1
|
Stroot IAS, Bart J, Hollema H, Jalving M, Wagner MM, Yigit R, van Doorn HC, de Hullu JA, Gaarenstroom KN, van Beurden M, van Lonkhuijzen LRCW, Slangen BFM, Zweemer RP, Gómez García EB, Ausems MGEM, Boere IA, van Hest LP, Duijkers FAM, van Asperen CJ, Schmidt MK, Wevers MR, Ruijs MWG, Devilee P, Collée JM, Hebon Investigators, de Bock GH, Mourits MJE. Long-term outcome of high-grade serous carcinoma established in risk-reducing salpingo-oophorectomy specimens in asymptomatic BRCA1/2 germline pathogenic variant carriers. Gynecol Oncol 2024; 187:198-203. [PMID: 38795508 DOI: 10.1016/j.ygyno.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/17/2024] [Accepted: 05/19/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE The aim of this study was to describe the long-term outcome of asymptomatic BRCA1/2 germline pathogenic variant (GPV) carriers with high-grade serous carcinoma (HGSC) in their risk-reducing salpingo-oophorectomy (RRSO) specimen. METHODS In a previously described cohort of asymptomatic BRCA1/2 GPV carriers derived from the Hereditary Breast and Ovarian cancer in the Netherlands (HEBON) study, women with HGSC at RRSO were identified. Main outcome was ten-year disease-free survival (DFS). Secondary outcomes were time to recurrence, ten-year disease-specific survival (DSS), ten-year overall survival (OS). Patient, disease and treatment characteristics associated with recurrence were described. RESULTS The 28 included women with HGSC at RRSO were diagnosed at a median age of 55.3 years (range: 33.5-74.3). After staging, eighteen women had (FIGO) stage I, three stage II and five had stage III disease. Two women did not undergo surgical staging and were classified as unknown stage. After a median follow-up of 13.5 years (range: 9.1-24.7), six women with stage I (33%), one woman with stage II (33%), two women with stage III (40%) and none of the women with unknown stage developed a recurrence. Median time to recurrence was 6.9 years (range: 0.8-9.2 years). Ten-year DFS was 68%, ten-year DSS was 88% and ten-year OS was 82%. CONCLUSION Most asymptomatic BRCA1/2 GPV carriers with HGSC at RRSO were diagnosed at an early stage. Nevertheless, after a median follow-up of 13.5 years, nine of the 28 women with HGSC at RRSO developed a recurrence after a median of 6.9 years.
Collapse
Affiliation(s)
- Iris A S Stroot
- University of Groningen, University Medical Center Groningen, Department of Gynecologic Oncology, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands.
| | - Joost Bart
- University of Groningen, University Medical Center Groningen, Department of Pathology, Groningen, the Netherlands
| | - Harry Hollema
- University of Groningen, University Medical Center Groningen, Department of Pathology, Groningen, the Netherlands
| | - Mathilde Jalving
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, the Netherlands
| | - Marise M Wagner
- University of Groningen, University Medical Center Groningen, Department of Gynecologic Oncology, Groningen, the Netherlands
| | - Refika Yigit
- University of Groningen, University Medical Center Groningen, Department of Gynecologic Oncology, Groningen, the Netherlands
| | - Helena C van Doorn
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Gynecologic Oncology, Rotterdam, the Netherlands
| | - Joanne A de Hullu
- Radboud University Medical Center, Department of Obstetrics and Gynecology, Nijmegen, the Netherlands
| | - Katja N Gaarenstroom
- Leiden University Medical Center, Department of Obstetrics and Gynecology, Leiden, the Netherlands
| | - Marc van Beurden
- Antoni van Leeuwenhoek, Department of Gynecology, Amsterdam, the Netherlands
| | - Luc R C W van Lonkhuijzen
- Amsterdam University Medical Center-Center for Gynecological Oncology Amsterdam, Department of Gynecologic Oncology, Amsterdam, the Netherlands
| | - Brigitte F M Slangen
- Maastricht University Medical Center, Department of Gynecology, Maastricht, the Netherlands
| | - Ronald P Zweemer
- University Medical Center Utrecht, Department of Gynecologic Oncology, Utrecht, the Netherlands
| | - Encarna B Gómez García
- University Medical Center Maastricht, Department of Clinical Genetics, Maastricht, the Netherlands
| | - Margreet G E M Ausems
- University Medical Center Utrecht, Department of Genetics, Division Laboratories, Pharmacy and Biomedical Genetics, Utrecht, the Netherlands
| | - Ingrid A Boere
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Medical Oncology, Rotterdam, the Netherlands
| | - Liselotte P van Hest
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Human Genetics, Amsterdam, the Netherlands
| | - Floor A M Duijkers
- Amsterdam UMC, University of Amsterdam, Department of Human Genetics, Amsterdam, the Netherlands
| | - Christi J van Asperen
