Impact of incidental bilateral salpingo-oophorectomy in a family member on breast cancer risk assessment: Clinical considerations

Background: Hysterectomy (TAH/TVH) with bilateral salpingo-oophorectomy (BSO) remains prevalent in the general population; however, current risk tools do not account for the potential impact of BSO on breast cancer risk calculations in family members. Methods: CancerGene© software was used to estimate the effect of BSO in a family member on proband risk across a range of simulated family cancer histories. Results: Impact of BSO on proband risk appears most salient when it occurs in a first-degree relative. Race appears to modify the attainment of clinically significant risk thresholds, suggesting possible systematic risk underestimations among black women. Conclusions: When clinicians calculate risk in families where a close relative had BSO, they may choose to supplement standard risk calculations with numerical ranges of risk that account for the risk-reducing effect of BSO. More consideration is needed of whether failing to account for BSO in risk models perpetuates race-based health disparities.