Oral contraceptives, salpingo-oophorectomy and hormone replacement therapy in BRCA1-2 mutation carriers

Over the last few years, different preventive strategies have been developed to reduce gynaecologic cancer risk in BRCA 1/2-mutation carriers. OCs use reduces the risk of ovarian cancer in the general population and probably also in BRCA mutations carriers. Unfortunately OCs seem to be associated with an increase of breast cancer risk in mutation carriers. As consequences, it is still too early to recommend OCs use as a chemoprevention strategy against ovarian cancer in high-risk women. Though intensive screening programs and chemoprevention with tamoxifen play a role in the management of women with BRCA mutations, prophylactic surgery is clearly the most effective strategy to reduce the incidence of breast and ovarian cancer.On the other hand, prophylactic bilateral oophorectomy is associated with the abrupt onset of menopausal symptoms in premenopausal women at the time of surgery. HRT is effective in relieving vasomotor and urogenital dystrophic symptoms, but it is still controversial whether it may or may not decrease the protective effect of oophorectomy on breast cancer risk. The few data available do not demonstrate any adverse modification of breast cancer risk by short-term use of HRT after oophorectomy, though further studies are needed to confirm the efficacy and safety of different preparations. The body of knowledge on cancer hereditary syndromes is growing at rapid pace and we are now able to provide women with more detailed information on their cancer risk. Nevertheless, all efforts should be directed towards a better understanding of the biology of cancers associated with BRCA1 and BRCA2 germline mutations. This may allow to improve prevention and surveillance strategies and hopefully avoid that these women will have to face the drastic choice of prophylactic surgery.