No. 344-Opportunistic Salpingectomy and Other Methods of Risk Reduction for Ovarian/Fallopian Tube/Peritoneal Cancer in the General Population

Salvador, Shannon; Scott, Stephanie; Francis, Julie A.; Agrawal, Anita; Giede, Christopher

doi:10.1016/j.jogc.2016.12.005

Cited by 48 publications

(40 citation statements)

References 84 publications

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“…Thus, proposals have come forth to prevent the disease by ‘opportunistic’ salpingectomy, i.e. the removal of the Fallopian tubes during routine hysterectomies or sterilization procedures . Retrospective studies have estimated that this would reduce the risk of ovarian cancer by approximately 50%, pending outcome data from prospective analyses .…”

Section: Discussionmentioning

confidence: 99%

Evidence for lineage continuity between early serous proliferations (ESPs) in the Fallopian tube and disseminated high‐grade serous carcinomas

Soong

Howitt

Miron³

et al. 2018

The Journal of Pathology

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The distal Fallopian tube is a site of origin for many 'ovarian' high-grade serous carcinomas (HGSCs) with intraepithelial carcinomas (STICs) that share identical TP53 mutations with metastatic tumors. TP53 mutation-positive early serous proliferations (ESPs) comprise a spectrum including p53 signatures and serous tubal intraepithelial lesions (STILs) and are not considered malignant; however, ESPs are often the only abnormality found in Fallopian tubes of women with metastatic HGSC. The purpose of this study was to determine if a relationship exists between isolated ESPs and concurrent metastatic HGSCs in the absence of STIC. Fallopian tubes from 32 HGSCs without a co-existing STIC/HGSC in the endosalpinx were exhaustively sectioned. The presence of either STIC/HGSC or ESP in the endosalpinx was documented and DNA from tissues containing ESPs, concurrent HGSC, and control epithelia were interrogated for TP53 mutations by targeted amplicon-based sequencing with average coverage reads >4000 across DNA replicate samples. Serial sectioning revealed a previously unrecognized STIC/HGSC in 3 of 32 (9.3%) and ESPs in 13 (40.6%). Twelve contained TP53 mutations. Nine (75%) shared identical TP53 mutations with concurrent HGSCs, four at high (≥ 5%) and five at low (< 5%) allele frequency. All control epithelia were TP53 mutation-negative. This study, for the first time, indicates lineage identity between ESPs in the distal tube and some metastatic HGSCs via a shared site-specific TP53 mutation. It supports a novel serous carcinogenic sequence in which an ESP could eventually culminate in a metastatic serous cancer via 'precursor escape' and would explain the apparent sudden onset of cancers without co-existing STICs. This paradigm for serous cancer development underscores the likelihood that multiple precursor types in the Fallopian tube contribute to serous cancer development with implications for the evolution, pathologic classification, and prevention of this lethal malignancy. Copyright © 2018 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

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Section: Discussionmentioning

confidence: 99%

Evidence for lineage continuity between early serous proliferations (ESPs) in the Fallopian tube and disseminated high‐grade serous carcinomas

Soong

Howitt

Miron³

et al. 2018

The Journal of Pathology

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“…Since then, the American College of Obstetricians and Gynecologists and the Society of Obstetricians and Gynecologists of Canada have endorsed the recommendation. 14,15 Previous research has indicated a substantial uptake of OS in both the United States 16e18 and Canada. 19e21 The safety research done to date that has examined both major perioperative events 18,20 and minor complications 22 has been reassuring.…”

Section: Introductionmentioning

confidence: 99%

Examining indicators of early menopause following opportunistic salpingectomy: a cohort study from British Columbia, Canada

Hanley

Kwon

McAlpine

et al. 2020

American Journal of Obstetrics and Gynecology

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“…Women who are at or above the target age who decline salpingo-oophorectomy should also be offered salpingectomy (with or without delayed oopherectomy), but should be counselled regarding the limitations of this strategy with respect to achieving optimal risk reduction. Additionally, the SOGC recommends that women at average risk (without BRCA1/2 pathogenic variants) who have completed child-bearing should consider opportunistic salpingectomy (with complete removal of the fimbriated end of the fallopian tube), either for family planning (instead of tubal ligation) or at the time of benign gynecologic surgery, 27 for ovarian cancer risk reduction.…”

Section: Salpingectomy (With or Without Delayed Oophorectomy)mentioning

confidence: 99%

Management of ovarian cancer risk in women with BRCA1/2 pathogenic variants

Walker

Jacobson

Sobel

2019

CMAJ

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varian cancer has the highest mortality of all female reproductive cancers, largely owing to the absence of early symptoms and lack of effective screening, resulting in diagnosis at an advanced stage. Hereditary breast and ovarian cancers include specifically identified genetic variants that greatly increase the lifetime risk of breast and ovarian cancer. BRCA1 and BRCA2 (BRCA 1/2) pathogenic germline variants account for most hereditary breast and ovarian cancer syndromes. Given the substantial lifetime risk and high mortality of ovarian cancer in women with BRCA1/2 pathogenic variants, risk reduction is a priority, and a risk-reducing salpingo-oophorectomy can decrease the lifetime risk of ovarian cancer by about 80%. 1 Gynecologic management associated with reducing the risk of ovarian cancer in this population includes medical and surgical prophylaxis, important contraception and fertility considerations, and the management of iatrogenic premature menopause, as detailed in the recently published Society of Obstetrician and Gynaecologists of Canada (SOGC) clinical practice guideline. 1 We discuss the gynecologic management of women with a BRCA1/2 pathogenic variant who are at high risk of ovarian cancer, based on evidence outlined in Box 1. These women with a BRCA1/2 pathogenic variant are also at substantially increased risk of breast cancer and require specific management, 5,6 but this is outside the scope of this review and will not be covered. What are BRCA 1/2 pathogenic variants? Pathogenic germline variants in BRCA1/2 substantially increase a woman's lifetime risk of breast and ovarian cancer, in addition to other cancers such as prostate and pancreatic cancer and melanoma. BRCA1/2 genes code for tumour suppressor proteins that function to maintain DNA integrity. BRCA1/2 pathogenic variants are inherited in an autosomal dominant fashion, and the prevalence in the general population ranges from 1/400 to 1/800, but can be as high as 1/40 in women of Ashkenazi Jewish descent. 7,8 Women with BRCA1 and BRCA2 pathogenic variants have a cumulative lifetime risk of ovarian cancer of 39%-44% and 11%-17%, respectively, 9,10 and this is greatly increased above the 1.4% lifetime risk of ovarian cancer in the average Canadian woman. 11 The risk of ovarian cancer begins to rise above the population risk after age 40 years in women with BRCA1, and after age 50 in women with BRCA2; this finding forms the basis for the approach to risk reduction outlined below. Given the histopathologic similarity between high-grade serous

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No. 344-Opportunistic Salpingectomy and Other Methods of Risk Reduction for Ovarian/Fallopian Tube/Peritoneal Cancer in the General Population

Cited by 48 publications

References 84 publications

Evidence for lineage continuity between early serous proliferations (ESPs) in the Fallopian tube and disseminated high‐grade serous carcinomas

Evidence for lineage continuity between early serous proliferations (ESPs) in the Fallopian tube and disseminated high‐grade serous carcinomas

Examining indicators of early menopause following opportunistic salpingectomy: a cohort study from British Columbia, Canada

Management of ovarian cancer risk in women with BRCA1/2 pathogenic variants

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