Ovarian Cancer After Prophylactic Salpingectomy in a Patient With Germline BRCA1 Mutation

Abstract

BACKGROUND: Women with germline BRCA1 or BRCA2 mutations have a lifetime risk of ovarian cancer of up to 46%. Opportunistic salpingectomy has been advocated as a risk-reducing strategy owing to increasing recognition of tubal origin, yet evidence of efficacy in this high-risk population is limited. CASE: This is the case of a woman with a BRCA1 mutation who underwent prophylactic mastectomy and bilateral salpingectomy with ovarian retention before the age of 40 years. She did not undergo oophorectomy and subsequently developed stage IV high-grade serous ovarian cancer 4 years after her initial surgery. CONCLUSION: More research is needed to determine the role of prophylactic salpingectomy with delayed oophorectomy, optimal timing of completion oophorectomy, and the risks and benefits compared with up-front risk-reducing salpingo-oophorectomy.

Risk-Reducing Breast and Gynecological Surgery for BRCA Mutation Carriers: A Narrative Review

“…One of the ongoing studies recently published the effects of salpingectomy vs. RRSO on quality of life and demonstrated that QoL was better in the salpingectomy group than in the RRSO group [ 61 ]. However, it is known that new ovarian neoplasms can develop not only after salpingectomy but also after RRSO [ 62 , 63 ]. Looking at the ongoing studies, the efficacy analysis in risk reduction is a long-term balance, with the end dates of the ongoing studies planned beyond 2030 [ 62 , 63 ].…”

“…However, it is known that new ovarian neoplasms can develop not only after salpingectomy but also after RRSO [ 62 , 63 ]. Looking at the ongoing studies, the efficacy analysis in risk reduction is a long-term balance, with the end dates of the ongoing studies planned beyond 2030 [ 62 , 63 ]. Meanwhile, only limited data on cancer risk reduction in this group of high-risk women are currently available [ 62 , 63 ].…”

“…Looking at the ongoing studies, the efficacy analysis in risk reduction is a long-term balance, with the end dates of the ongoing studies planned beyond 2030 [ 62 , 63 ]. Meanwhile, only limited data on cancer risk reduction in this group of high-risk women are currently available [ 62 , 63 ]. Before considering this approach outside of a study protocol, more information is needed.…”

The challenging screen detection of ovarian cancer in BRCA mutation carriers adhering to a 6-month follow-up program: results from a 6-years surveillance

“…23 However, caution is needed with translating the tubal hypothesis into clinical practice before it is proven. 24 Besides, even if fallopian tubes are removed, initiated cells may spread to the ovary at a very early point. 20,22 The preferred left side has never been reported for OC origin in BRCA mutation carriers, herein verified for both ovary and tube locations.…”

Prophylactic salpingectomy with delayed oophorectomy as a two-staged alternative for primary prevention of ovarian cancer in BRCA1/2 mutation carriers: women's point of view

“…Ultimately, the risk of breast cancer remains at baseline and may limit the potential option for future HT if later developed 16 . Lastly, although the risk for ovarian epithelial cancer is considered reduced after risk-reducing bilateral salpingectomy, it still exists and could be lethal 17 …”