- Leiden University Medical Center, Department of Human Genetics & Department of Pathology, Leiden, the Netherlands
| | - Marjanka K Schmidt
- Leiden University Medical Center, Department of Human Genetics & Department of Pathology, Leiden, the Netherlands; Netherlands Cancer Institute, Department of Epidemiology, Amsterdam, the Netherlands; Netherlands Cancer Institute, Division of Molecular Pathology, Amsterdam, the Netherlands
| | - Marijke R Wevers
- Radboud University Medical Center, Department of Clinical Genetics, Nijmegen, the Netherlands
| | - Marielle W G Ruijs
- Netherlands Cancer Institute, Department of Clinical Genetics, Amsterdam, the Netherlands
| | - Peter Devilee
- Leiden University Medical Center, Department of Human Genetics & Department of Pathology, Leiden, the Netherlands
| | - J Margriet Collée
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Clinical Genetics, Rotterdam, the Netherlands
| | - Hebon Investigators
- Hereditary Breast and Ovarian Cancer Research Group Netherlands (HEBON), Coordinating Center: Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Geertruida H de Bock
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Marian J E Mourits
- University of Groningen, University Medical Center Groningen, Department of Gynecologic Oncology, Groningen, the Netherlands
| |
Collapse
|
2
|
Yamada J, Fukuda K, Sugawara T, Makino K, Shimazu K, Yoshida T, Taguchi D, Shinozaki H, Terada Y, Nanjo H, Shibata H. A case of hereditary breast and ovarian cancer syndrome of initially presented as cancer of unknown primary with lymph node metastases unveiled by genetic analysis. Int Cancer Conf J 2024; 13:139-143. [PMID: 38524651 PMCID: PMC10957858 DOI: 10.1007/s13691-023-00652-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/27/2023] [Indexed: 03/26/2024] Open
Abstract
Cancer of unknown primary (CUP) is a heterogeneous disease concept involving various malignant tumors. Understanding its pathophysiology is often difficult, together with its treatment. Here, we present a case of CUP with abdominal lymph node enlargement and elevated carbohydrate antigen 125 levels. It initially resembled a favorable prognosis type similar to ovarian cancer, but metastases were observed in cervical lymph nodes, indicating a somewhat atypical CUP compared to the typical ovarian cancer-like CUP. We identified a germline Breast Cancer 1 (BRCA1) p.L63* variant through a family history inquiry and BRCA analysis, indicating hereditary breast and ovarian cancer syndrome. The patient achieved near-complete remission with platinum-based therapy followed by poly (ADP-ribose) polymerase (PARP) inhibitor. The variant has shown sensitivity in both clinical and pathogenic reports in the ClinVar database of the National Institutes of Health. No clinical studies reported on the efficacy of PARP inhibitors specific to this variant, but our case demonstrated the sensitivity of platinum-based therapy followed by PARP inhibitor. Reports of CUP in hereditary breast and ovarian cancer syndrome are very rare, with only a single report in the literature.
Collapse
Affiliation(s)
- Juri Yamada
- Department of Clinical Oncology, Graduate School of Medicine, Akita University, Hondo 1-1-1, Akita, Japan
| | - Koji Fukuda
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Akita University, Akita, Japan
| | - Tae Sugawara
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Akita University, Akita, Japan
| | - Kenichi Makino
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Akita University, Akita, Japan
| | - Kazuhiro Shimazu
- Department of Clinical Oncology, Graduate School of Medicine, Akita University, Hondo 1-1-1, Akita, Japan
| | - Taichi Yoshida
- Department of Clinical Oncology, Graduate School of Medicine, Akita University, Hondo 1-1-1, Akita, Japan
| | - Daiki Taguchi
- Department of Clinical Oncology, Graduate School of Medicine, Akita University, Hondo 1-1-1, Akita, Japan
| | - Hanae Shinozaki
- Department of Clinical Oncology, Graduate School of Medicine, Akita University, Hondo 1-1-1, Akita, Japan
| | - Yukihiro Terada
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Akita University, Akita, Japan
| | - Hiroshi Nanjo
- Department of Pathology, Akita University Hospital, Akita, Japan
| | - Hiroyuki Shibata
- Department of Clinical Oncology, Graduate School of Medicine, Akita University, Hondo 1-1-1, Akita, Japan
| |
Collapse
|
3
|
Kang OJ, Lee SW, Kim JH, Park JY, Suh DS, Kim DY, Kim JH, Kim YM, Kim YT. Pathological findings and long-term prognosis in Korean BRCA1/2 mutation carriers undergoing risk-reducing salpingo-oophorectomy. Int J Gynecol Cancer 2023; 33:1743-1749. [PMID: 37541685 DOI: 10.1136/ijgc-2023-004618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023] Open
Abstract
