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Background

In the UK, ovarian cancer is diagnosed in around 7,400 women each year and has the highest mortality rate of all the gynaecological cancers. Despite significant efforts to develop new drugs and treatment strategies, ovarian cancer survival rates have remained much poorer than other cancers.

Over 1 in 10 of all ovarian cancers are familial (run in families) or are caused by faulty genes. The most common cause is an inherited fault/alteration in the BRCA1 or BRCA2 gene. Individuals with these BRCA1/BRCA2 faulty genes, have a 17-44% risk of developing ovarian cancer and 69-72% risk of developing breast cancer over their lifetime. This is much higher than the risk for women who do not carry the gene alteration. In the general population, 1 in 50 (2%) women get ovarian cancer and 1 in 8 (12%) get breast cancer over their lifetime. Focusing on developing strategies to prevent ovarian cancer in women at increased risk has the potential to have a significant impact on disease burden.

There is currently no screening programme for ovarian cancer available on the National Health Service (NHS) as ovarian cancer screening has not yet been shown to save lives. The most effective method to prevent ovarian cancer is surgery to remove both the fallopian tubes (‘tubes’) and ovaries. This procedure is called ‘risk reducing salpingo-oophorectomy’ (RRSO). This significantly reduces the risk of ovarian cancer by over 80% and is offered to women at increased risk once they have completed their family. However, in premenopausal women, removing the ovaries causes early menopause, which has a serious detrimental impact on general health. Early menopause results in symptoms such as hot flushes, changes in mood, irritability and impaired sexual function. It also increases the risk of osteoporosis (brittle bones), heart disease, deaths from heart disease, stroke and dementia.

Current research suggests that a significant number of cancers of the ovary actually start in the tubes. This has led to the proposal of an alternative strategy for reducing ovarian cancer risk, in which women are offered preventive surgery in two stages. The first procedure involves only removing the tubes (early salpingectomy). The second procedure involves removing the ovaries (delayed oophorectomy) after the individual has gone through the menopause. This novel prevention strategy (RRESDO – risk reducing early salpingectomy with delayed oophorectomy) offers protection against ovarian cancer in young women whilst avoiding the negative health consequences of early menopause.

However, the overall impact of this two-step prevention strategy has not yet been adequately studied. The PROTECTOR study will be able to assess impact within the safe environment of a research study where women will be closely followed up.

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