LAUSR

Dear Editor, We read with great interest the recent article by Corrado et al, but would like to comment on a particular issue of concern. The authors state: “women may choose surgical options, such as risk reducing bilateral salpingooophorectomy, bilateral salpingectomy, or hysterectomy to reduce the risk of cancer”. We believe the authors have assumed salpingectomy could be an option for the high risk ovarian cancer population. Although it is possible for the fallopian tubes to be the origin of many highgrade pelvic serous carcinomas, it should be pointed out that up to 21% of occult cancers may involve the ovary alone. Despite some evidence regarding the safety and feasibility of salpingectomy for women at average risk of ovarian cancer, the safety of an ‘incomplete riskreducing surgery’ for BRCA mutation carriers is unknown. Clinical trials of interval salpingectomy and delayed oophorectomy are ongoing (eg, NCT02321228, NCT01907789, ISRCTN25173360). Regarding the role of risk reduction hysterectomy for BRCA mutation carriers, since there is evidence that these women have a higher risk of highgrade serous uterine cancer compared with women at average risk, hysterectomy should be discussed and could avoid the use of progesterone if hormone replacement therapy is indicated after surgery.