Without preventive interventions, women with germline pathogenic variants in BRCA1 or BRCA2 have high lifetime risks for breast cancer and tubo-ovarian cancer. The increased risk for breast cancer starts at a considerably younger age than that for tubo-ovarian cancer. Risk-reducing bilateral salpingo-oophorectomy (rrBSO) is effective in reducing tubo-ovarian cancer risk for BRCA1 and BRCA2 mutation carriers, but whether it reduces breast cancer risk is less clear. All studies of rrBSO and breast cancer risk are observational in nature and subject to various forms of bias and confounding, thus limiting conclusions that can be drawn about causation. Early studies supported a statistically significant protective association for rrBSO on breast cancer risk, which is reflected by several international guidelines that recommend consideration of premenopausal rrBSO for breast cancer risk reduction. However, these historical studies were hampered by the presence of several important biases, including immortal person-time bias, confounding by indication, informative censoring, and confounding by other risk factors, which may have led to overestimation of any protective benefit. Contemporary studies, specifically designed to reduce some of these biases, have yielded contradictory results. Taken together, there is no clear and consistent evidence for a role of premenopausal rrBSO in reducing breast cancer risk in BRCA1 or BRCA2 mutation carriers.

中文翻译：

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BRCA1 和 BRCA2 突变携带者的双侧输卵管卵巢切除术和乳腺癌风险：评估证据

如果不进行预防性干预，携带 BRCA1 或 BRCA2 种系致病性变异的女性终生患乳腺癌和输卵管卵巢癌的风险很高。与输卵管卵巢癌相比，乳腺癌风险增加的年龄要小得多。降低风险的双侧输卵管卵巢切除术 (rrBSO) 可有效降低 BRCA1 和 BRCA2 突变携带者的输卵管卵巢癌风险，但它是否能降低乳腺癌风险尚不清楚。所有关于 rrBSO 和乳腺癌风险的研究本质上都是观察性的，并且受到各种形式的偏见和混杂的影响，因此限制了可以得出的因果关系的结论。早期研究支持 rrBSO 对乳腺癌风险具有统计学意义的保护关联，这反映在一些建议考虑绝经前 rrBSO 以降低乳腺癌风险的国际指南中。然而，这些历史研究因存在几个重要的偏差而受到阻碍，包括不朽的人-时间偏差、适应症混杂、信息审查以及其他风险因素的混杂，这些可能导致对任何保护性益处的高估。专门为减少其中一些偏见而设计的当代研究产生了相互矛盾的结果。总之，没有明确一致的证据表明绝经前 rrBSO 在降低 BRCA1 或 BRCA2 突变携带者患乳腺癌风险方面的作用。包括不朽的人时偏差、适应症混杂、信息删失和其他风险因素混杂，这可能导致高估任何保护性益处。专门为减少其中一些偏见而设计的当代研究产生了相互矛盾的结果。总之，没有明确一致的证据表明绝经前 rrBSO 在降低 BRCA1 或 BRCA2 突变携带者患乳腺癌风险方面的作用。包括不朽的人时偏差、适应症混杂、信息删失和其他风险因素混杂，这可能导致高估任何保护性益处。专门为减少其中一些偏见而设计的当代研究产生了相互矛盾的结果。总之，没有明确一致的证据表明绝经前 rrBSO 在降低 BRCA1 或 BRCA2 突变携带者患乳腺癌风险方面的作用。