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Lee YJ, Kim JH, Kim YJ, Chang YJ, Kong SY, Yoo CW, Lee DO, Seo SS, Kang S, Park SY, Lim MC. The pathologic and clinical outcomes of risk-reducing salpingo-oophorectomy in asymptomatic carriers of homologous recombination repair gene mutation. J Gynecol Oncol 2024; 36:36.e15. [PMID: 39028150 DOI: 10.3802/jgo.2025.36.e15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/16/2024] [Accepted: 06/25/2024] [Indexed: 07/20/2024] Open
Abstract
OBJECTIVE To investigate the prevalence of pathological findings and clinical outcomes of risk-reducing salpingo-oophorectomy (RRSO) in asymptomatic carriers with germline homologous recombination repair (HRR) gene pathogenic/likely pathogenic variants (PV/LPV). METHODS This retrospective study enrolled asymptomatic carriers with germline HR gene PV/LPV who underwent RRSO between 2006 and 2022 at the National Cancer Center in Korea. Clinical characteristics, including history of breast cancer, family history of ovarian/breast cancer, parity, and oral contraceptive use, were analyzed. RESULTS Of the 255 women who underwent RRSO, 129 (50.6%) had PV/LPV in BRCA1, 121 (47.5%) in BRCA2, and 2 (0.7%) had both BRCA1 and BRCA2 PV/LPV. In addition, 1 carried PV/LPV in RAD51D, and 2 in BRIP1. Among the BRCA1/2 PV/LPV carriers, occult neoplasms were identified in 3.5% of patients: serous tubal intraepithelial carcinoma (1.1%, n=3), fallopian tubal cancers (0.8%, n=2), ovarian cancer (1.2%, n=3), and breast cancer (0.4%, n=1). Of the 9 patients with occult neoplasms, 5 (2.0%) were identified from the 178 breast cancer patients, and 4 (1.6%) were detected in 65 healthy mutation carriers. During the median follow-up period of 36.7 months (interquartile range, 25.9-71.4), 1 (0.4%) BRCA1 PV carrier with no precursor lesions at RRSO developed primary peritoneal carcinomatosis after 30.1 months. CONCLUSION Women with HRR gene mutations PV/LPV who undergo RRSO are at a risk of detecting occult neoplasms, with a of 3.5%. Even in the absence of precursor lesions during RRSO, there was a cumulative risk of peritoneal carcinomatosis development, emphasizing the need for continued surveillance.
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Affiliation(s)
- Yeon Jee Lee
- Center for Gynecologic Cancer, Hospital, National Cancer Center, Goyang, Korea
- Department of Obstetrics and Gynecology, Myongji Hospital, Goyang, Korea
| | - Ji Hyun Kim
- Center for Gynecologic Cancer, Hospital, National Cancer Center, Goyang, Korea
| | - Youn Jee Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon Jung Chang
- Department of Family Medicine, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sun-Young Kong
- Department of Laboratory Medicine and Genetic Counseling Clinic, Hospital, National Cancer Center, Goyang, Korea
| | - Chong Woo Yoo
- Center for Gynecologic Cancer and Department of Pathology, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Dong Ock Lee
- Center for Gynecologic Cancer, Hospital, National Cancer Center, Goyang, Korea
| | - Sang-Soo Seo
- Center for Gynecologic Cancer, Hospital, National Cancer Center, Goyang, Korea
| | - Sokbom Kang
- Center for Gynecologic Cancer, Hospital, National Cancer Center, Goyang, Korea
| | - Sang-Yoon Park
- Center for Gynecologic Cancer, Hospital, National Cancer Center, Goyang, Korea
| | - Myong Cheol Lim
- Center for Gynecologic Cancer, Hospital, National Cancer Center, Goyang, Korea
- Rare and Pediatric Cancer Branch and Immuno-Oncology Branch, Division of Rare and Refractory Cancer, Research Institute and Center for Clinical Trial, Hospital, National Cancer Center, Goyang, Korea
- Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.
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Kim J, Choi CH. Basic knowledge for counseling patients undergoing risk-reducing salpingo-oophorectomy. Obstet Gynecol Sci 2024; 67:343-355. [PMID: 38817104 PMCID: PMC11266848 DOI: 10.5468/ogs.24054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/09/2024] [Accepted: 05/23/2024] [Indexed: 06/01/2024] Open
Abstract
Significant progress has been made in the molecular diagnosis of cancer. It provides personalized medicine, including cancer diagnosis, prognosis, targeted therapy, and risk detection. These advances allow physicians to identify patients at risk for cancer before it develops and offer them an opportunity to prevent its development. Mutations in breast cancer susceptibility genes 1 and 2 (BRCA1 and 2) are one of the most well-known cancer-related gene mutations since actor Angelina Jolie shared her experience with genetic mutations and risk-reducing surgery in the media. In Korea, tests for germline BRCA1/2 mutations have been covered by insurance since May 2012 and the number of women of BRCA1/2 mutations has continued to increase over the past decade. Most carriers of BRCA1/2 mutations consider risk-reducing salpingo-oophorectomy (RRSO) resulting in early menopause and want to know the lifetime risks and benefits of RRSO. However, despite the increasing number of carriers of BRCA1/2 mutations, the counseling and management of patients requiring RRSO varies among physicians. This article provides basic knowledge on RRSO to help physicians comprehensively assess its risks and benefits and manage at-risk women.
