Uptake and predictors of opportunistic salpingectomy for ovarian cancer risk reduction in the United States

Abstract Objective The purpose of this guideline is to make recommendations regarding the care of women who harbour a pathogenic or likely pathogenic variant in BRCA1 and BRCA2. Methods Draft recommendations were formulated based on evidence obtained through a systematic review of RCTs, comparative retrospective studies and guideline endorsement. The draft recommendations underwent an internal review by clinical and methodology experts, and an external review by clinical practitioners. Results The literature search yielded 1 guideline, 5 systematic reviews, and 15 studies that met the eligibility criteria. Conclusions In women who harbour a pathogenic or likely pathogenic variant in BRCA1 and BRCA2 screening for ovarian cancer is not recommended. Risk-reducing surgery is recommended to reduce the risk of ovarian cancer. In the absence of contraindications, premenopausal women undergoing RRSO should be offered hormone therapy until menopause. Systemic hormone replacement therapy, is not recommended for women who have had a personal history of breast cancer. RRSO should be considered for breast cancer risk reduction in women younger than 50 years. After a breast cancer diagnosis, RRSO for breast cancer mortality reduction can be considered within two years to women who harbour a pathogenic or likely pathogenic variant in BRCA1 if younger than the recommended age range for ovarian cancer risk reduction. RRSO before the age of 40 and specifically for breast cancer treatment in BRCA2 should be considered only if recommended by their breast cancer oncologist. Following RRSO, it is not recommended to do surveillance for peritoneal cancer.

Download Full-text

Primary Fallopian Tube Malignancies in BRCA-Positive Women Undergoing Surgery for Ovarian Cancer Risk Reduction

Journal of Clinical Oncology ◽

10.1200/jco.2007.12.2622 ◽

2007 ◽

Vol 25 (25) ◽

pp. 3985-3990 ◽

Cited By ~ 335

Author(s):

Michael J. Callahan ◽

Christopher P. Crum ◽

Fabiola Medeiros ◽

David W. Kindelberger ◽

Julia A. Elvin ◽

...

Keyword(s):

Ovarian Cancer ◽

Cancer Risk ◽

Risk Reduction ◽

Fallopian Tube ◽

Brca Mutation ◽

Gynecologic Oncology ◽

Prophylactic Surgery ◽

Ovarian Cancer Risk ◽

Brca Mutations ◽

Cancer Risk Reduction

Purpose To review the frequency and location of malignancies detected after prophylactic salpingo-oophorectomy in women with BRCA mutations. Methods Medical records and pathology findings were reviewed from BRCA-positive women undergoing prophylactic surgery for ovarian cancer risk reduction who underwent complete examination of the adnexa. Patients undergoing this procedure between January 1999 and January 2007 were identified. Results From January 1999 to January 2007, 122 BRCA-positive patients underwent prophylactic surgery in the Division of Gynecologic Oncology at Brigham and Women's Hospital. The median age was 46.5 years (range, 33 to 76 years). Seven (5.7%) were found to have an early malignancy in the upper genital tract and all patients were age ≥ 44 years at diagnosis. Of seven consecutive cancers culled between January 1999 and January 2007, all (100%) originated in the fimbrial or ampullary region of the tube; six had an early (intraepithelial) component. Two were associated with surface implants on the ovary and two required repeated sectioning to detect microscopic carcinomas in the fimbria. Conclusion The distal fallopian tube seems to be the dominant site of origin for early malignancies detected in approximately 6% of women undergoing ovarian cancer risk-reduction surgery. The greatest proportion of serous cancer risk in BRCA mutation–positive women should be assigned to the fimbria rather than the ovary, and future clinical and research protocols should employ thorough examination of the fimbria, including multiple sections from each tissue block, to maximize detection of early malignancies in this population.