OBJECTIVE Our study aimed to evaluate the incidence of pathological findings in asymptomatic Korean patients with BRCA1/2 pathogenic variants who underwent risk-reducing salpingo-oophorectomy and to assess their long-term prognosis. METHODS We retrospectively analyzed the medical records of patients with a germinal BRCA1/2 pathologic variant who had undergone risk-reducing salpingo-oophorectomy at Asan Medical Center (Seoul, Korea) between January 2013 and December 2020. All pathologic reports were made based on the sectioning and extensively examining the fimbriated end of the fallopian tube (SEE/FIM) protocol. RESULTS Out of 243 patients who underwent risk-reducing salpingo-oophorectomy, 121 (49.8%) had a BRCA1 mutation, 119 (48.9%) had a BRCA2 mutation, and three (1.2%) had both mutations. During the procedure, four (3.3%) patients with a BRCA1 mutation were diagnosed with serous tubal intraepithelial carcinoma (STIC) or serous tubal intraepithelial lesion (STIL), and another four patients (3.3%) were diagnosed with occult cancer despite no evidence of malignancy on preoperative ultrasound. In the BRCA2 mutation group, we found one (0.8%) case of STIC, but no cases of STIL or occult cancer. During the median follow-up period of 98 months (range, 44-104) for STIC and 54 months (range, 52-56) for STIL, none of the patients diagnosed with these precursor lesions developed primary peritoneal carcinomatosis. CONCLUSIONS Risk-reducing salpingo-oophorectomy, in asymptomatic Korean patients with BRCA1/2 pathogenic variants, detected ovarian cancer and precursor lesions, including STIC or STIL. Furthermore, our follow-up period did not reveal any instances of primary peritoneal carcinomatosis, suggesting a limited body of evidence supporting the imperative need for adjuvant treatment in patients diagnosed with these precursor lesions during risk-reducing salpingo-oophorectomy.
Collapse
Affiliation(s)
- Ok-Ju Kang
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Shin-Wha Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ju-Hyun Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jeong-Yeol Park
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dae-Shik Suh
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dae-Yeon Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jong-Hyeok Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yong-Man Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young-Tak Kim
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| |
Collapse
|
4
|
Abay M, Ozgen L, Yalcin Y, Ozerkan K. Clinical significance of risk-reducing salpingo-oophorectomy in patients with BRCA1/2 mutation. J Gynecol Obstet Hum Reprod 2023; 52:102642. [PMID: 37573025 DOI: 10.1016/j.jogoh.2023.102642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 08/06/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE Serous tubal intraepithelial carcinoma (STIC) is a precursor lesion which is located in the distal fallopian tube and causes high grade serous ovarian carcinoma (HGSOC). The incidence of STIC for women underwent risk reducing salpingo-oophorectomy for BRCA mutation varies from 0.6 to 7% and its clinical outcomes are still unclear. The aim of this study was to demonstrate the incidence of STIC and HGSOC in BRCA1/2 mutation carriers after risk reducing salpingo-oophorectomy (RRSO) and the clinical outcomes of these patients. MATERIAL AND METHODS We retrospectively reviewed the records of 48 BRCA1 and/or 2 mutation carriers who underwent prophylactic salpingo-oophorectomy with or without hysterectomy at the Department of Obstetrics and Gynecology, Bursa Uludag University between January 2000 and January 2022. INCLUSION CRITERIA BRCA 1 and/or 2 mutation carriers diagnosed by genetic testing, asymptomatic patients with no abnormal findings on pelvic examination. EXCLUSION CRITERIA patients with no abnormal findings on pelvic examination and a presence of a personal history of ovarian, fallopian tube or peritoneal cancer. RESULTS A total of 48 BRCA 1 and/or 2 mutation carriers underwent RRSO. STIC was diagnosed in 1 (2,0%) patient and restaging surgery was not performed. Primary peritoneal carcinoma (PPC) did not develop during the 20 months follow-up period. One (2.0%) patient was diagnosed with occult ovarian cancer. Restaging surgery was performed and chemotherapy treatments were given after surgery. A pelvic recurrence developed 25 months after the occult cancer diagnosis in the follow up period. One (2.0%) patient with normal histopathological findings after RRSO was diagnosed with peritoneal cancer 57 months after the operation. CONCLUSION The risk of PPC continues after RRSO. Therefore, close follow-up procedure is very important for early diagnosis and effective treatment of patients with PPC after RRSO.