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Affiliation(s)
- Jihye Kim
- Department of Obstetrics and Gynecology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
| | - Chel Hun Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Sunde J, Wasickanin M, Katz TA, Gillette L, Bidadi S, O’Neil D, Masand R, Burney RO, Pennington KA. The uterine secretome initiates growth of gynecologic tissues in ectopic locations. PLoS One 2024; 19:e0292978. [PMID: 38728307 PMCID: PMC11086859 DOI: 10.1371/journal.pone.0292978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/03/2024] [Indexed: 05/12/2024] Open
Abstract
Endosalpingiosis (ES) and endometriosis (EM) refer to the growth of tubal and endometrial epithelium respectively, outside of their site of origin. We hypothesize that uterine secretome factors drive ectopic growth. To test this, we developed a mouse model of ES and EM using tdTomato (tdT) transgenic fluorescent mice as donors. To block implantation factors, progesterone knockout (PKO) tdT mice were created. Fluorescent lesions were present after oviduct implantation with and without WT endometrium. Implantation was increased (p<0.05) when tdt oviductal tissue was implanted with endometrium compared to oviductal tissue alone. Implantation was reduced (p<0.0005) in animals implanted with minced tdT oviductal tissue with PKO tdT endometrium compared to WT endometrium. Finally, oviductal tissues was incubated with and without a known implantation factor, leukemia inhibitory factor (LIF) prior to and during implantation. LIF promoted lesion implantation. In conclusion, endometrial derived implantation factors, such as LIF, are necessary to initiate ectopic tissue growth. We have developed an animal model of ectopic growth of gynecologic tissues in a WT mouse which will potentially allow for development of new prevention and treatment modalities.
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Affiliation(s)
- Jan Sunde
- Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, WA, United States of America
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Baylor College of Medicine, Houston, TX, United States of America
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston TX, United States of America
| | - Morgan Wasickanin
- Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, WA, United States of America
| | - Tiffany A. Katz
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Baylor College of Medicine, Houston, TX, United States of America
| | - Laurel Gillette
- Department of Clinical Investigation, Madigan Army Medical Center, Tacoma, WA, United States of America
| | - Sanam Bidadi
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Baylor College of Medicine, Houston, TX, United States of America
| | - Derek O’Neil
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Baylor College of Medicine, Houston, TX, United States of America
| | - Ramya Masand
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston TX, United States of America
- Department of Pathology and Immunology, Baylor College of Medicine, Houston TX, United States of America
| | - Richard O. Burney
- Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, WA, United States of America
- Department of Clinical Investigation, Madigan Army Medical Center, Tacoma, WA, United States of America
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Kathleen A. Pennington
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Baylor College of Medicine, Houston, TX, United States of America
- Department of Obstetrics and Gynecology, Basic Sciences Perinatology Research Laboratories, Baylor College of Medicine, Houston, TX, United States of America
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van der Ven J, Linz VC, Anic K, Schmidt MW, Loewe A, Krajnak S, Schmidt M, Kommoss S, Schmalfeldt B, Sehouli J, Hasenburg A, Battista MJ. A questionnaire-based survey on the diagnostic and therapeutic approaches for patients with STIC in Germany. Arch Gynecol Obstet 2023; 308:527-534. [PMID: 36707423 PMCID: PMC10293341 DOI: 10.1007/s00404-023-06919-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/08/2023] [Indexed: 01/28/2023]
Abstract
PURPOSE Despite the growing understanding of the carcinogenesis of pelvic high-grade serous carcinoma (HGSC) of the ovary and peritoneum and its precursor lesion serous tubal intraepithelial carcinoma (STIC), evidence-based proven recommendations on the clinical management of patients with STIC are lacking so far. METHODS A questionnaire containing 21 questions was developed to explore the clinical experience with patients with the diagnosis of STICs and the diagnostic, surgical and histopathological approaches in Germany. Overall, 540 clinical heads of department in all German gynaecological centres were asked to participate. RESULTS 131 questionnaires (response rate 24.3%) were included in this survey. 45.8% of the respondents had treated one to three STIC patients during their career. 75.6% of the respondents performed opportunistic bilateral salpingectomies during other gynaecological surgeries. Most of the participants (31.3%) started with the SEE-FIM (Sectioning and Extensively Examining the FIMbria) protocol in 2014. It was requested by 39.7% centres for prophylactic salpingectomies, by 13.7% for both prophylactic and opportunistic salpingectomies and by 22.1% for neither of both. 38.2%, 1.5% and 24.4% of the participants would use the laparoscopic, transverse and midline laparotomic approach for a surgical staging procedure, respectively. 25.6% (54.7%) of the respondents recommended a hysterectomy in premenopausal (versus postmenopausal) patients with a STIC, 24.4% (88.4%) a bilateral oophorectomy and 50.0% (4.7%) an affected side oophorectomy (all p values < 0.001). Omentectomy, pelvic and para-aortic lymphadenectomy would be performed by 60.5% (64.0%), 9.3% (11.6%) and 9.3% (11.6%) of respondents in premenopausal (versus postmenopausal) patients (all p values > 0.05). CONCLUSION Our survey highlights significant inconsistency in the management of patients with STIC. Prospective data are urgently needed to elucidate the clinical impact of a STIC lesion and its clinical management.
