Long-Term Non-Cancer Risks in People with BRCA Mutations following Risk-Reducing Bilateral Salpingo-Oophorectomy and the Role of Hormone Replacement Therapy: A Review

Simple Summary People with BRCA mutations are at high risk for ovarian and breast cancer. In order to greatly reduce their risks of these cancers, people with BRCA mutations undergo surgery between the ages of 35-45 to remove both ovaries and fallopian tubes. However, this type of surgery results in early menopause, which leads to negative long-term health effects. Little is known about these health effects in people with BRCA mutations. In addition, uncertainty surrounds the safety and effectiveness of hormone replacement therapy to treat these health effects and improve quality of life. This review summarizes the current research on the long-term health consequences of early surgical menopause in people with BRCA mutations and highlights the existing research in support of hormone replacement therapy use in this population. Risk-reducing bilateral salpingo-oophorectomy (RRBSO) is the gold standard preventative option for BRCA mutation carriers at high risk for ovarian and breast cancer. However, when performed at the recommended ages of 35-45 years, RRBSO induces immediate premature surgical menopause, along with the accompanying adverse psychosocial, cardiovascular, bone, and cognitive health consequences. While these health consequences have been thoroughly studied in the general population, little is known about the long-term health outcomes in the BRCA population. Hormone replacement therapy (HRT) until the average age of natural menopause can help mitigate these health risks, yet the initiation of HRT is a complex decision among BRCA carriers due to concern of increasing the already high risk of breast cancer in these people. This review summarizes the current research on long-term non-cancer risks in BRCA carriers following RRBSO-induced premature surgical menopause, and highlights the existing evidence in support of HRT use in this population.