive surgery
Key Developments:
- BRCA1 carriers face higher residual ovarian cancer risk
- Study estimates risk according to age and surgery timing
- Researchers emphasize individualized clinical decisions
(The ASCO Po) — October 08, 2026: Women carrying pathogenic BRCA1 or BRCA2 variants may continue to face a meaningful risk of ovarian cancer as they age, according to a prospective international study examining how the timing of preventive surgery affects remaining lifetime risk.
The research, published in JAMA Surgery, analysed data from 5,713 BRCA carriers whose ovaries were intact and who had no ovarian cancer diagnosis when they entered the study. Researchers used age-specific cancer rates and competing mortality data to estimate the remaining risk according to a woman's age and the projected timing of bilateral salpingo-oophorectomy, a procedure that removes both ovaries and fallopian tubes.
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The cohort included 4,286 BRCA1 carriers and 1,427 BRCA2 carriers between the ages of 30 and 74. Participants were followed for an average of 4.4 years, during which 249 cases of ovarian cancer were recorded.
The researchers estimated an overall lifetime ovarian cancer risk of 55% for BRCA1 carriers and 24.1% for BRCA2 carriers. For a 30-year-old BRCA1 carrier who postponed bilateral salpingo-oophorectomy until age 50, the projected residual risk was 23.9%.
A number of genes increase the risk of ovarian cancer, only one of which is the BRCA gene. CREDIT: Verywell.
Even among older carriers, the estimated risk did not disappear. At age 75, the residual risk was calculated at 8.4% for BRCA1 carriers and 3.7% for BRCA2 carriers, although the confidence intervals around these estimates were wide.
The findings are particularly relevant because some BRCA carriers delay preventive surgery because of concerns involving fertility, menopause and the consequences of removing the ovaries. The study provides estimates that can help doctors and patients weigh those considerations against the remaining cancer risk.
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The investigators wrote: “Clinical decision support tools can help personalize the risk of ovarian cancer and inform decisions regarding the timing and projected benefit of bilateral salpingo-oophorectomy in BRCA carriers.”
They also stated that the estimates are intended to help patients and healthcare professionals make informed decisions about when preventive surgery may provide the greatest benefit.
This schematic summarizes and categorizes a spectrum of factors linked to ovarian cancer risk, distinguishing between factors that increase risk and factors that confer protection. CREDIT: ResearchGate.
The researchers concluded: “These risk estimates are intended to support informed decisions between health-care providers and patients about the timing of bilateral salpingo-oophorectomy.”
The study's authors said the findings are consistent with their stated recommendations for risk-reducing surgery at age 35 for BRCA1 carriers and age 45 for BRCA2 carriers. However, a JAMA Surgery commentary notes that current National Comprehensive Cancer Network guidance cited by the authors of that commentary recommends risk-reducing salpingo-oophorectomy beginning at 35 for BRCA1 carriers and 40 for BRCA2 carriers. This difference underscores why individual clinical guidance and the specific guideline being followed matter.
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The research also highlights the importance of identifying BRCA carriers earlier. According to the investigators, the potential benefit of preventive surgery is greatest when high-risk individuals are identified while still young and healthy.
The study does not mean that every BRCA1 or BRCA2 carrier should undergo immediate surgery. Rather, its calculations provide additional information for discussions involving genetic risk, age, reproductive plans, menopause and individual medical circumstances.
Absolute risk of cancers in BRCA1 or BRCA2 mutation. CREDIT: Wikipedia.
The researchers said: “These findings further emphasize the importance of timely identification of BRCA1 and BRCA2 carriers in young healthy women for whom the expected benefit of bilateral salpingo-oophorectomy is greatest.”
The findings add to existing evidence that risk-reducing surgery can play an important role in managing ovarian-cancer risk among people with inherited BRCA variants, while also showing why the timing of that intervention can require individualized assessment.
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For patients who carry a BRCA1 or BRCA2 pathogenic variant, the study therefore provides another tool for discussing residual ovarian-cancer risk with genetics and gynecologic specialists rather than establishing a single age or approach that applies to everyone.
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