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Affiliation(s)
- Josche van der Ven
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstreet 1, 55131, Mainz, Rhineland-Palatinate, Germany
| | - Valerie Catherine Linz
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstreet 1, 55131, Mainz, Rhineland-Palatinate, Germany.
| | - Katharina Anic
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstreet 1, 55131, Mainz, Rhineland-Palatinate, Germany
| | - Mona Wanda Schmidt
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstreet 1, 55131, Mainz, Rhineland-Palatinate, Germany
| | - Amelie Loewe
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstreet 1, 55131, Mainz, Rhineland-Palatinate, Germany
| | - Slavomir Krajnak
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstreet 1, 55131, Mainz, Rhineland-Palatinate, Germany
| | - Marcus Schmidt
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstreet 1, 55131, Mainz, Rhineland-Palatinate, Germany
| | - Stefan Kommoss
- Department of Women's Health, Tübingen University Hospital, Calwerstreet 7, 72076, Tübingen, Baden-Württemberg, Germany
| | - Barbara Schmalfeldt
- Department of Gynaecology, University Medical Centre Hamburg-Eppendorf, Martinistreet 52, 20251, Hamburg, Germany
| | - Jalid Sehouli
- Department of Gynaecology and Centre of Oncological Surgery, Charité Universitaetsmedizin Berlin Charité Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Annette Hasenburg
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstreet 1, 55131, Mainz, Rhineland-Palatinate, Germany
| | - Marco Johannes Battista
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstreet 1, 55131, Mainz, Rhineland-Palatinate, Germany
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Linz VC, Löwe A, van der Ven J, Hasenburg A, Battista MJ. Incidence of pelvic high-grade serous carcinoma after isolated STIC diagnosis: A systematic review of the literature. Front Oncol 2022; 12:951292. [PMID: 36119503 PMCID: PMC9472545 DOI: 10.3389/fonc.2022.951292] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Serous tubal intraepithelial carcinoma (STIC) is a precursor lesion of pelvic high-grade serous carcinoma (HGSC). Information on treatment and outcome of isolated STIC is rare. Therefore, we reviewed systematically the published literature to determine the incidence of subsequent HGSC in the high- and low-risk population and to summarize the current diagnostic and therapeutic options. Methods A systematic review of the literature was conducted in MEDLINE-Ovid, Cochrane Library and Web of Science of articles published from February 2006 to July 2021. Patients with an isolated STIC diagnosis and clinical follow-up were included. Study exclusion criteria for review were the presence of synchronous gynaecological cancer and/or concurrent non-gynaecological malignancies. Results 3031 abstracts were screened. 112 isolated STIC patients out of 21 publications were included in our analysis with a pooled median follow-up of 36 (interquartile range (IQR): 25.3-84) months. 71.4% of the patients had peritoneal washings (negative: 62.5%, positive: 8%, atypic cells: 0.9%). Surgical staging was performed in 28.6% of all STICs and did not show any malignancies. 14 out of 112 (12.5%) patients received adjuvant chemotherapy with Carboplatin and Paclitaxel. Eight (7.1%) patients developed a recurrence 42.5 (IQR: 33-72) months after isolated STIC diagnosis. Cumulative incidence of HGSC after five (ten) years was 10.5% (21.6%). Recurrence occurred only in BRCA1 carriers (seven out of eight patients, one patient with unknown BRCA status). Conclusion The rate of HGSC after an isolated STIC diagnosis was 7.1% with a cumulative incidence of 10.5% (21.6%) after five (ten) years. HGSC was only observed in BRCA1 carriers. The role of adjuvant therapy and routine surveillance remains unclear, however, intense surveillance up to ten years is necessary. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier CRD42021278340.
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Steenbeek MP, van Bommel MH, Bulten J, Hulsmann JA, Bogaerts J, Garcia C, Cun HT, Lu KH, van Beekhuizen HJ, Minig L, Gaarenstroom KN, Nobbenhuis M, Krajc M, Rudaitis V, Norquist BM, Swisher EM, Mourits MJ, Massuger LF, Hoogerbrugge N, Hermens RP, IntHout J, de Hullu JA. Risk of Peritoneal Carcinomatosis After Risk-Reducing Salpingo-Oophorectomy: A Systematic Review and Individual Patient Data Meta-Analysis. J Clin Oncol 2022; 40:1879-1891. [PMID: 35302882 PMCID: PMC9851686 DOI: 10.1200/jco.21.02016] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE After risk-reducing salpingo-oophorectomy (RRSO), BRCA1/2 pathogenic variant (PV) carriers have a residual risk to develop peritoneal carcinomatosis (PC). The etiology of PC is not yet clarified, but may be related to serous tubal intraepithelial carcinoma (STIC), the postulated origin for high-grade serous cancer. In this systematic review and individual patient data meta-analysis, we investigate the risk of PC in women with and without STIC at RRSO. METHODS Unpublished data from three centers were supplemented by studies identified in a systematic review of EMBASE, MEDLINE, and the Cochrane library describing women with a BRCA-PV with and without STIC at RRSO until September 2020. Primary outcome was the hazard ratio for the risk of PC between BRCA-PV carriers with and without STIC at RRSO, and the corresponding 5- and 10-year risks. Primary analysis was based on a one-stage Cox proportional-hazards regression with a frailty term for study. RESULTS From 17 studies, individual patient data were available for 3,121 women, of whom 115 had a STIC at RRSO. The estimated hazard ratio to develop PC during follow-up in women with STIC was 33.9 (95% CI, 15.6 to 73.9), P < .001) compared with women without STIC. For women with STIC, the five- and ten-year risks to develop PC were 10.5% (95% CI, 6.2 to 17.2) and 27.5% (95% CI, 15.6 to 43.9), respectively, whereas the corresponding risks were 0.3% (95% CI, 0.2 to 0.6) and 0.9% (95% CI, 0.6 to 1.4) for women without STIC at RRSO. CONCLUSION BRCA-PV carriers with STIC at RRSO have a strongly increased risk to develop PC which increases over time, although current data are limited by small numbers of events.