Collapse
Affiliation(s)
- Merve Abay
- Faculty of Medicine Gynecological Oncology Surgery, Uludag University, Bursa 16059, Turkey
| | - Levent Ozgen
- Faculty of Medicine Gynecological Oncology Surgery, Uludag University, Bursa 16059, Turkey.
| | - Yakup Yalcin
- Faculty of Medicine Gynecological Oncology Surgery, Uludag University, Bursa 16059, Turkey
| | - Kemal Ozerkan
- Faculty of Medicine Gynecological Oncology Surgery, Uludag University, Bursa 16059, Turkey
| |
Collapse
|
5
|
Schwartz ZP, Li AJ, Walsh CS, Rimel BJ, Alvarado MM, Lentz SE, Cass I. Patterns of care and outcomes of risk reducing surgery in women with pathogenic variants in non-BRCA and Lynch syndrome ovarian cancer susceptibility genes. Gynecol Oncol 2023; 173:1-7. [PMID: 37030072 DOI: 10.1016/j.ygyno.2023.03.017] [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: 12/30/2022] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 04/10/2023]
Abstract
OBJECTIVES Guidelines recommend risk-reducing bilateral salpingo-oophorectomy (RRSO) for women with pathogenic variants of non-BRCA and Lynch syndrome-associated ovarian cancer susceptibility genes. Optimal timing and findings at the time of RRSO for these women remains unclear. We sought to characterize practice patterns and frequency of occult gynecologic cancers for these women at our two institutions. METHODS Women with germline ovarian cancer susceptibility gene pathogenic variants who underwent RRSO between 1/2000-9/2019 were reviewed 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. RESULTS 26 Non-BRCA (9 BRIP1, 9 RAD51C, and 8 RAD51D) and 75 Lynch (36 MLH1, 18 MSH2, 21 MSH6) pathogenic variants carriers were identified. Median age at time of RRSO was 47. There were no occurrences of occult ovarian or fallopian tube cancer in either group. Two patients (3%) in the Lynch group had occult endometrial cancer. Median follow up was 18 and 35 months for non-BRCA and Lynch patients, respectively. No patient developed primary peritoneal cancer upon follow up. Post-surgical complications occurred in 9/101 (9%) of patients. Hormone replacement therapy (HRT) was rarely used despite reported post-menopausal symptoms in 6/25 (23%) and 7/75 (37%) patients, respectively. CONCLUSIONS No occult ovarian or tubal cancers were observed in either group. No recurrent or primary gynecologic-related cancers occurred upon follow-up. Despite frequent menopausal symptoms, HRT use was rare. Both groups experienced surgical complications when hysterectomy and/or concurrent colon surgery was performed suggesting concurrent surgeries should only be performed when indicated.
Collapse
Affiliation(s)
- Zachary P Schwartz
- Kaiser Permanente Panorama City Medical Center, Division of Gynecologic Oncology, 13640 Roscoe Blvd., Panorama City, CA 91402, USA.
| | - Andrew J Li
- Cedars-Sinai Medical Center, Samuel Oschin Cancer Center, 127 S. San Vicente Blvd., 7th Floor, Los Angeles, CA 90048, USA.
| | - Christine S Walsh
- University of Colorado Cancer Center, 1665 Aurora Court, Aurora, CO 80045, USA.
| | - B J Rimel
- Cedars-Sinai Medical Center, Samuel Oschin Cancer Center, 127 S. San Vicente Blvd., 7th Floor, Los Angeles, CA 90048, USA.
| | - Monica M Alvarado
- Kaiser Permanente Southern California Regional Genetic Services, 393 E. Walnut St. 6 SW, Pasadena, CA 91188, USA.
| | - Scott E Lentz
- Kaiser Permanente Los Angeles Medical Center, Gynecology Oncology Department, 4950 W., Sunset Blvd., Los Angeles, CA 90027, USA.
| | - Ilana Cass
- Dartmouth Hitchcock Medical Center, Department of Obstetrics and Gynecology, 1 Medical, Center Drive, Lebanon, NH 03756, USA.
| |
Collapse
|
6
|
Smallwood KG, Crockett S, Huang V, Cullimore V, Davies J, Satti G, Phillips A. Changing patterns of referral into a family history clinic and detection of ovarian cancer: a retrospective 10-year review. J OBSTET GYNAECOL 2022; 42:2652-2658. [PMID: 35980980 DOI: 10.1080/01443615.2022.2111253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This study examines whether a change in the criteria for genetic testing for ovarian cancer risk changed the nature of referrals into our Familial Cancer service. This is a retrospective review of 273 women who underwent risk reducing surgery (RRS). The primary outcome was to establish whether there was an increase in women having RRS with a confirmed genetic mutation. Secondary outcomes included the incidence of occult cancer and of subsequent primary peritoneal cancer. The results showed an increase in women being offered RRS based on genetic diagnosis; 91% versus 32% before the criteria change. Four occult malignancies (1.5%) and two peritoneal cancers (0.7%) were noted.We have demonstrated a change in the nature of referrals to the familial cancer service from perceived risk to genetic diagnosis. We can now counsel women more accurately. With a defined risk we are enabling them to make an informed decision regarding risk reduction.
