For women carrying BRCA1 or BRCA2 mutations alongside a breast cancer diagnosis, the calculus of preventive surgery is consequential: prophylactic removal of the ovaries and fallopian tubes can reduce ovarian cancer risk by up to 80%. Yet real-world adherence to this guideline-recommended intervention remains poorly characterized in Asian populations, where genetic counseling infrastructure and cultural attitudes toward elective surgery may differ substantially from Western cohorts.

This retrospective analysis from Siriraj Hospital in Bangkok tracked 138 Thai women diagnosed with breast cancer who also carried germline BRCA pathogenic or likely pathogenic variants, observed between 2020 and 2024. Of these, 81 women — 58.7% — proceeded with risk-reducing salpingo-oophorectomy (RRSO). Among those who underwent the procedure, six cases (7.4%) yielded incidental ovarian cancer on pathology, underscoring the clinical stakes of the decision. Two independent factors were associated with higher likelihood of undergoing RRSO: age 45 or older, and the absence of distant metastatic disease. The median time elapsed between genetic testing and surgery was eight months. The 57 women who declined surgery showed no cancer detections over a median surveillance window of 39 months, though this follow-up period is likely insufficient to assess long-term divergence in outcomes.

The 58.7% uptake rate here compares modestly with published rates in Western European and North American settings, which often reach 70–85% in comparable high-risk cohorts. The gap may reflect barriers including limited access to genetic counseling, concerns about surgical menopause side effects, competing treatment priorities in metastatic cases, or differing patient-physician communication norms. The 7.4% incidental ovarian malignancy rate among surgical patients is notably high and reinforces the biological urgency behind current guidelines. A key limitation is the single-center, retrospective design with a relatively small cohort, constraining generalizability. The short surveillance follow-up in the non-surgical group also prevents meaningful outcome comparisons at this stage. Still, this study contributes rare real-world data from Southeast Asia and highlights the need for culturally tailored decision-support tools to close the adherence gap in BRCA-positive populations across diverse healthcare systems.