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Affiliation(s)
- Miranda P. Steenbeek
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Obstetrics and Gynaecology, Nijmegen, the Netherlands,Miranda P. Steenbeek, MD, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands; e-mail:
| | - Majke H.D. van Bommel
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Obstetrics and Gynaecology, Nijmegen, the Netherlands
| | - Johan Bulten
- Radboud University Medical Center, Department of Pathology, Nijmegen, the Netherlands
| | - Julia A. Hulsmann
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Obstetrics and Gynaecology, Nijmegen, the Netherlands
| | - Joep Bogaerts
- Radboud University Medical Center, Department of Pathology, Nijmegen, the Netherlands
| | - Christine Garcia
- Kaiser Permanente Northern California, Division of Gynecologic Oncology San Francisco, San Francisco CA
| | - Han T. Cun
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Karen H. Lu
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Heleen J. van Beekhuizen
- Erasmus MC Cancer Center, University Medical Center Rotterdam, Department of Gynecological Oncology, Rotterdam, the Netherlands
| | - Lucas Minig
- Gynecologic Oncology Unit, IMED Hospitales, Valencia, Spain
| | - Katja N. Gaarenstroom
- Leiden University Medical Center, Department of Obstetrics and Gynecology, Leiden, the Netherlands
| | - Marielle Nobbenhuis
- The Royal Marsden NHS Foundation Trust, Department of Gynaecology, London, England
| | - Mateja Krajc
- Institute of Oncology Ljubljana, Department of Clinical Genetics, Ljubljana, Slovenia
| | - Vilius Rudaitis
- Vilnius University Faculty of Medicine, Clinic of Obstetrics and Gynecology, Vilnius, Lithuania
| | | | | | - Marian J.E. Mourits
- University Medical Center Groningen, University of Groningen, Department of Gynecologic Oncology, Groningen, the Netherlands
| | - Leon F.A.G. Massuger
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Obstetrics and Gynaecology, Nijmegen, the Netherlands
| | - Nicoline Hoogerbrugge
- Radboud University Medical Center, Department of Human Genetics, Nijmegen, the Netherlands
| | - Rosella P.M.G. Hermens
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, the Netherlands
| | - Joanna IntHout
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department for Health Evidence, Nijmegen, the Netherlands
| | - Joanne A. de Hullu
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Obstetrics and Gynaecology, Nijmegen, the Netherlands
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Creating Breast and Gynecologic Cancer Guidelines for Transgender Patients With BRCA Mutations. Obstet Gynecol 2021; 138:911-917. [PMID: 34735408 DOI: 10.1097/aog.0000000000004597] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/26/2021] [Indexed: 02/06/2023]
Abstract
More than 1.5 million individuals in the United States identify as transgender. Transgender individuals have lower rates of health care utilization and higher rates of health care discrimination than cisgender patients. With a growing interest in providing comprehensive and compassionate care to the transgender community, there has been a concurrent increase in research on transgender health. However, lack of long-term data limits understanding the effects of hormone therapy on cancer risk factors in this population. This is particularly relevant for patients with hormonally mediated cancers and those at elevated risk from hereditary breast and ovarian cancer syndromes. Few cancer-screening and management guidelines currently exist for this population. Specific practices guided by the nuances of gender identity and gender-affirming care are essential to improve clinical management and to avoid further alienating a population that is already marginalized from the health care system. This commentary summarizes screening, management, and surveillance strategies devised for cisgender patients to offer corresponding recommendations tailored for transgender BRCA mutation carriers. In doing so, it highlights critical unanswered questions pertaining to the care of these patients. To address these questions, we must prioritize this population and adopt more inclusive frameworks in medicine and research.
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Cowan R, Nobre SP, Pradhan N, Yasukawa M, Zhou QC, Iasonos A, Soslow RA, Arnold AG, Trottier M, Catchings A, Roche KL, Gardner G, Robson M, Abu Rustum NR, Aghajanian C, Cadoo K. Outcomes of incidentally detected ovarian cancers diagnosed at time of risk-reducing salpingo-oophorectomy in BRCA mutation carriers. Gynecol Oncol 2021; 161:521-526. [PMID: 33712278 DOI: 10.1016/j.ygyno.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/03/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Prior data suggested that women with incidentally detected occult invasive ovarian cancer (OIOC) at the time of risk-reducing salpingo-oophorectomy (RRSO) for BRCA mutation may have poorer prognoses than would be expected based on disease stage. We sought to evaluate prevalence and outcomes of patients with OIOC in a tertiary referral center. METHODS Patients with BRCA mutation undergoing RRSO from 01/2005 to 05/2017 were identified, and their records reviewed. Women with incidentally detected OIOC were included; those with clinical features raising preoperative suspicion for malignancy were excluded. RESULTS 548 patients with BRCA mutation who underwent RRSO were identified. 26 (4.7%) had an OIOC (median age 55 years; range 42-75); 15(58%) patients, BRCA1; 9(34%), BRCA2; 2(8%) had a mutation in both genes. All OIOCs were high-grade serous: 10 (38%) Stage I; 8 (31%) Stage II; 8(31%) Stage III. 24(92%) patients received adjuvant platinum/taxane therapy. Of Stage III patients, 4 (50%) were identified intraoperatively; the remaining 4 (50%) had microscopic nodal disease on final pathology only. At median follow-up of 67.3 months (28-166) no Stage I patients have recurred; 2 Stage II and 6 Stage III patients recurred. 5-year progression-free survival (PFS) was 72% (95%CI, 50.2-85.7%); median PFS for the cohort was 129 months (95%CI, 75.3-not estimable). 5-year disease-specific survival (DSS) was 96% (95%CI, 76-99%); median DSS not reached. CONCLUSION Consistent with prior reports, almost 5% of patients had an OIOC at RRSO. The majority with early-stage disease had excellent PFS and DSS outcomes, as would be expected based on disease stage.
