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Surgery to Prevent Gynecologic Cancers in Women with BRCA1 or BRCA2 Mutations

Prophylactic salpingo-oophorectomy reduces the combined risk for ovarian, fallopian tube, and peritoneal cancer in women carrying BRCA1 or BRCA2 mutations.

Women with mutations in the BRCA gene are at increased risk for ovarian, fallopian tube, and peritoneal cancers. In this prospective cohort study, investigators in North America, Europe, and Israel enrolled women with BRCA1 and BRCA2 mutations who were free of ovarian cancer at the time of genetic testing. The mean age at study entry was 47 years. Of 1828 evaluable women, 30% had had a prophylactic bilateral salpingo-oophorectomy (BSO) prior to study entry. Among the 1273 women with intact ovaries at study entry, 38% underwent BSO during follow-up. The women in the study were observed for a mean of 3.5 years.

Among women with intact ovaries, 32 cancers (29 ovarian, 2 tubal, and 1 primary peritoneal) were observed. Among the women who underwent BSO during follow-up, 11 were found to have occult cancers (7 ovarian, 3 tubal, and 1 with malignant cytology without identifiable primary tumor) at the time of surgery. Seven women were diagnosed with primary peritoneal cancer at a mean of 5.3 years after BSO. The authors estimated that BSO reduced the combined risk for ovarian, fallopian tube, and peritoneal cancers in this high-risk cohort by 80%, with a residual risk of 4% for peritoneal cancer.

Comment: Most prior reports regarding gynecologic cancer risk in BRCA1 and BRCA2 mutation carriers have been retrospective (see also Journal Watch Women’s Health Jul 23 2002). This prospective cohort study represents the largest such study to date and supports current recommendations that women with BRCA mutations should consider BSO. Prophylactic BSO in such women also reduces subsequent breast cancer risk, but may lead to severe menopausal symptoms and accelerated loss of bone-mineral density. Fortunately, hormone therapy has not been found to increase breast cancer risk in these high-risk women who have undergone BSO (J Natl Compr Canc Netw 2006; 4:177).

— Andrew M. Kaunitz, MD

Published in Journal Watch Women's Health August 17, 2006

Citation(s):

Finch A et al. Salpingo-oophorectomy and the risk of ovarian, fallopian tube, and peritoneal cancers in women with a BRCA1 or BRCA2 mutation. JAMA 2006 Jul 12; 296:185-92.

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