Risk-reducing surgery for ovarian cancer: outcomes in 300 surgeries suggest a low peritoneal primary risk

Abstract

Risk-reducing salpingo-oophorectomy is currently advocated for the reduction of both breast and ovarian cancer risk in BRCA1/2 carriers, but residual risk of peritoneal primary cancer remains a concern. A sequential series of women attending a single institution for ovarian risk management underwent either risk-reducing surgery or screening. A person-years at risk analysis was used to compare observed versus expected cancers. In total, 300 women underwent risk-reducing salpingo-oophorectomy, including 160 BRCA1/2 mutation carriers. Three occult ovarian cancers were detected at surgery. There have been 2400.4 years of follow-up and 15.79 expected cancers. No peritoneal cancers have occurred. Amongst 503 women controls with 3444.3 years of follow-up, 15.93 ovarian cancers were expected and 17 were found. There were six ovarian cancer-related deaths in the control group compared with one in the surgery group. Risk-reducing salpingo-oophorectomy in a single institution has so far avoided peritoneal cancer incidence.

Screening for gynaecologic cancers in genetically predisposed women

“…Peritoneal washings should be obtained and examined by cytology. It seems that previous reports overestimated the incidence of primary peritoneal carcinoma following preventative oophorectomy, possibly due to missed diagnosis of early or occult cancer at the time of surgery [48]. This surgery can be followed by hormone replacement in HBOC patients without apparent detrimental effect [80].…”

“…This disease almost invariably has papillary serous histology and more than 10% of cases are explained by germline BRCA mutations [48]. The malignancy is mostly but not completely prevented by prophylactic BSO [49,44] and not amenable for screening.…”

Familial and genetic cancers in gynaecology

“…It seems that previous reports overestimated the incidence of primary peritoneal carcinoma following preventative oophorectomy, possibly due to missed diagnosis of early or occult cancer at the time of surgery. 19 This surgery can be done with or without a hysterectomy and can be followed by hormone replacement without apparent detrimental effect. 20 Ovarian cancer screening Screening for ovarian cancer cannot prevent the disease at all and it is seriously doubted whether it will really improve survival signifi cantly in women at very high risk for the disease.…”

Análise de custo-efetividade de programa para diagnóstico de mutação germinativa em genes BRCA1/2 e de estratégias preventivas para pacientes com câncer de ovário e seus familiares de primeiro grau

“….................. 147 Tabela 41. Estudos prospectivos que apresentam risco relativo para neoplasias malignas de mama e ovário após a realização de salpingo-ooforectomia redutora de risco (45,(127)(128)(129)(130) . .. Estudos prospectivos que apresentam risco relativo para câncer de mama após a realização de mastectomia bilateral profilática (45,(131)(132)(133) .…”

“…Quanto à redução no risco de desenvolvimento de neoplasia maligna após cirurgia profilática em portadores de mutação germinativa em genes BRCA1/2, de mama e ovário após a realização de salpingo-ooforectomia redutora de risco (45,(127)(128)(129)(130) .…”