Collapse
Affiliation(s)
- K G Smallwood
- Department of Obstetrics and Gynaecology, University Hospitals of Derby and Burton, Derby, UK
| | - S Crockett
- Department of Familial Cancer, University Hospitals of Derby and Burton, Derby, UK
| | - V Huang
- Medical School, University of Nottingham, Nottingham, UK
| | - V Cullimore
- Department of Obstetrics and Gynaecology, University Hospitals of Derby and Burton, Derby, UK
| | - J Davies
- Department of Obstetrics and Gynaecology, University Hospitals of Derby and Burton, Derby, UK
| | - G Satti
- Department of Obstetrics and Gynaecology, University Hospitals of Derby and Burton, Derby, UK
| | - A Phillips
- Department of Obstetrics and Gynaecology, University Hospitals of Derby and Burton, Derby, UK
| |
Collapse
|
7
|
Netter A, Niddam R, Agostini A, Crochet P. Vaginal NOTES approach for risk-reducing salpingo-oophorectomy in BRCA mutation carriers: A video demonstration. J Gynecol Obstet Hum Reprod 2021; 50:102212. [PMID: 34482210 DOI: 10.1016/j.jogoh.2021.102212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/22/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
Risk-reducing bilateral salpingo-oophorectomy (BSO) is an important option to prevent the development of ovarian and fallopian tube cancers in women with a BRCA1/2 mutation. Conventional laparoscopy is the current preferred technique since it is associated with less morbidity compared to laparotomy. Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is a new minimally invasive technique that allows access to the peritoneal cavity through the vagina without skin incisions. The vNOTES technique for risk-reducing BSO is presented herein. This article includes a narrated, step-by-step video demonstration of the entire procedure. Risk-reducing BSO using the vNOTES approach is a feasible technique that appears to be simple, safe, and reproducible. This technique has the potential to improve patients' surgical experience and provide good long-term functional and cosmetics outcomes. This technique needs to be further evaluated and compared to the conventional laparoscopic approach.
Collapse
Affiliation(s)
- Antoine Netter
- Department of Gynecology and Obstetrics, La Conception Hospital, Aix Marseille University, Marseille, France; Institut Méditerranéen de Biodiversité et d'Écologie marine et continentale (IMBE), Aix Marseille University, CNRS, IRD, Avignon University, Marseille, France
| | - Raphael Niddam
- Department of Gynecology and Obstetrics, La Conception Hospital, Aix Marseille University, Marseille, France
| | - Aubert Agostini
- Department of Gynecology and Obstetrics, La Conception Hospital, Aix Marseille University, Marseille, France
| | - Patrice Crochet
- Department of Gynecology and Obstetrics, La Conception Hospital, Aix Marseille University, Marseille, France. '
| |
Collapse
|
8
|
Efficacy of risk-reducing salpingo-oophorectomy in BRCA1-2 variants and clinical outcomes of follow-up in patients with isolated serous tubal intraepithelial carcinoma (STIC). Gynecol Oncol 2021; 163:364-370. [PMID: 34465478 DOI: 10.1016/j.ygyno.2021.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Serous tubal intraepithelial carcinoma (STIC) is currently considered the precursor lesion of pelvic high-grade serous carcinoma. The management of STIC diagnosed after risk-reducing salpingo-oophorectomy (RRSO) in women with BRCA1-2 variants remains unclear. The aim of our study was to evaluate the incidence of STIC, serous tubal intraepithelial lesions (STIL) and occult invasive cancer (OC) and to determine the long-term outcomes of these patients. METHODS We conducted a retrospective study of patients with BRCA 1-2 variants who underwent RRSO between January-2010 and Dicember-2020 at the Clinic of Gynaecology of University of Padova. INCLUSION CRITERIA women with a negative pelvic examination at the last screening prior to RRSO, patients with fallopian tubes analysed using the SEE-FIM protocol. EXCLUSION CRITERIA patients with a positive gynaecologic screening or with ovarian/tubal cancer prior to RRSO. RESULTS We included 153 patients. STICs were diagnosed in 4 patients (2.6%) and STILs in 6 patients (3.9%). None of the patients with STIC underwent restaging surgery or adjuvant chemotherapy; all patients were followed closely every 6 months. None of the patients developed primary peritoneal carcinomas (PPCs) with a median FUP of 54.5 months (15-106). OC was diagnosed in 3 patients (2%). All patients with OC underwent staging surgery, and one patient developed a peritoneal carcinoma (PC) after 18 months by staging surgery. CONCLUSION(S) The incidence of STIC, STIL and OC after RRSO in BRCA1-2 variants was low. Our results demonstrated that long-term close surveillance in patients diagnosed with STIC should be considered a possible management strategy.
Collapse
|
9
|
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.
