TABLE 1.

Evidence of surgical measures for risk reduction in the National Comprehensive Cancer Network guidelines in May 2023.

Cancer	Gene	Measures	Evidence level	Age
Breast	BRCA1	Mastectomy	Discuss	–
Breast	BRCA2	Mastectomy	Discuss	–
Breast	CDH1	Mastectomy	Discuss	–
Breast	PALB2	Mastectomy	Discuss	–
Breast	STK11	Mastectomy	Discuss	–
Ovarian	BRCA1	Salpingo‐oophorectomy a	Recommend	35–40 years old b
Ovarian	BRCA2	Salpingo‐oophorectomy a	Recommend	35–45 years old b
Ovarian	BRIP1	Salpingo‐oophorectomy a	Recommend	45–50 years old
Ovarian	PALB2	Salpingo‐oophorectomy a	Consider	>45 years old
Ovarian	RAD51C	Salpingo‐oophorectomy a	Recommend	45–50 years old
Ovarian	RAD51D	Salpingo‐oophorectomy a	Recommend	45–50 years old
Colorectal	APC	Colectomy	Consider–Recommend	–
Gastric	CDH1	Gastrectomy	Recommend	18–40 years old

Note: Extracted from the National Comprehensive Cancer Network guidelines in May 2023. ²³ , ²⁴ , ²⁵

^a Risks and benefits of premature surgical menopause versus the risk of cancer and family history should be carefully considered, and the guidelines recommend that patients seek expert care. ²⁴

^b Salpingo‐oophorectomy is typically recommended at 35–40 years of age and upon completion of childbearing. Because ovarian cancer onset in patients with pathogenic variant in BRCA2 is an average of 8–10 years later than that in patients with pathogenic variant in BRCA1, it is reasonable to delay salpingo‐oophorectomy for the management of ovarian cancer risk until the age of 40–45 years in patients with pathogenic variant in BRCA2 unless the age at diagnosis in the family warrants earlier age for consideration of surgery. ²⁴