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Affiliation(s)
- Renee Cowan
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Silvana Pedra Nobre
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nisha Pradhan
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maya Yasukawa
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Qin C Zhou
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexia Iasonos
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert A Soslow
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Medical College of Cornell University, New York, NY, USA
| | - Angela G Arnold
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Magan Trottier
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Amanda Catchings
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kara Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Medical College of Cornell University, New York, NY, USA
| | - Ginger Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Medical College of Cornell University, New York, NY, USA
| | - Mark Robson
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Medical College of Cornell University, New York, NY, USA; Robert and Kate Niehaus Center for Inherited Cancer Genomics, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nadeem R Abu Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Medical College of Cornell University, New York, NY, USA
| | - Carol Aghajanian
- Weill Medical College of Cornell University, New York, NY, USA; Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Karen Cadoo
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Medical College of Cornell University, New York, NY, USA; Robert and Kate Niehaus Center for Inherited Cancer Genomics, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; HOPe Directorate, St. James's Hospital, Dublin, Ireland.
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Daly MB, Pal T, Berry MP, Buys SS, Dickson P, Domchek SM, Elkhanany A, Friedman S, Goggins M, Hutton ML, Karlan BY, Khan S, Klein C, Kohlmann W, Kurian AW, Laronga C, Litton JK, Mak JS, Menendez CS, Merajver SD, Norquist BS, Offit K, Pederson HJ, Reiser G, Senter-Jamieson L, Shannon KM, Shatsky R, Visvanathan K, Weitzel JN, Wick MJ, Wisinski KB, Yurgelun MB, Darlow SD, Dwyer MA. Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021; 19:77-102. [DOI: 10.6004/jnccn.2021.0001] [Citation(s) in RCA: 211] [Impact Index Per Article: 70.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic focus primarily on assessment of pathogenic or likely pathogenic variants associated with increased risk of breast, ovarian, and pancreatic cancer and recommended approaches to genetic testing/counseling and management strategies in individuals with these pathogenic or likely pathogenic variants. This manuscript focuses on cancer risk and risk management for BRCA-related breast/ovarian cancer syndrome and Li-Fraumeni syndrome. Carriers of a BRCA1/2 pathogenic or likely pathogenic variant have an excessive risk for both breast and ovarian cancer that warrants consideration of more intensive screening and preventive strategies. There is also evidence that risks of prostate cancer and pancreatic cancer are elevated in these carriers. Li-Fraumeni syndrome is a highly penetrant cancer syndrome associated with a high lifetime risk for cancer, including soft tissue sarcomas, osteosarcomas, premenopausal breast cancer, colon cancer, gastric cancer, adrenocortical carcinoma, and brain tumors.
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Affiliation(s)
| | - Tuya Pal
- 2Vanderbilt-Ingram Cancer Center
| | - Michael P. Berry
- 3St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center
| | | | - Patricia Dickson
- 5Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | - Michael Goggins
- 9The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | - Seema Khan
- 12Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | | | | | | | | | | | | | - Holly J. Pederson
- 22Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
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10
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Molecular Features and Clinical Management of Hereditary Gynecological Cancers. Int J Mol Sci 2020; 21:ijms21249504. [PMID: 33327492 PMCID: PMC7765001 DOI: 10.3390/ijms21249504] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 12/18/2022] Open
Abstract
Hereditary gynecological cancers are caused by several inherited genes. Tumors that arise in the female reproductive system, such as ovaries and the uterus, overlap with hereditary cancers. Several hereditary cancer-related genes are important because they might lead to therapeutic targets. Treatment of hereditary cancers should be updated in line with the advent of various new methods of evaluation. Next-generation sequencing has led to rapid, economical genetic analyses that have prompted a concomitant and significant paradigm shift with respect to hereditary cancers. Molecular tumor profiling is an epochal method for determining therapeutic targets. Clinical treatment strategies are now being designed based on biomarkers based on tumor profiling. Furthermore, the National Comprehensive Cancer Network (NCCN) guidelines significantly changed the genetic testing process in 2020 to initially consider multi-gene panel (MGP) evaluation. Here, we reviewed the molecular features and clinical management of hereditary gynecological malignancies, such as hereditary breast and ovarian cancer (HBOC), and Lynch, Li–Fraumeni, Cowden, and Peutz–Jeghers syndromes. We also reviewed cancer-susceptible genes revealed by MGP tests.
