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UBC Theses and Dissertations

Cardiovascular and bone health among women with BRCA1/2 mutations after a risk-reducing bilateral salpingo-oophorectomy : a population-based study Abreu do Valle, Helena


Objectives: To prevent ovarian cancer among women at high genetic risk due to BRCA1/2 mutations, risk-reducing bilateral salpingo-oophorectomy (RRBSO) is recommended between 35-45 years. However, there is currently little evidence on long-term, non-cancer health outcomes among women who undergo this treatment. This thesis examined: 1) the risk of cardiovascular disease (CVD), of predisposing conditions to CVD, and the receipt of cardioprotective medications, and 2) the risk of bone fractures and osteoporosis, and the receipt of health services to prevent bone disease, following RRBSO among women with BRCA1/2 mutations. Methods: Using population-based data from British Columbia, Canada, between 1996 to 2017, I compared the hazard of CVD, and of fractures and osteoporosis among women with known deleterious BRCA1/2 mutations who underwent RRBSO before the age of 50 with two groups of age-matched women without known BRCA1/2 mutations: 1) women who underwent bilateral oophorectomy (BO) for benign gynecologic conditions; and, 2) women who underwent hysterectomy and/or salpingectomy but had intact ovaries. Results: Women with BRCA1/2 mutations were at increased risk for CVD compared to women without mutations and intact ovaries, and no significant increased risk for CVD when compared to women without mutations who underwent BO. Compared to both control groups, they were less likely to be diagnosed with predisposing conditions and to fill cardioprotective medications, although this did not reach statistical significance. Regarding bone health, women with BRCA1/2 mutations had a higher likelihood of having an osteoporosis diagnosis than women in both control groups, but they were not at an increased risk of fractures during the follow-up period. Although the likelihood of having a dual-energy x-ray absorptiometry scan was higher for women with BRCA1/2 mutations, under 50% of them were screened for bone loss by the end of follow-up. The rate of bisphosphonates use among women with osteoporosis was also low. Conclusions: These results suggest that the cardiovascular and bone health of women with BRCA1/2 mutations is worse than age-matched women with intact ovaries. We recommend that women with BRCA1/2 mutations receive focused care after RRBSO in order to prevent CVD, fractures and osteoporosis.

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