Prophylactic risk-reducing salpingo-oophorectomy in BRCA mutation carriers: what is going on in a region of northern Italy?

Grandi, Giovanni; Perrone, A.M.; Mandato, Vincenzo Dario; Comerci, Giuseppe; Sammarini, Margaret; Merisio, Carla; Amadori, Alberto; Stefanetti, Marco; Martinello, Rossella; Facchinetti, Fabio; Iaco, Pierandrea De; Aguzzoli, Lorenzo; Arcangeli, Valentina; Berretta, Roberto; Cortesi, Laura; Domenico, Renato De; Nuzzo, Maria De; Friso, Stefano; Greco, Pantaleo; Rosati, F.; Scutiero, Gennaro; Toss, Angela

doi:10.1016/j.maturitas.2020.08.011

Cited by 3 publications

(3 citation statements)

References 42 publications

(87 reference statements)

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“…An incidental carcinoma involving the ovary, fallopian tube or peritoneum is detected during surgery or in the surgical specimen in 2-14% of patients undergoing risk-reducing procedures among multiple large studies. The frequency, however, in several studies is 3-5%, [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52] although it could be argued that there may be publication bias in the rates of positivity in the literature with the possibility of lower rates in current practice due to a shift to surgery in younger patients.…”

Section: Incidental Detection Of Stic In the Setting Of Prophylactic ...mentioning

confidence: 99%

Serous tubal intra‐epithelial carcinoma: what do we really know at this point?

Vang

Shih

2022

Histopathology

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Serous tubal intra‐epithelial carcinoma (STIC) is the earliest morphologically recognisable step in the development of invasive high‐grade serous carcinoma of the fallopian tube. Lesions occurring prior to STIC within the carcinogenic sequence for the pathogenesis of invasive high‐grade serous carcinoma include the p53 signature and secretory cell outgrowth (SCOUT). Variable histological criteria have been used for diagnosing STIC, but a combination of morphology and immunohistochemistry for p53/Ki‐67 improves interobserver agreement. Half of all carcinomas identified in risk‐reducing salpingo‐oophorectomy specimens are in the form of STIC; however, STIC also may be incidentally found on occasion in specimens from women at low or average risk of ovarian/tubal/peritoneal carcinoma. TP53 mutation is the earliest known DNA sequence alteration in STIC and almost all invasive high‐grade serous carcinomas of the ovary and peritoneum. Data on the clinical behaviour of STIC are limited. While the short‐term follow‐up in the prior literature suggests a low risk of malignant progression, a more recent meta‐analysis indicates a 10‐year risk of 28%. STIC probably should be best regarded as a lesion with uncertain malignant potential at present, and future molecular analysis will help to classify those with higher risk of dissemination. This review provides an update on the current knowledge of STIC and related issues.

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Section: Incidental Detection Of Stic In the Setting Of Prophylactic ...mentioning

confidence: 99%

Serous tubal intra‐epithelial carcinoma: what do we really know at this point?

Vang

Shih

2022

Histopathology

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“…This issue was just discussed in a recent study and it could be related in our region to the age at genetic testing or to the trend to delay the RRSO procedure to the age of the natural menopause. 9 Moreover, in this first study, we did not include a control group (women who refused RRSO). This was done because our main outcome was to evaluate the satisfaction with an intervention (RRSO), and this intervention would not have happened in this control group.…”

Section: Limitationsmentioning

confidence: 99%

“…5 RRSO substantially reduces the risk of ovarian and fallopian tube cancer in women who carry a BRCA mutation, with estimates of the reduction in risk ranging from 75% to 96%. [6][7][8][9] However, after RRSO, there is a small residual risk of developing primary peritoneal cancer. RRSO also reduces the risk of breast cancer by up to 50%, 10 though the amplitude of this protective effect has recently been widely questioned.…”

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confidence: 99%

Satisfaction with prophylactic risk-reducing salpingo-oophorectomy in BRCA mutation carriers is very high and little dependent on the participants’ characteristics at surgery: a prospective study

et al. 2021

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Objective: BRCA carriers are recommended to undergo prophylactic risk-reducing salpingo-oophorectomy (RRSO). Possible adverse health impacts of RRSO, particularly when done before natural menopause, can reduce the long-term satisfaction with this risk-reducing strategy. The aim of this study was to prospectively evaluate the level of satisfaction of women undergoing RRSO, also in relation to some specific characteristics at RRSO.Methods: A prospective cohort study was performed in the Modena Family Cancer Clinic of the University Hospital of Modena (Italy). All BRCA1/2 confirmed mutation carriers who decided to undergo RRSO were recruited between 2016 and 2019.Results: Fifty-five women (29 BRCA1 and 26 BRCA2) (mean age: 50.4 AE 7.7 years [range 35-79]) were included with a mean follow-up after RRSO of 660.9 days (1.8 years) (range 35-1,688 days) (median: 549 days). No intraepithelial (Serous Tubal Intraepithelial Carcinoma)/invasive cancers were found (0%) at RRSO. No vasomotor symptoms at 1 month after surgery were reported by 11/22 (50%) premenopausal women at RRSO. All women (100%) with new ''RRSO-caused'' vasomotor symptoms with no previous breast cancer initiated postmenopausal hormone therapy. At the final follow-up the satisfaction rate (0-100 visual analog scale points) of the participants was 96.4 AE 8.6 points (range 62-100). To the question ''Would you undergo RRSO again if it was proposed today? (0-100 visual analog scale points)'' the answer was 99.4 AE 3.2 points (range 79-100). These scores were in general very high and did not change in the different groups according to pre/postmenopausal status at RRSO, cancer survivors versus healthy women at RRSO, BRCA status, hormone therapy users/nonusers after RRSO, ''RRSO-caused'' symptoms versus not RRSO-caused (P > 0.05).Conclusions: Findings from this prospective study suggest that satisfaction with RRSO is very high and little dependent on the participants' characteristics at surgery. Women at high risk for ovarian cancer are very satisfied with their choice of risk-reduction strategy.

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