Prophylactic Salpingectomy and Delayed Oophorectomy as an Alternative for BRCA Mutation Carriers

Kwon, Janice S.; Tinker, Anna V.; Pansegrau, Gary; McAlpine, Jessica N.; Housty, Melissa; McCullum, Mary; Gilks, C. Blake

doi:10.1097/01.ogx.0000431320.60821.5a

Cited by 33 publications

(65 citation statements)

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“…Further studies to accurately identify the earliest precursors of serous carcinoma are imperative as they may lead to improved screening strategies and preventive interventions in women at high-risk for serous carcinoma. Our finding that one-third of STIC involved a portion of the middle and distal segments of the fallopian tube supports removal of as much of the fallopian tube as possible at the time of RRSO or interval salpingectomy in BRCA mutation carriers [34][35][36][37].…”

Section: Discussionmentioning

confidence: 78%

A cautious view of putative precursors of serous carcinomas in the fallopian tubes of BRCA mutation carriers

Cass

Walts

Barbuto

et al. 2014

Gynecologic Oncology

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Section: Discussionmentioning

confidence: 78%

A cautious view of putative precursors of serous carcinomas in the fallopian tubes of BRCA mutation carriers

Cass

Walts

Barbuto

et al. 2014

Gynecologic Oncology

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“…An additional gap in the literature is the lack of utility scores for salpingectomy. Whereas one report in the literature suggests that a 2-step approach could be cost-effective, 54 the lack of prospective outcome data and various gaps in knowledge previously highlighted preclude our ability to draw conclusions and maintain significant uncertainty around this issue. The precise risk thresholds for offering this in routine practice remain to be determined.…”

Section: Risk-reducing Salpingectomymentioning

confidence: 99%

Setting the Threshold for Surgical Prevention in Women at Increased Risk of Ovarian Cancer

Manchanda

Menon

2018

Int J Gynecol Cancer

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The number of ovarian cancer cases is predicted to rise by 14% in Europe and 55% worldwide over the next 2 decades. The current absence of a screening program, rising drug/treatment costs, and only marginal improvements in survival seen over the past 30 years suggest the need for maximizing primary surgical prevention to reduce the burden of ovarian cancer. Primary surgical prevention through risk-reducing salpingo-oophorectomy (RRSO) is well established as the most effective method for preventing ovarian cancer. In the UK, it has traditionally been offered to high-risk women (>10% lifetime risk of ovarian cancer) who have completed their family. The cost-effectiveness of RRSO in BRCA1/BRCA2 carriers older than 35 years is well established. Recently, RRSO has been shown to be cost-effective in postmenopausal women at lifetime ovarian cancer risks of 5% or greater and in premenopausal women at lifetime risks greater than 4%. The acceptability, uptake, and satisfaction with RRSO at these intermediate-risk levels remain to be established. Prospective outcome data on risk-reducing salpingectomy and delayed-oophorectomy for preventing ovarian cancer is lacking, and hence, this is best offered for primary prevention within the context and safe environment of a clinical trial. An estimated 63% of ovarian cancers occur in women with greater than 4% lifetime risk and 53% in those with 5% or greater lifetime-risk. Risk-reducing salpingo-oophorectomy can be offered for primary surgical prevention to women at intermediate risk levels (4%-5% to 10%). This includes unaffected women who have completed their family and have RAD51C, RAD51D, or BRIP1 gene mutations; first-degree relatives of women with invasive epithelial ovarian cancer; BRCA mutation-negative women from high-risk breast-and-ovarian cancer or ovarian-cancer-only families. In those with BRCA1, RAD51C/RAD51D/MMR mutations and the occasional families with a history of ovarian cancer in their 40s, surgery needs to be considered at younger than 45. In other moderate-risk gene mutation carriers and those with polygenic risk, RRSO needs be considered at 50. There is need for establishment/expansion of well-defined pathways to increase clinical access to RRSO. It is time to lower the risk threshold for RRSO to enable introduction of a targeted primary prevention approach, which could significantly impact the future burden of ovarian cancer.

