Prophylactic salpingo‐oophorectomy in a series of 89 women carrying a BRCA1 or a BRCA2 mutation

Abstract

BACKGROUND.Prophylactic salpingo‐oophorectomy (SO), which is recommended in BRCA1/2 mutation carriers, still needs to be reappraised.METHODS.In all, 89 BRCA1/BRCA2 mutation carriers underwent SO between 1994–2004. Past medical and familial history, SO, results and survival after SO were analyzed.RESULTS.The series consisted of 56 BRCA1 and 33 BRCA2 mutation carriers. All but 1 had a family history of breast (BC) and/or ovarian cancer; 42 BRCA1 and 31 BRCA2 had a personal history of BC. The median age at SO was 44 (BRCA1) and 49.5 (BRCA2) years for women without previous BC (not significant) and 48 (BRCA1) and 53 BRCA2) years (P = .03) for women with previous BC. Occult ovarian (n = 2) and/or fallopian (n = 3) carcinomas were found in 4 patients (4.5%): 1 experienced recurrence (4 years), 2 are disease‐free (26 and 38 months of follow‐up), and 1 died from BC (12 months). Among the other 69 patients with previous BC (median follow‐up, 42 months), 14 developed ipsilateral or contralateral BC and 8 developed metastatic disease. Among the 16 patients without previous BC (median follow‐up, 27 months), 3 developed BC. Of the 89 patients, 85 are still alive: 3 died from BC and 1 died from pancreatic cancer. No peritoneal malignancy was observed.CONCLUSIONS.This study shows that prophylactic SO remains an important option for BRCA1/2 mutation carriers as asymptomatic ovarian/fallopian cancers were found in 4.5% of patients. However, a longer follow‐up and larger series are required to more precisely evaluate the benefits of this procedure in terms of BC incidence, peritoneal malignancy, or recurrence. Cancer 2007. © 2007 American Cancer Society.

Uptake of risk-reducing salpingo-oophorectomy among female BRCA mutation carriers: experience at the National Cancer Center of Korea

“…Carriers might worry about OC because it tends to be diagnosed at an advanced stage, and it has a relatively high recurrence and a poor survival rate (Lim et al 2013). In addition, among BRCA1/2 mutation carriers, there is a 5-10 % probability that surgical specimens could reveal occult cancers in the fallopian tubes and ovary (Finch et al 2006;Hirst et al 2009;Laki et al 2007;Powell et al 2005). Therefore, we hypothesized that gynecologic oncologists who have clinical experience with OC might influence the carriers' decision-making regarding RRSO.…”

Second malignancies after breast cancer: the impact of different treatment modalities

“…The overall survival rate of patients with early advanced breast cancer (BC) has increased over the years largely because adjuvant therapy, whether chemotherapy, radiotherapy or hormone therapy, has helped prevent local and distant failures (Fox, 1979;Jones and Raghavan, 1993; EBCTCG, 2005). Second malignancies that occur in long-term survivors may be due to sporadic cancers that would have occurred anyway, environmental or genetic factors (Klijn et al, 1997;Schrag et al, 1997;Turner et al, 1999;Meijers-Heijboer et al, 2000;Pierce et al, 2000Pierce et al, , 2003 StoppaLyonnet et al, 2000;Galper et al, 2002;Kauff et al, 2002;Pierce, 2002;Robson, 2002;Seynaeve et al, 2004; Kirova et al, 2005aKirova et al, , b, 2006aLaki et al, 2007), or BC treatment (Neugut et al, 1993;Inskip et al, 1994;Ahsan and Neugut, 1998;Karlsson et al, 1998;Kirova et al, 1998 Kirova et al, , 2005aKirova et al, , b, 2007Obedian et al, 2000;Rubino et al, 2000;Scholl et al, 2001;Shousha et al 2001;Yap et al, 2002 Yap et al, , 2005Deutsch et al, 2003;Zablotska and Neugut, 2003;Zablotska et al, 2005;Mellemkjaer et al, 2006) The aim of this study was to estimate the risk of a second malignancy after adjuvant treatment for BC in a homogeneous cohort of patients from a single institution. The observed incidence of second malignancies in these BC patients was compared with the expected age-adjusted number of new cases in the general population of French women as given by data from five regional registries (Remontet et al, 2003).…”

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

“…It has been shown that BRCA carriers are diagnosed at a younger mean age than patients without a mutation (60 versus 70 years), but the overall median survival is in favor of the BRCA carriers (148 versus 41 months) (22). Primary peritoneal cancer can be found many years after prophylactic salpingo-oophorectomy, and it usually presents at advanced stages (6). In the present review, the interval from initial surgery to presentation of peritoneal cancer ranged from 12 to 84 months.…”

“…The median survival rates vary from 11.3 to 17.8 months (5). Prophylactic salpingo-oophorectomy is used for cancer risk reduction in BRCA gene carriers and leads to decrease of ovarian/tubal/peritoneal cancer risk to 3.5-4.3% and breast cancer risk to 30-40% (1,6). In a more optimistic study, prophylactic salpingo-oophorectomy was shown to be more effective in preventing ovarian, tubal, and breast cancers, with low surgical morbidity and complications including hematomas, cardiac arrhythmias, and injury of adjacent organs such as the bladder, ureters, and intestines (4).…”