Primary peritoneal cancer in BRCA carriers after prophylactic bilateral salpingo-oophorectomy

Abstract

Objective:The presence of deleterious mutations in breast cancer (BRCA)-1 or BRCA-2 gene has a decisive influence on the development of various types of neoplasms, such as breast, ovarian, tubal, and peritoneal cancers. Primary peritoneal cancer is an aggressive malignancy which, due to the absence of a specific screening test, cannot be diagnosed in its early stages. As a risk-reducing option, prophylactic bilateral salpingo-oophorectomy and mastectomy are often proposed in BRCA gene carriers. The effectiveness of a preventive surgical treatment is, however, unclear in the development of peritoneal cancer. Material and Methods:An extensive electronic search was performed in PubMed, Scopus, and Cochrane databases. Results: The total number of patients who underwent prophylactic bilateral salpingo-oophorectomy was 1,830, of whom 28 presented with peritoneal cancer (1.53%). The age of the included patients ranged from 48 to 61 years. BRCA-1 was present in 9 out of 28 patients and BRCA-2 in 2 patients, while the type of BRCA was unclear in 17 patients. Salpingo-oophorectomy was performed in 23 out of 28 patients, while oophorectomy was carried out in 5 patients. The interval from initial risk-reducing surgical treatment to the presentation of peritoneal cancer ranged from 12 to 84 months. Conclusion:Modification of the follow-up guidelines and increase in healthcare providers' awareness may reduce the risk of peritoneal cancer. Abstract written only in the English language were included. The reporting data on primary peritoneal cancer in BRCA carriers after prophylactic bilateral salpingo-oophorectomy of the retrieved studies were regarded as includable for this review.

Development of Peritoneal Carcinoma in women diagnosed with Serous Tubal Intraepithelial Carcinoma (STIC) following Risk-Reducing Salpingo-Oophorectomy (RRSO)

“…In BRCA carriers, peritoneal high grade serous carcinoma usually presents as advanced stage disease many years after RRSO. Iavazzo et al [30] looking at 1830 RRSO for BRCA carriers, estimated at 1.53% the lifetime risk of developing primary peritoneal cancer for this subset of patients and found a long interval of time ranging from 12 to 84 months from initial prophylactic surgery to presentation of peritoneal cancer. For this reason they suggested long term follow-up for this patients but did not comment about presence or absence of STICs at the time of RRSO.…”

Peritoneal cancer after bilateral mastectomy, hysterectomy, and bilateral salpingooophorectomy with a poor prognosis: A case report and review of the literature

“…Third, cancerous oviductal epithelial cells may flow into the abdominal cavity before resection during surgery and may lead to peritoneal cancer after many years[35]. The fourth hypothesis is that primary ovarian epithelial cancer, fallopian tube cancer, and PPC may originate from Mullerian hormones due to histological similarities between ovarian and peritoneal cancer[36].…”

Specialist oncological surgery for removal of the ovaries and fallopian tubes in BRCA1 and BRCA2 pathogenic variant carriers may reduce primary peritoneal cancer risk to very low levels

“…Although the results from the meta-analysis show only a 79% reduction in overall ovarian type cancer risk with RRBSO, some reviews have perhaps misled those counselling about risk after surgery that these are small and of the order of just 1% to 2%. 29 The last review quoted a 1.53% incidence of PPC (28/1830); however, this represents short-term follow-up rather than lifetime risk. 27 The two papers that assessed risk at 20 years came up with risks of 4.3% based on 7 PPCs post RRBSO 30 and 3.9% in BRCA1 carriers based on 5 PPCs.…”