Patients who may benefit from risk-reducing surgery include those with:

• a potentially high risk of ovarian cancer – these patients should be referred to a familial cancer service for risk assessment, possible genetic testing and management planning (which may include risk-reducing surgery)
• a high risk of ovarian cancer due to a confirmed gene mutation (surgery is recommended for these patients and should include complete removal of the extrauterine component of both the fallopian tubes and ovaries at a time considered appropriate after consultation with their treating clinicians)
• a high risk of ovarian cancer due to confirmed Lynch syndrome (the surgery should include a hysterectomy and bilateral salpingo-oophorectomy at a time considered appropriate after consultation with their treating clinicians)
• other less common mutations as deemed by a familial cancer service.

For patients who are considering risk-reducing surgery, the surgeon should provide:

• a clear description of the risk-reducing surgery technique and clear information about the objective of the procedure
• information about managing menopausal symptoms and other long-term side effects risk-reducing surgery as well as hormone replacement therapy use
• a discussion about psychosocial wellbeing after risk-reducing surgery

Genetic counselling is appropriate for women who have:

• a first- or second-degree relative with invasive epithelial ovarian, fallopian tube or primary peritoneal cancer and an additional first- or second-degree relative with one of the following:
  • epithelial ovarian, fallopian tube or primary peritoneal cancer
  • breast cancer
  • colorectal cancer under the age of 50 years
  • endometrial cancer under the age of 50 years
• three or more first- or second-degree relatives with Lynch syndrome–associated cancer such as adenocarcinoma of the colorectum, endometrium, small intestine, stomach, ovary or pancreas, urothelial carcinoma of the ureter or renal pelvis, cholangiocarcinoma, brain tumour or sebaceous gland tumour (eviQ 2019a).

For more information see eviQ’s Referral guidelines for ovarian cancer risk assessment and consideration of genetic testing.