Collapse
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.
| |
Collapse
|
10
|
La Marca A, Mastellari E. Fertility preservation for genetic diseases leading to premature ovarian insufficiency (POI). J Assist Reprod Genet 2021; 38:759-777. [PMID: 33495935 DOI: 10.1007/s10815-021-02067-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/07/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The current review aims to summarize the data available concerning the applicability of fertility preservation techniques to genetic conditions at risk of premature ovarian insufficiency (POI). METHODS A literature review through the PubMed Database was carried out. RESULTS About 10% of cases of POI is related to genetic diseases. The most frequent conditions associated with POI are Turner syndrome and fragile X pre-mutation; mutation of BRCA 1-2 genes and several other mutations and genetic syndromes have recently been highlighted, although they rarely occur. If a diagnosis is issued before POI onset, counseling on currently available fertility preservation techniques is advisable. In case of spontaneous menarche (this can occur variably depending on the mutation) established techniques like embryo or oocyte cryopreservation can be proposed, even if, in some cases, their effectiveness may be reduced by ovarian alterations connected to the mutation. Ovarian tissue cryopreservation has recently been defined as an established medical procedure for fertility preservation in young cancer patients and may be an option for prepubertal patients. However, it is still experimental in special populations with genetic diseases causing POI. New innovative experimental techniques, like in vitro maturation of immature oocytes (IVM) and vitro activation (IVA) of immature follicles on ovarian tissue, have shown limited but encouraging data and they will be probably available in the near future. For a correct risk-benefit evaluation, the following aspects should be considered: actual knowledge about the pathology-specific efficacy of the various techniques, the average age of onset of POI, the possible risks associated with the procedure in relation to the underlying pathology, the probability of spontaneous conception, as well as the health implications of a possible future pregnancy.. CONCLUSIONS Fertility preservation techniques represent a crucial opportunity for patients with genetic risk of POI. Early diagnosis increases the chances to apply these techniques. No specific recommendations concerning fertility preservation for each genetic pathology are available, and clinicians should first counsel the patient and her relatives about known risks and benefits of the available techniques, both those established and those considered as experimental.
Collapse
Affiliation(s)
- Antonio La Marca
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy. .,Clinica Eugin Modena, Modena, Italy.
| | - Elisa Mastellari
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
11
|
Abstract
Fertility represents a biological and psychological requirement for women. Some genetic diseases represent a rare cause of infertility, being responsible for 10% of cases of premature ovarian insufficiency. Among these, the most frequent and also those most studied by researchers are Turner Syndrome - due to a karyotype abnormality of the X chromosome pair - and the presence of fragile X premutation (FMR1). To exclude these conditions the diagnostic workup for non-iatrogenic premature ovarian insufficiency (POI) involves the performance of a karyotype analysis and the search for the FMR1 gene mutation, as well as the search for the presence of Y-chromosomal material. However, several other mutations and genetic syndromes associated with POI development have recently been highlighted, although they occur rarely, such as the GALT gene mutation in galactosemia or the FOXL2 gene mutation in BPES and many others, and further autosomal genetic testing are indicated if clinical suspicion is present. Mutations of BRCA 1 and 2 genes, make patients at genetically determined high risk of developing early ovarian or breast cancer and of getting POIs for the treatments they must undergo to prevent it (prophylactic bilateral oophorectomy) or treat it (chemotherapy). The management of impaired fertility is not less important than that of other syndromic manifestations for the quality of life of patients. Few data are available regarding the efficiency of cryopreservation of reproductive material (oocytes, embryos or ovarian tissue) in order to preserve fertility in this particular subgroup of patients, but certainly it represents a promising chance and a hope for the future.
Collapse
Affiliation(s)
- Elisa Mastellari
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonio La Marca
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy -
- Clinica Eugin Modena, Modena, Italy
| |
Collapse
|
12
|
Newcomb LK, Toal CT, Rindos NB, Wang L, Mansuria SM. Risk-reducing Bilateral Salpingo-oophorectomy: Assessing the Incidence of Occult Ovarian Cancer and Surgeon Adherence to Recommended Practices. J Minim Invasive Gynecol 2020; 27:1511-1515. [DOI: 10.1016/j.jmig.2020.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 12/29/2019] [Accepted: 01/01/2020] [Indexed: 11/15/2022]
|
13
|
Abstract
OBJECTIVE To perform a systematic review of the literature to estimate the prevalence and outcomes of occult tubal carcinoma in BRCA mutation carriers and high-risk patients undergoing risk-reducing salpingo-oophorectomy. DATA SOURCE A search was done using OVID MEDLINE, EMBASE, and ClinicalTrials.gov between 1946 and March 2019 with keywords and MeSH terms selected by an expert medical librarian and coauthors. METHODS OF STUDY SELECTION Two independent reviewers performed study selection with an initial screen on abstracts and a second on full articles. Articles were rejected if they were irrelevant to the study question, pertained to a different population or did not report occult tubal neoplasia. Quality was assessed using methodologic index for nonrandomized studies criteria. TABULATION, INTEGRATION, AND RESULTS Data were extracted and recorded in an Excel database. Forest plots for the prevalence of occult carcinoma were done using STATA. Among 2,402 studies assessed, 27 met the inclusion criteria for qualitative and quantitative analysis. A total of 6,283 patients underwent risk-reducing salpingo-oophorectomy between 2002 and 2019: 2,894 cases were BRCA1, 1,579 BRCA2, and 1,810 high-risk based on family history. Among these, 75 patients were diagnosed with occult tubal carcinoma at the time of surgery. The pooled prevalence was 1.2% (I=7.1%, P=.363) occurring at a median age of 53.2 years (range 42.4-67). In a subanalysis of 18 studies reporting follow-up data, 10 recurrences (18.7%, 95% CI 7.5-53%) and 24 cases of post-risk-reducing salpingo-oophorectomy peritoneal cancer (0.54%, 95% CI 0.4-1.9%) were reported after a median follow-up of 52.5 months. BRCA1, older age, and previous breast cancer were more often associated with occult malignancy. CONCLUSION Occult tubal carcinomas found at risk-reducing salpingo-oophorectomy in high-risk patients and BRCA mutation carriers have significant potential for recurrence despite the frequent administration of postoperative chemotherapy.