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11
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Ovarian Cancer After Prophylactic Salpingectomy in a Patient With Germline BRCA1 Mutation. Obstet Gynecol 2020; 135:1270-1274. [PMID: 32459417 DOI: 10.1097/aog.0000000000003864] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Women with germline BRCA1 or BRCA2 mutations have a lifetime risk of ovarian cancer of up to 46%. Opportunistic salpingectomy has been advocated as a risk-reducing strategy owing to increasing recognition of tubal origin, yet evidence of efficacy in this high-risk population is limited. CASE This is the case of a woman with a BRCA1 mutation who underwent prophylactic mastectomy and bilateral salpingectomy with ovarian retention before the age of 40 years. She did not undergo oophorectomy and subsequently developed stage IV high-grade serous ovarian cancer 4 years after her initial surgery. CONCLUSION More research is needed to determine the role of prophylactic salpingectomy with delayed oophorectomy, optimal timing of completion oophorectomy, and the risks and benefits compared with up-front risk-reducing salpingo-oophorectomy.
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12
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Crosbie EJ, Flaum N, Harkness EF, Clayton RD, Holland C, Martin-Hirsch P, Wood N, Keating P, Woodward ER, Lalloo F, Donnai P, Edmondson RJ, Evans DG. Specialist oncological surgery for removal of the ovaries and fallopian tubes in BRCA1 and BRCA2 pathogenic variant carriers may reduce primary peritoneal cancer risk to very low levels. Int J Cancer 2020; 148:1155-1163. [PMID: 33152107 PMCID: PMC7839461 DOI: 10.1002/ijc.33378] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/27/2020] [Accepted: 10/16/2020] [Indexed: 01/04/2023]
Abstract
Risk‐reducing bilateral salpingo‐oophorectomy (RRBSO) is highly effective for the prevention of high‐grade serous ovarian cancer (HGSOC) in BRCA1/2 pathogenic variant carriers (PVCs), but does not completely eliminate future risk of primary peritoneal cancer (PPC). The requirement to completely remove fallopian tubes at RRBSO and carefully exclude occult cancer/serous tubal intraepithelial carcinoma (STIC) lesions may not have been appreciated historically. We calculated rates of HGSOC and PPC in confirmed BRCA1/2 PVCs registered on the regional database in those who did (cases) and did not (controls) undergo RRBSO after genetic testing. Expected annual rates of ovarian/peritoneal cancer were 1% for BRCA1 ≥ 35 years and 0.5% for BRCA2 ≥ 45 years. Follow‐up before 35/45 years was “risk free” and lead time excluded RRBSO <35 years and <45 years for BRCA1 and BRCA2, respectively. Women were followed from personal mutation report (controls) or RRBSO (cases) to death, ovarian/peritoneal cancer or last follow‐up, whichever was sooner. In total, 891 cases (BRCA1 = 468, BRCA2 = 423) and 1302 controls had follow‐up ≥35 years (BRCA1 = 736) and ≥45 years (BRCA2 = 566), respectively, over a total of 7261.1 risk eligible years (mean = 8.15 years). Twenty‐one occult ovarian cancers were found at RRBSO (2.4%), 16 at stage 1. Post RRBSO, 56.97 ovarian/peritoneal cancers were expected but only 3 were observed (HR = 0.053; 95% CI = 0.013‐0.14), with combined Kaplan‐Meier analysis HR = 0.029 (95% CI = 0.009‐0.100, P < .001). Risk reduction was greater in specialist (HR = 0.03; 95% CI = 0.001‐0.13) compared to non‐specialist centres (HR = 0.11; 95% CI = 0.02‐0.37) (P = .07). In controls, 23.35 ovarian/peritoneal cancers were expected with 32 observed (HR = 1.37; 95% CI = 0.95‐1.91). RRBSO <35/<45 years reduces the risk of ovarian/peritoneal cancer by 95% in BRCA1/2 PVCs and may be greater in specialist centres. What's new? Women who carry genetic variants in BRCA1/2 that are linked to high‐grade serous ovarian cancer are advised to undergo risk‐reducing prophylactic bilateral salpingo‐oophorectomy (RRBSO). RRBSO, however, is associated with a significant residual risk of primary peritoneal cancer (PPC). Here, the rate of PPC following prophylactic surgery for high‐grade serous ovarian cancer was investigated among 2,193 BRCA1/2 mutation carriers who had undergone RRBSO. Estimates indicate that prophylactic surgery reduced the overall risk of PPC by 95 percent, a far greater reduction than previously described. Residual risk was lowest when RRBSO was carried out at specialist centers compared to non‐specialist centers.
