Referral to a Gynecologic Oncologist is Associated with Uptake of Risk Reducing Surgery for Non-BRCA Mutation Carriers at Increased Risk of Ovarian Cancer

2020 ◽  
Vol 158 (1) ◽  
pp. e17
Author(s):  
S.S. Lee ◽  
K.E. Baumann ◽  
B. Bhuptani ◽  
S. Turecamo ◽  
D. Gerber ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Brca Mutation ◽  
Gynecologic Oncologist ◽  
Mutation Carriers ◽  
Increased Risk ◽  
Brca Mutation Carriers ◽  
Risk Reducing

scholarly journals Cost Effectiveness of Risk-Reducing Mastectomy versus Surveillance in BRCA Mutation Carriers with a History of Ovarian Cancer

2017 ◽  
Vol 24 (11) ◽  
pp. 3116-3123 ◽  
Author(s):  
Charlotte Gamble ◽  
Laura J. Havrilesky ◽  
Evan R. Myers ◽  
Junzo P. Chino ◽  
Scott Hollenbeck ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cost Effectiveness ◽  
Brca Mutation ◽  
Mutation Carriers ◽  
Brca Mutation Carriers ◽  
History Of ◽  
Risk Reducing

Comparison of risk-reducing surgery in women with BRCA and non-BRCA ovarian cancer susceptibility genes.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 1547-1547
Author(s):  
Zachary Phillip Schwartz ◽  
Mae Zakhour ◽  
Andrew John Li ◽  
Christine S. Walsh ◽  
Bj Rimel ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cancer Susceptibility ◽  
Brca Mutation ◽  
Susceptibility Genes ◽  
Brca Mutations ◽  
Cancer Susceptibility Genes ◽  
Mutation Carriers ◽  
Brca Mutation Carriers ◽  
History Of ◽  
Risk Reducing

1547 Background: Risk reducing gynecologic surgery (RRSO) is standard of care for women with BRCA mutations. The optimal management for women with non-BRCA ovarian cancer susceptibility mutations remains unclear. We sought to characterize the practice patterns for these women at our two institutions. Methods: Women with germline ovarian cancer susceptibility genes who had a RRSO were identified from 1/2000-1/2019 in an IRB approved study. All patients were asymptomatic with no suspicion for malignancy at time of RRSO. Clinico-pathologic characteristics were extracted from the medical records. Continuous variables were analyzed with Kruskal-Wallis and categorical variables analyzed with chi square and t-tests. Results: 152 BRCA1, 95 BRCA2, and 63 Non-BRCA mutation carriers were identified—50 Lynch (22 MLH1, 13 MSH2, 13 MSH6, 2 PMS2) and 13 Other (6 BRIP1, 2 RAD51C, 5 RAD51D). There was no difference between age at testing, age at RRSO, and interval between testing and RRSO between groups. Genetic counseling was higher in Non-BRCA patients. Family history of ovarian cancer was more common in women with BRCA1 and Other germline mutations compared to BRCA2 and Lynch. Family and personal history of breast cancer was high in all groups except Lynch carriers. Prophylactic mastectomy was seen mostly in BRCA mutation carriers. Concomitant hysterectomy was performed in the majority of women (BRCA1 59%, BRCA2 57%, and Other 62%), with the highest frequency in Lynch carriers (86%, p<.01). Occult cancer was only seen in BRCA mutation carriers: BRCA1 (7%), BRCA2 (2%), Lynch (0%), Other (0%). Conclusions: In this cohort, women with Non-BRCA mutations are managed similarly to women with BRCA mutations. We observed no occult cancers in Non-BRCA patients. The optimal role of surgery as a risk reducing strategy in this group requires further study. [Table: see text]

Pathologic findings at risk-reducing salpingo-oophorectomy among women at increased ovarian cancer risk: Results from GOG-199.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1519-1519 ◽  
Author(s):  
Phuong L. Mai ◽  
Mark E Sherman ◽  
Marion Piedmonte ◽  
Olga B. Ioffe ◽  
Brigitte M. Ronnett ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Family History ◽  
Brca Mutation ◽  
Brca2 Mutation ◽  
Ovarian Cancer Risk ◽  
Strong Family History ◽  
Mutation Carriers ◽  
Pelvic Cancer ◽  
Brca Mutation Carriers ◽  
Risk Reducing

1519 Background: Although risk-reducing salpingo-oophorectomy (RRSO) is a standard management option for women with BRCA1/2 mutations, the lack of large, prospective cohort studies makes estimating the prevalence of cancer at RRSO problematic. Methods: GOG-199 is a large, non-randomized multi-center trial which enrolled women at high-risk (due to BRCA mutations or strong family history) of ovarian cancer, comparing surgery at enrollment with serial transvaginal ultrasound and CA-125 screening. RRSO specimens were processed according to a standardized tissue processing protocol including 2-3mm sectioning of both ovaries and tubes. Results: 2,605 participants were accrued to GOG-199. Of the 1 030 enrolled in the baseline RRSO cohort, 28 were ineligible and 36 declined surgery after enrollment, resulting in 966 baseline RRSO. Pathology review demonstrated 4 tubal intraepithelial carcinoma and 20 serous pelvic cancers, of which 12 were identified only microscopically. Among the 20 serous cancers, the predominant or exclusive site of involvement was ovary in 10, fallopian tube in 5, and peritoneum in 5 cases. In addition, 6 endometrial cancers (among the 515 undergoing concomitant hysterectomy) and 3 adenocarcinomas suggestive of metastasis were identified. The serous pelvic cancer prevalence was: entire cohort=2.1% (20/966), all BRCA mutation carriers=3.2 (18/558), BRCA1 mutation carriers=3.7% (12/325), BRCA2 mutation carriers=2.6% (6/231), and mutation-negative=0.5% (2/402). Compared to those without cancer, women with serous pelvic cancer were older at surgery (p< .001), and more often menopausal (vs pre-menopausal, p= .002), nulliparous (vs parous, p=.04) and never users of tamoxifen (vs ever users, p= .04). Serous pelvic cancers were more frequent in BRCA mutation carriers (vs no mutation, p= .004), and among carriers, more common in those with BRCA1 mutations (vs BRCA2 mutation, p= .02). Conclusions: The prevalence of serous pelvic cancers in this cohort was 3.2% among carriers vs 0.5% among the mutation-negative but with a strong family history. Our data will be useful when counseling women at increased ovarian cancer risk who are contemplating risk-reducing surgery.