Collapse
|
14
|
Health Care Provider Adherence to Surgical Guidelines for Risk-Reducing Salpingo-Oophorectomy. Obstet Gynecol 2020; 134:520-526. [PMID: 31403600 DOI: 10.1097/aog.0000000000003421] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate health care provider adherence to the surgical protocol endorsed by the National Comprehensive Cancer Network and the American College of Obstetricians and Gynecologists at the time of risk-reducing salpingo-oophorectomy and compare adherence between gynecologic oncologists and obstetrician-gynecologists (ob-gyns). METHODS In this multicenter retrospective cohort study, women were included if they had a pathogenic BRCA mutation and underwent risk-reducing salpingo-oophorectomy between 2011 and 2017. Adherence was defined as completing all of the following: collection of washings, complete resection of the fallopian tube, and performing the Sectioning and Extensively Examining the Fimbriated End (SEE-FIM) pathologic protocol. RESULTS Of 290 patients who met inclusion criteria, 160 patients were treated by 18 gynecologic oncologists and 130 patients by 75 ob-gyns. Surgery was performed at 10 different hospitals throughout a single metropolitan area. Demographic and clinical characteristics were similar between groups. Overall, 199 cases (69%) were adherent to the surgical protocol. Gynecologic oncologists were more than twice as likely to fully adhere to the full surgical protocol as ob-gyns (91% vs 41%, P<.01). Specifically, gynecologic oncologists were more likely to resect the entire tube (99% vs 95%, P=.03), to have followed the SEE-FIM protocol (98% vs 82%, P<.01), and collect washings (94% vs 49%, P<.01). Complication rates did not differ between groups. Occult neoplasia was diagnosed in 11 patients (3.8%). The incidence of occult neoplasia was 6.3% in gynecologic oncology patients and 0.8% in obstetrics and gynecology patients (P=.03). CONCLUSION Despite clear surgical guidelines, only two thirds of all health care providers were fully adherent to guidelines. Gynecologic oncologists were more likely to follow surgical guidelines compared with general ob-gyns and more likely to diagnose occult neoplasia despite similar patient populations. Rates of risk-reducing surgery will likely continue to increase as genetic testing becomes more widespread, highlighting the importance of health care provider education for this procedure. Centralized care or referral to subspecialists for risk-reducing salpingo-oophorectomy may be warranted.
Collapse
|
15
|
Cheng A, Li L, Wu M, Lang J. Pathological findings following risk-reducing salpingo-oophorectomy in BRCA mutation carriers: A systematic review and meta-analysis. Eur J Surg Oncol 2019; 46:139-147. [PMID: 31521389 DOI: 10.1016/j.ejso.2019.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/23/2019] [Accepted: 09/04/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To evaluate the benefit of risk-reducing salpingo-oophorectomy (RRSO) by estimating the pathological positive rate of occult lesions, including serous tubal intraepithelial carcinoma (STIC) and occult cancers (OCCs). METHODS BRCA1/2 mutation carriers who underwent RRSO in a Chinese study center between 2014 and 2018 were included. A literature review was performed, followed by a meta-analysis of the literature to further validate the findings. RESULTS Twenty-four BRCA1/2 mutation carriers who underwent RRSO were identified; one patient (4.2%) had STIC, and one patient (4.2%) had occult fallopian tube cancer complicated by STIC. Thirty-four articles were ultimately included in the meta-analysis. Of the reported cases of OCC, 61.3% occurred in the fallopian tubes and 32.3% in the ovaries, and 81.5% were in the early stages. The estimated rate of overall pathological positive events was 5%. The estimated rates of overall STIC events and OCC were 1% and 3%, respectively. The rates of STIC and OCC were 1% and 3%, respectively, for BRCA1 mutation carriers and 1% and 1%, respectively, for BRCA2 mutation carriers. No significant difference was observed between the results of a routine examination of pathological sections and those of the Sectioning and Extensively Examining the Fimbriae (SEE-FIM) protocol. CONCLUSIONS This study is the first report of RRSO results in China. In this systematic review, the positive rates of STIC or OCC after RRSO were no more than 3%, which are 200-fold higher than the risk of the general population. The use of a strict SEE-FIM protocol would likely increase positive results.
