Unmet needs after prevention: a model for managing premature surgical menopause post-risk-reducing bilateral salpingo-oophorectomy.
Academic Article
Overview
abstract
Risk-reducing bilateral salpingo-oophorectomy (rrBSO) is a standard of care for individuals with BRCA1/2 pathogenic variants and other hereditary ovarian cancer syndromes. While the oncologic benefits are clear, the abrupt estrogen deprivation of premature surgical menopause confers increased risks of cardiovascular disease, osteoporosis, and cognitive decline-yet long-term preventive care remains inconsistently provided. This commentary presents a multidisciplinary pilot model developed at a major academic center to bridge this gap. Eligible patients seen in a gynecologic oncology clinic received an educational flyer summarizing chronic disease risks and evidence-based prevention strategies. Referral algorithms were created to streamline access to cardiology, endocrinology, and neurology. From December 2023 to October 2024, 49 patients (median age 49 years, range 27-61) engaged with the program. All patients accepted the flyers, and at one-month follow-up (47 reached), 98% reported positive feedback, 94% found the material accessible, and 23% noted increased motivation for preventive care. The most frequent comment was that the flyers were easily understandable (70%). Eight patients were referred to preventive cardiology (6 scheduled), and six to endocrinology for low bone density (5 scheduled). These preliminary findings suggest that patients with premature surgical menopause are highly motivated to engage in chronic disease prevention when provided with accessible education and a clear pathway to care. Integrating survivorship-focused preventive strategies into routine gynecologic oncology visits is feasible, well-received, and addresses a pressing unmet need. As cancer prevention improves, the next frontier must include structured care for long-term health after premature surgical menopause.