Hormone replacement therapy (HRT) among BRCA mutation carriers.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 1561-1561
Author(s):  
Nicole Centers ◽  
Olga Ivanov ◽  
Cynthia Buffington ◽  
Aileen Caceres
Keyword(s):  
Hormone Replacement Therapy ◽  
Replacement Therapy ◽  
Brca Mutation ◽  
Hormone Replacement ◽  
Premature Menopause ◽  
Mutation Carriers ◽  
Increased Risk ◽  
Brca Mutation Carriers ◽  
Risk Of Cancer ◽  
Risk Reducing

1561 Background: BRCA mutation carriers are often offered risk-reducing surgery (oophorectomy, hysterectomy) and medication regimens (hormone modulators, chemotherapy) in a preventative format. These therapies cause premature menopause and associated symptoms including reduced libido and sexuality. Hormone replacement therapy (HRT) is beneficial in alleviating climacteric symptoms of menopause. However, due to high risk for breast cancer in BRCA mutation carriers, many within the healthcare community oppose the use of HRT, despite recent studies that fail to demonstrate an adverse effect on oncologic outcomes. The purpose of this study was to identify current HRT practices among BRCA1,2 mutation carriers. Methods: The study population included 763 BRCA1,2 mutation carriers (52% previvors, 48% survivors) who are members of Facing Our Risk of Cancer Empowered, a support, education, and advocacy group for individuals with gene mutations. Data was collected via an online survey that included questions pertaining to patient characteristics, preventative procedures, menopausal status and symptoms, HRT use, and provider recommendations. Results: According to the survey findings, 73% of BRCA mutation carriers were postmenopausal (59% previvors, 88% survivors) and, among these, 81% had become menopausal prematurely due to risk-reducing surgery or medications. Major postmenopausal concerns of BRCA mutation carriers involved low libido/sexuality (78%) and an increased risk for weight gain (83%), cardiovascular disease (77%), and osteoporosis (65%). Despite the high incidence of premature menopause and associated symptomatology of the population, HRT usage was low (13% previvors, 28% survivors). According to the survey respondents, only 26% of healthcare providers for the previvors and 8% for the survivors favored HRT use. Conclusions: High rates of premature menopause with related symptoms occur among BRCA1,2 mutation carriers in association with cancer preventative therapies. Despite the young age of this postmenopausal population, only a small percentage are on HRT. These findings suggest the need for improved education to patients and providers regarding HRT and cancer risk, as well as the exploration of HRT options.

scholarly journals Management Options after Prophylactic Surgeries in Women with BRCA Mutations: A Review

2007 ◽  
Vol 14 (4) ◽  
pp. 330-337 ◽  
Author(s):  
Dawn C. Allain ◽  
Kevin Sweet ◽  
Doreen M. Agnese
Keyword(s):  
Medical Management ◽  
Cancer Susceptibility ◽  
Brca Mutation ◽  
Brca2 Gene ◽  
Brca1 And Brca2 ◽  
Management Options ◽  
Cancer Susceptibility Genes ◽  
Mutation Carriers ◽  
Increased Risk ◽  
Brca Mutation Carriers

Background Although breast cancer is relatively common, only about 5% of cases are due to inheritance of highly penetrant cancer susceptibility genes. The majority of these are caused by mutations in the BRCA1 and BRCA2 genes, which are also associated with an increased risk of ovarian cancer. Increased surveillance, chemoprevention, and prophylactic surgeries are standard options for the effective medical management of mutation carriers. However, optimal management of female carriers who choose to undergo prophylactic surgeries is still poorly understood. Methods The authors provide an overview of the current literature regarding medical management options for women carriers of BRCA1 and BRCA2 gene mutations and the implications for those individuals who have chosen to undergo prophylactic surgeries. Results BRCA mutation carriers who opt for prophylactic surgeries are still at risk for development of malignancy, and appropriate monitoring is warranted. Conclusions There are limited data on the appropriate medical management for BRCA mutation carriers after prophylactic surgeries. However, a management plan can be extrapolated from the general management recommendations for surveillance and other risk-reducing strategies in BRCA-positive individuals.

Risk-reducing mastectomy and salpingo-oophorectomy in unaffected BRCA mutation carriers: uptake and timing

2010 ◽  
Vol 77 (4) ◽  
pp. 342-349 ◽  
Author(s):  
A-B Skytte ◽  
A-M Gerdes ◽  
MK Andersen ◽  
L Sunde ◽  
K Brøndum-Nielsen ◽  
...  
Keyword(s):  
Brca Mutation ◽  
Mutation Carriers ◽  
Brca Mutation Carriers ◽  
Risk Reducing
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