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Affiliation(s)
- Emma J Crosbie
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Department of Obstetrics and Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Nicola Flaum
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Genetic Medicine, Manchester Centre for Genomic Medicine and NW Laboratory Genetics Hub, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Elaine F Harkness
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Prevention Breast Cancer Centre and Nightingale Breast Screening Centre, University Hospital of South Manchester, Manchester, UK
| | - Richard D Clayton
- Department of Obstetrics and Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Cathrine Holland
- Department of Obstetrics and Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Pierre Martin-Hirsch
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Department of Obstetrics and Gynaecology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust, Preston, UK
| | - Nick Wood
- Department of Obstetrics and Gynaecology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust, Preston, UK
| | - Patrick Keating
- Department of Obstetrics and Gynaecology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust, Preston, UK
| | - Emma R Woodward
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Genetic Medicine, Manchester Centre for Genomic Medicine and NW Laboratory Genetics Hub, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Fiona Lalloo
- Genetic Medicine, Manchester Centre for Genomic Medicine and NW Laboratory Genetics Hub, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Paul Donnai
- Department of Obstetrics and Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Richard J Edmondson
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Department of Obstetrics and Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - D Gareth Evans
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Genetic Medicine, Manchester Centre for Genomic Medicine and NW Laboratory Genetics Hub, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Prevention Breast Cancer Centre and Nightingale Breast Screening Centre, University Hospital of South Manchester, Manchester, UK.,The Christie NHS Foundation Trust, Manchester, UK.,Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, Manchester, UK
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13
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The reduction of CA 125 serum levels in BRCA 1/2 mutation carriers after risk-reducing salpingo-oophorectomy is only partially associated with surgery: a prospective cohort, other biomarker controlled, study. Eur J Cancer Prev 2020; 29:350-356. [DOI: 10.1097/cej.0000000000000606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Dullens B, de Putter R, Lambertini M, Toss A, Han S, Van Nieuwenhuysen E, Van Gorp T, Vanderstichele A, Van Ongeval C, Keupers M, Prevos R, Celis V, Dekervel J, Everaerts W, Wildiers H, Nevelsteen I, Neven P, Timmerman D, Smeets A, Denayer E, Van Buggenhout G, Legius E, Punie K. Cancer Surveillance in Healthy Carriers of Germline Pathogenic Variants in BRCA1/2: A Review of Secondary Prevention Guidelines. JOURNAL OF ONCOLOGY 2020; 2020:9873954. [PMID: 32655641 PMCID: PMC7322604 DOI: 10.1155/2020/9873954] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/30/2020] [Indexed: 02/06/2023]
Abstract
Germline pathogenic alterations in the breast cancer susceptibility genes 1 (BRCA1) and 2 (BRCA2) are the most prevalent causes of hereditary breast and ovarian cancer. The increasing trend in proportion of cancer patients undergoing genetic testing, followed by predictive testing in families of new index patients, results in a significant increase of healthy germline BRCA1/2 mutation carriers who are at increased risk for breast, ovarian, and other BRCA-related cancers. This review aims to give an overview of available screening guidelines for female and male carriers of pathogenic or likely pathogenic germline BRCA1/2 variants per cancer type, incorporating malignancies that are more or less recently well correlated with BRCA1/2. We selected guidelines from national/international organizations and/or professional associations that were published or updated between January 1, 2015, and February 1, 2020. In total, 12 guidelines were included. This review reveals several significant discordances between the different guidelines. Optimal surveillance strategies depend on accurate age-specific cancer risk estimates, which are not reliably available for all BRCA-related cancers. Up-to-date national or international consensus guidelines are of utmost importance to harmonize counseling and proposed surveillance strategies for BRCA1/2 carriers.
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Affiliation(s)
- Boudewijn Dullens
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
| | - Robin de Putter
- Department of Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Matteo Lambertini
- Department of Medical Oncology, U.O.C Clinica di Oncologia Médica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Angela Toss
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Sileny Han
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
- Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Els Van Nieuwenhuysen
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
- Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Toon Van Gorp
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
- Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Adriaan Vanderstichele
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
- Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Chantal Van Ongeval
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Machteld Keupers
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Renate Prevos
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Valerie Celis
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Jeroen Dekervel
- Digestive Oncology, Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - Wouter Everaerts
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Hans Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
| | - Ines Nevelsteen
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
- Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Patrick Neven
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
- Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Dirk Timmerman
- Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Ann Smeets
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
- Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Ellen Denayer
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
- Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Griet Van Buggenhout
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
- Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Eric Legius
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
- Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Kevin Punie
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
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15
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Kotsopoulos J, Karlan B, Gronwald J, Hall E, Moller P, Tung N, Zakalik D, Foulkes WD, Rosen B, Neuhausen SL, Sun P, Lubinksi J, Narod SA. Long-term outcomes following a diagnosis of ovarian cancer at the time of preventive oophorectomy among BRCA1 and BRCA2 mutation carriers. Int J Gynecol Cancer 2020; 30:825-830. [PMID: 32354794 DOI: 10.1136/ijgc-2019-001141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/24/2020] [Accepted: 03/05/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Preventive bilateral salpingo-oophorectomy is the most effective means of reducing the risk of ovarian cancer among women with an inherited BRCA1 or BRCA2 mutation. Some women are diagnosed with an invasive cancer (ovarian or fallopian tube) at the time of preventive surgery, referred to as an 'occult' cancer. The survival experience of these women is not known. METHODS We estimated the 10-year survival for 52 BRCA mutation carriers diagnosed with an occult ovarian or fallopian tube cancer at the time of preventive bilateral salpingo-oophorectomy. RESULTS The mean age at diagnosis was 51.6 (range 33-69) years. All were serous cancers (although 14 were missing information on histologic subtype). Of the 20 cases with information available on stage at diagnosis, 10 were stage I, 1 was stage II, and 9 were stage III (n=32 missing). After a mean of 6.8 years, 12 women died (23%). The 10-year all-cause survival was 74%. CONCLUSION Although based on only 52 cases, these findings suggest a more favorable prognosis for BRCA mutation carriers diagnosed with an occult rather than incident disease.