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“…6 In this month's issue of Obstetrics & Gynecology, Kwon et al (see page 14) publish their Markov Monte Carlo simulation comparing risk-reduction BSO at 40 years of age with both risk-reduction salpingectomy at 40 years of age and risk-reduction salpingectomy at 40 years of age followed by delayed bilateral oophorectomy at 50 years of age. 10 This thoughtful model predicts the expected reduction in pelvic serous cancers, breast cancers, and incremental deaths due to cardiovascular disease. Qualityadjusted life-years and cost-effectiveness of the three interventions also are compared.…”

Section: Financial Disclosurementioning

confidence: 99%

Ideal Risk Reduction Management for Women With BRCA Gene Mutations

Pearlman¹

2013

Obstetrics & Gynecology

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Still Not There Yet S ince the initial reports of the discoveries of the BRCA1 and BRCA2 genes in the mid-1990s in families with very high rates of breast and ovarian cancer, researchers and clinicians have worked together to assemble clinical recommendations to reduce both the incidence and effects of these cancers. 1,2 Through intensive cancer surveillance, chemoprophylaxis, and risk-reduction surgery, thousands of lives have been saved. 3 This discovery and the efforts that followed have been referred to as "the major scientific accomplishment in clinical cancer genetics during the past decade." 4 Early on, the high incidence of ovarian cancer in this population was felt to be due to just that-ovarian cancer. More recently, careful pathologic examination of removed fallopian tubes and ovaries demonstrated that many of these "ovarian cancers" actually originated in the fallopian tube. 5 There is now general agreement that the fallopian tube is a major site of BRCA1-related and BRCA2-related malignancies. In fact, women who carry these gene mutations are at increased risk for tubal, ovarian, and primary peritoneal cancers, and the more encompassing term "pelvic serous cancers" has been proposed. 6 Expert groups have reached general consensus that, because there is currently no effective screening for pelvic serous cancers, routine risk-reduction bilateral salpingo-oophorectomy (BSO) should be offered to all of these women and ideally should be performed between the ages of 35 and 40 years. Risk-reduction BSO reduces the future incidence of ovarian and fallopian tube cancers by 80-90% and also results in fewer deaths related to these cancers. An additional benefit mediated by the premature loss of ovarian hormonal production is a reduced future incidence of and mortality due to breast cancer, especially in BRCA2 gene mutation carriers. 3 Although risk-reduction BSO has saved the lives of thousands of women by reducing pelvic serous and breast cancers in those who carry these gene mutations, there are obvious downsides to this surgery in these young women. The loss of ovarian function and its attendant disturbing symptoms and possible increase in future disease (premature bone loss and an increase in cardiovascular disease and mortality) are a highly undesirable, but expected, result of risk-reduction BSO. 7,8 Because the cancer mortality benefits of risk-reduction BSO clearly exceed the cardiovascular mortality risk, most BRCA carriers agree to undergo risk-reduction BSO. However, because of concerns related to the premature loss of ovarian function, some women are reluctant to undergo this intervention. 9 The unfortunate consequence of this decision will, for some, be a potentially preventable death down the road.With the understanding that perhaps 60% of pelvic serous cancers may originate in the fallopian tube, there has been a more recent

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Prophylactic Salpingectomy and Delayed Oophorectomy as an Alternative for BRCA Mutation Carriers

Cited by 33 publications

References 0 publications

A cautious view of putative precursors of serous carcinomas in the fallopian tubes of BRCA mutation carriers

A cautious view of putative precursors of serous carcinomas in the fallopian tubes of BRCA mutation carriers

Setting the Threshold for Surgical Prevention in Women at Increased Risk of Ovarian Cancer

Ideal Risk Reduction Management for Women With BRCA Gene Mutations

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