Factors associated with use of hormone therapy after preventive oophorectomy in BRCA mutation carriers

Abstract

Objective: Bilateral salpingo-oophorectomy (oophorectomy) is recommended to women with a germline BRCA1 or BRCA2 mutation before natural menopause to prevent ovarian and fallopian tube cancer. The adverse effects of early surgical menopause are well established. Although many of the side effects can be ameliorated by the use of hormone therapy (HT); use of HT in this group of predominantly young patients remains suboptimal. The goal of this study was to identify the frequency of HT use, as well as predictors of HT uptake in BRCA mutation carriers who underwent preventive oophorectomy before natural menopause. Methods: Eligible participants were identified from a longitudinal study of BRCA mutation carriers. We included premenopausal women with no personal history of cancer who underwent oophorectomy before age 50 and who had a minimum of 2 years of follow-up. Detailed information on HT use and other important variables was collected by a research questionnaire every 2 years. Descriptive statistics were used to evaluate the use of HT in various subgroups. Results: A total of 793 women with a BRCA1 or BRCA2 mutation were included in this analysis. The mean age at oophorectomy was 42 years (range 28-49). Sixty-one percent of the women reported using HT after oophorectomy. Factors associated with HT use included young age at surgery, a high level of education and preventive mastectomy. Conclusions: The uptake of HT after oophorectomy in women with a BRCA1 or BRCA2 mutation varies by age, education, and surgical history. Clinician and patient awareness may lead to better utilization of HT in women who undergo oophorectomy at an early age to help mitigate the adverse effects associated with surgical menopause.

A prospective controlled study of sexual function and sexually related personal distress up to 12 months after premenopausal risk-reducing bilateral salpingo-oophorectomy

“…32 However, overall uptake of ET is low in this population, potentially because the risks versus benefits of ET in highrisk women are not fully understood and safety concerns remain. 33 Strengths of this study include the prospective design and the comparison of premenopausal women undergoing RRBSO with premenopausal controls of a similar age, providing a meaningful comparison group. Additional strengths include the use of validated questionnaires that assessed several domains of sexual function and sexually related personal distress, and detailed prospective data on the use of ET.…”

“…Overall, the benefits of ET are thought to outweigh the risks for younger premenopausal women undergoing RRBSO 32 . However, overall uptake of ET is low in this population, potentially because the risks versus benefits of ET in high-risk women are not fully understood and safety concerns remain 33 …”

Bilateral Oophorectomy and All-Cause Mortality in Women With BRCA1 and BRCA2 Sequence Variations

“…Eligible study participants were identified from a longitudinal study of 17 947 women with a pathogenic or likely pathogenic germline variant in the BRCA1 or BRCA2 gene, which was initiated in 1995 and includes 83 participating centers from 16 countries. 2,[13][14][15][16] The women underwent genetic testing over an extended period of time . These women sought genetic testing because of a personal or family history of breast and/or ovarian cancer.…”

Hereditary determinants of gynecological cancer and recommendations

“…(23) Women with deleterious mutations in the BRCA1 or BRCA2 genes undergoing prophylactic BSO may experience improved menopausal symptoms with hormone replacement. Mejia-Gomez et al (24) found that only 61% of these women under the age of 50 underwent hormone therapy. Estrogenic therapy in young women reduces the risk of vulvovaginal atrophy, osteoporosis, dyspareunia, atherosclerosis, cardiovascular disease and possibly dementia.…”

“…Estrogenic therapy in young women reduces the risk of vulvovaginal atrophy, osteoporosis, dyspareunia, atherosclerosis, cardiovascular disease and possibly dementia. (24) In women with an intact uterus, adding progestogens to hormone therapy is recommended to prevent hyperplasia and endometrial carcinoma. (25) However, the use of progestogens has been associated with a higher risk of breast cancer in women with a BRCA1 mutation.…”