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Affiliation(s)
- Joanne Kotsopoulos
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Beth Karlan
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Jacek Gronwald
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian, Pomeranian Medical University in Szczecin, Szczecin, Zachodniopomorskie, Poland
| | - Elizabeth Hall
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Pal Moller
- Department of Tumor Biology, Institute of Cancer Research, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Nadine Tung
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Dana Zakalik
- Beaumont Hospital, Royal Oak, Troy, Michigan, USA
| | - William D Foulkes
- Program in Cancer Genetics, Department of Oncology and Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Barry Rosen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Susan L Neuhausen
- Division of Biomarkers of Early Detection and Prevention, Department of Population Sciences, Beckman Research Institute City of Hope, Duarte, California, USA
| | - Ping Sun
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Jan Lubinksi
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian, Pomeranian Medical University in Szczecin, Szczecin, Zachodniopomorskie, Poland
| | - Steven A Narod
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada .,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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16
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Kotsopoulos J, Narod SA. Prophylactic salpingectomy for the prevention of ovarian cancer: Who should we target? Int J Cancer 2020; 147:1245-1251. [PMID: 32037528 DOI: 10.1002/ijc.32916] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/14/2020] [Accepted: 01/31/2020] [Indexed: 12/12/2022]
Abstract
Ovarian cancer is the most fatal gynecologic malignancy (50% 5-year survival) due to a typically advanced stage at diagnosis and a high rate of recurrence. Chemoprevention options are limited, and few interventions have been shown to reduce cancer risk or mortality. Emerging data support the model that fallopian tubes are the site of origin for a proportion of high-grade serous cancers. This implies that a subset of cancers may be prevented by removing the fallopian tubes while leaving the ovaries intact. Accordingly, there has been shift in clinical practice for average risk women; some now recommend removal of both the fallopian tubes only instead of tubal ligation for sterilization or at the time of benign gynecologic surgery. This has been termed opportunistic salpingectomy and represents a means of decreasing the burden of ovarian cancer by preventing cancers that arise in the fallopian tubes. There have been no detailed, prospective reports that have estimated ovarian cancer risk reduction with opportunistic salpingectomy, neither among women at baseline population risk nor among women at a high risk of developing the disease. The situation is complicated for women with a BRCA mutation-bilateral salpingo-oophorectomy is a proven means of risk reduction and salpingectomy alone is not the standard of care. Based on the existing data, salpingectomy alone should only be reserved for women with a lifetime risk of ovarian cancer of less than 5%.
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Affiliation(s)
- Joanne Kotsopoulos
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Steven A Narod
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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17
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Ma YN, Bu HL, Jin CJ, Wang X, Zhang YZ, Zhang H. Peritoneal cancer after bilateral mastectomy, hysterectomy, and bilateral salpingo-oophorectomy with a poor prognosis: A case report and review of the literature. World J Clin Cases 2019; 7:3872-3880. [PMID: 31799317 PMCID: PMC6887594 DOI: 10.12998/wjcc.v7.i22.3872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/19/2019] [Accepted: 10/05/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Primary peritoneal cancer (PPC) patients with BRCA mutations have a good prognosis; however, for patients with BRCA mutations who are diagnosed with PPC after prophylactic salpingo-oophorectomy (PSO), the prognosis is poor, and survival information is scarce.
CASE SUMMARY We treated a 56-year-old woman with PPC after bilateral mastectomy, hysterectomy, and bilateral salpingo-oophorectomy. This patient had primary drug resistance and died 12 mo after the diagnosis of PPC. The genetic test performed on this patient indicated the presence of a germline BRCA1 mutation. We searched the PubMed, Scopus, and Cochrane databases and extracted studies of patients with BRCA mutations who developed PPC after PSO. After a detailed literature search, we found 30 cases, 7 of which had a history of breast cancer, 14 of which had no history of breast cancer, and 9 of which had an unknown history. The average age of PSO patients was 48.86 years old (range, 31-64 years). The average time interval between the diagnosis of PPC and preventive surgery was 61.03 mo (range, 12-292 mo). The 2-year survival rate for this patient population was 78.26% (18/23), the 3-year survival rate was 50.00% (9/18), and the 5-year survival rate was 6.25% (1/16).
CONCLUSION Patients with BRCA mutations who are diagnosed with PPC after preventative surgery have a poor prognosis. Prevention measures and treatments for these patients need more attention.
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Affiliation(s)
- Ya-Na Ma
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
| | - Hua-Lei Bu
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
| | - Cheng-Juan Jin
- Department of Obstetrics and Gynecology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 201620, China
| | - Xia Wang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
| | - You-Zhong Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
| | - Hui Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
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18
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Bercow AS, Eisenhauer EL. Screening and surgical prophylaxis for hereditary cancer syndromes with high risk of endometrial and ovarian cancer. J Surg Oncol 2019; 120:864-872. [PMID: 31355450 DOI: 10.1002/jso.25645] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/10/2019] [Indexed: 01/23/2023]
Abstract
In the era of advanced cancer genomics, our recognition of hereditary cancer mutations continues to increase. Two of these conditions, which carry an increased risk of female cancers including endometrial, ovarian, breast, are hereditary breast and ovarian cancer syndrome and Lynch syndrome. Risk-reducing surgery, such as mastectomy, salpingo-oophorectomy, and hysterectomy may decrease cancer risk for mutation carriers. Background, indications, techniques, and consequences of these surgical procedures are reviewed.
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Affiliation(s)
- Alexandra S Bercow
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eric L Eisenhauer
- Division of Gynecologic Oncology, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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19
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Retrospective study of a 16 year cohort of BRCA1 and BRCA2 carriers presenting for RRSO: Prevalence of invasive and in-situ carcinoma, with follow-up. Gynecol Oncol 2019; 153:326-334. [DOI: 10.1016/j.ygyno.2019.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/28/2019] [Accepted: 03/02/2019] [Indexed: 12/18/2022]
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Walsh CS. Who is at risk after risk reduction? Cancer 2018; 124:884-887. [PMID: 29315505 DOI: 10.1002/cncr.31209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 11/29/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Christine S Walsh
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
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