Risk‐reducing gynecologic surgery in hereditary cancer: Evidence, timing, and counseling

Risk-reducing gynecologic surgery is an established preventive option for women with selected hereditary cancer predisposition syndromes. In BRCA1 and BRCA2 pathogenic variant carriers, observational studies associate risk-reducing salpingo-oophorectomy with lower tubo-ovarian cancer incidence and mortality. In Lynch syndrome, hysterectomy is associated with reduced endometrial cancer incidence, while ovarian removal requires gene-specific assessment of age, menopausal status, family history, and preferences. Accumulating pathologic and molecular evidence supports a distal tubal origin for many high-grade serous carcinomas, informing complete salpingectomy and meticulous pathology and providing a biologic rationale for investigating salpingectomy with delayed oophorectomy. Prospective preference studies associate this staged strategy with better menopause-related quality of life, but selection bias remains relevant and oncologic non-inferiority is unestablished. This narrative review critically integrates observational findings, risk estimates, guideline recommendations, and expert consensus into a clinical framework for patient selection, procedure choice, timing, counseling, and survivorship. Prevention planning should address fertility, surgical menopause, hormone therapy, residual peritoneal cancer risk, and unequal access to testing and specialist care.