Tubal Ligation Cuts Ovarian Ca Risk.

Women with BRCA1 mutations who have undergone a tubal ligation have a 60% lower risk of developing invasive ovarian cancer than those who haven't had the procedure, results of a matched case-control study indicate.

And women who used oral contraceptives before having a tubal ligation had an even greater benefit; their risk dropped by 72%. "Up until now, I have been advising high-risk women to have their ovaries removed at age 35, but that comes with all the side effects of surgical menopause," the study's lead author, Dr. Steven Narod, said in an interview.

Because of these side effects, few women choose to have oophorectomy before age 35. Offering tubal ligation as soon as childbearing is complete is a reasonable alternative and should be followed by an oophorectomy at a later date, said Dr. Narod, a medical geneticist at Sunnybrook and Women's College Hospital, Toronto.

Previous studies have suggested that tubal ligation reduces ovarian cancer risk, but this is the first study to look specifically at its effects in carriers of BRCA1 or BRCA2 mutations, who are at high risk for the disease.

Aside from prophylactic oophorectomy, other strategies for reducing the risk of ovarian cancer in high-risk women include chemoprevention with oral contraceptives and regular ultrasound screening. But the effectiveness of ultrasound screening has not been established, and there are concerns that oral contraceptive use could be associated with an increased risk of breast cancer.

Women are considered to be at high risk for ovarian cancer if they have a mutation in either the BRCA1 or BRCA2 gene. The risk of developing ovarian cancer is about 40% in BRCA1 carriers and about 25% in BRCA2 carriers. In the study, the protective effect of tubal ligation was apparent only in carriers of BRCA1 mutations. "We don't fully understand why this is, but because of this we cannot yet make specific recommendations for carriers of BRCA2" mutations, he said.

The study compared women from the United States, Canada, and the United Kingdom who carried a pathogenic mutation in their BRCA1 or BRCA2 genes. A total of ...