Download Full-text

Fallopian tube tumorigenesis and clinical implications for ovarian cancer risk-reduction

Cancer Treatment Reviews ◽

10.1016/j.ctrv.2018.06.004 ◽

2018 ◽

Vol 69 ◽

pp. 66-71 ◽

Cited By ~ 6

Author(s):

Allison A. Gockley ◽

Kevin M. Elias

Keyword(s):

Ovarian Cancer ◽

Cancer Risk ◽

Risk Reduction ◽

Fallopian Tube ◽

Clinical Implications ◽

Ovarian Cancer Risk ◽

Cancer Risk Reduction

Download Full-text

Preserving the Self: The Process of Decision Making About Hereditary Breast Cancer and Ovarian Cancer Risk Reduction

Qualitative Health Research ◽

10.1177/1049732310387798 ◽

2010 ◽

Vol 21 (4) ◽

pp. 502-519 ◽

Cited By ~ 32

Author(s):

A. Fuchsia Howard ◽

Lynda G. Balneaves ◽

Joan L. Bottorff ◽

Patricia Rodney

Keyword(s):

Breast Cancer ◽

Ovarian Cancer ◽

Decision Making ◽

Cancer Risk ◽

Risk Reduction ◽

Hereditary Breast Cancer ◽

The Self ◽

Ovarian Cancer Risk ◽

Cancer Risk Reduction

Download Full-text

Bilateral salpingectomy with delayed oophorectomy for ovarian cancer risk reduction: A pilot study in women with BRCA1/2 mutations

Gynecologic Oncology ◽

10.1016/j.ygyno.2018.04.564 ◽

2018 ◽

Vol 150 (1) ◽

pp. 79-84 ◽

Cited By ~ 25

Author(s):

Denise R. Nebgen ◽

Jean Hurteau ◽

Laura L. Holman ◽

Andrea Bradford ◽

Mark F. Munsell ◽

...

Keyword(s):

Ovarian Cancer ◽

Pilot Study ◽

Cancer Risk ◽

Risk Reduction ◽

Ovarian Cancer Risk ◽

Bilateral Salpingectomy ◽

Cancer Risk Reduction

Download Full-text

Surgical decision making in premenopausal BRCA carriers considering risk-reducing early salpingectomy or salpingo-oophorectomy: a qualitative study

Journal of Medical Genetics ◽

10.1136/jmedgenet-2020-107501 ◽

2021 ◽

pp. jmedgenet-2020-107501

Author(s):

Faiza Gaba ◽

Shivam Goyal ◽

Dalya Marks ◽

Dhivya Chandrasekaran ◽

Olivia Evans ◽

...

Keyword(s):

Ovarian Cancer ◽

Decision Making ◽

Cancer Risk ◽

Risk Reduction ◽

Ovarian Cancer Risk ◽

Early Menopause ◽

Surgical Decision ◽

Risk Reducing ◽

Surgical Decision Making ◽

Cancer Risk Reduction

BackgroundAcceptance of the role of the fallopian tube in ‘ovarian’ carcinogenesis and the detrimental sequelae of surgical menopause in premenopausal women following risk-reducing salpingo-oophorectomy (RRSO) has resulted in risk-reducing early-salpingectomy with delayed oophorectomy (RRESDO) being proposed as an attractive alternative risk-reducing strategy in women who decline/delay oophorectomy. We present the results of a qualitative study evaluating the decision-making process among BRCA carriers considering prophylactic surgeries (RRSO/RRESDO) as part of the multicentre PROTECTOR trial (ISRCTN:25173360).MethodsIn-depth semistructured 1:1 interviews conducted using a predeveloped topic-guide (development informed by literature review and expert consultation) until informational saturation reached. Wording and sequencing of questions were left open with probes used to elicit additional information. All interviews were audio-recorded, transcribed verbatim, transcripts analysed using an inductive theoretical framework and data managed using NVIVO-v12.ResultsInformational saturation was reached following 24 interviews. Seven interconnected themes integral to surgical decision making were identified: fertility/menopause/cancer risk reduction/surgical choices/surgical complications/sequence of ovarian-and-breast prophylactic surgeries/support/satisfaction. Women for whom maximising ovarian cancer risk reduction was relatively more important than early menopause/quality-of-life preferred RRSO, whereas those more concerned about detrimental impact of menopause chose RRESDO. Women managed in specialist familial cancer clinic settings compared with non-specialist settings felt they received better quality care, improved hormone replacement therapy access and were more satisfied.ConclusionMultiple contextual factors (medical, physical, psychological, social) influence timing of risk-reducing surgeries. RRESDO offers women delaying/declining premenopausal oophorectomy, particularly those concerned about menopausal effects, a degree of ovarian cancer risk reduction while avoiding early menopause. Care of high-risk women should be centralised to centres with specialist familial gynaecological cancer risk management services to provide a better-quality, streamlined, holistic multidisciplinary approach.

Download Full-text