Collapse
Affiliation(s)
- Aoshuang Cheng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, 100730, China.
| | - Lei Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, 100730, China.
| | - Ming Wu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, 100730, China.
| | - Jinghe Lang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, 100730, China.
| |
Collapse
|
16
|
Secoșan C, Balint O, Pirtea L, Grigoraș D, Bălulescu L, Ilina R. Surgically Induced Menopause-A Practical Review of Literature. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E482. [PMID: 31416275 PMCID: PMC6722518 DOI: 10.3390/medicina55080482] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 07/31/2019] [Accepted: 08/09/2019] [Indexed: 01/12/2023]
Abstract
Menopause can occur spontaneously (natural menopause) or it can be surgically induced by oophorectomy. The symptoms and complications related to menopause differ from one patient to another. We aimed to review the similarities and differences between natural and surgically induced menopause by analyzing the available data in literature regarding surgically induced menopause and the current guidelines and recommendations, the advantages of bilateral salpingo-oophorectomy in low and high risk patients, the effects of surgically induced menopause and to analyze the factors involved in decision making.
Collapse
Affiliation(s)
- Cristina Secoșan
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy "Victor Babeş", 300041 Timişoara, Romania
| | - Oana Balint
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy "Victor Babeş", 300041 Timişoara, Romania.
| | - Laurențiu Pirtea
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy "Victor Babeş", 300041 Timişoara, Romania
| | - Dorin Grigoraș
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy "Victor Babeş", 300041 Timişoara, Romania
| | - Ligia Bălulescu
- Department of Obstetrics and Gynecology, County Hospital Timişoara, 300172 Timişoara, Romania
| | - Răzvan Ilina
- Department of Surgery, University of Medicine and Pharmacy "Victor Babeş", 300041 Timişoara, Romania
| |
Collapse
|
17
|
Toss A, Molinaro E, Sammarini M, Del Savio MC, Cortesi L, Facchinetti F, Grandi G. Hereditary ovarian cancers: state of the art. Minerva Med 2019; 110:301-319. [DOI: 10.23736/s0026-4806.19.06091-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
18
|
Peccatori FA, Mangili G, Bergamini A, Filippi F, Martinelli F, Ferrari F, Noli S, Rabaiotti E, Candiani M, Somigliana E. Fertility preservation in women harboring deleterious BRCA mutations: ready for prime time? Hum Reprod 2019; 33:181-187. [PMID: 29207007 DOI: 10.1093/humrep/dex356] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 11/09/2017] [Indexed: 12/31/2022] Open
Abstract
Fertility issues have become critical in the management and counseling of BRCA mutation carriers. In this setting four points deserve consideration. (1) Women in general lose their ability to conceive at a mean age of 41 years, thus the suggested policy of prophylactic bilateral salpingo-oophorectomy at age 40 for BRCA mutation carriers does not affect the chances of natural pregnancy. Conversely, if the procedure is chosen at 35 years old, oocyte cryopreservation prior to surgery should be considered. (2) Some evidence suggests that ovarian reserve may actually be partly reduced in BRCA mutations carriers and that the mutation may affect ovarian responsiveness to stimulation. However, these findings are still controversial. (3) Breast cancer is not rare before the age of 40 and fertility preservation after diagnosis can be requested in a significant proportion of BRCA mutation carriers. Thus, a policy of oocyte cryopreservation in young healthy carriers deserves consideration. The procedure could be considered at a young age and in an elective setting, when ovarian stimulation may yield more oocytes of better quality. (4) Preimplantation genetic diagnosis (PGD) could be considered in BRCA mutations carriers, particularly when good quality oocytes have been stored at a young age. Based on the current knowledge, a univocal approach cannot be recommended; in depth patient counseling is warranted.
Collapse
Affiliation(s)
- Fedro Alessandro Peccatori
- Fertility and Procreation Unit, Division of Gynecologic Oncology, European Institute of Oncology, Via S. Luca 8, 20122 Milan, Italy
| | - Giorgia Mangili
- Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Alice Bergamini
- Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Francesca Filippi
- Obstetrics and Gynecology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda 12, 20122 Milan, Italy
| | - Fabio Martinelli
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Via G. Venezian, 1, 20133 Milan, Italy
| | - Federica Ferrari
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Via S. Luca 8, 20122 Milan, Italy
| | - Stefania Noli
- Fertility and Procreation Unit, Division of Gynecologic Oncology, European Institute of Oncology, Via S. Luca 8, 20122 Milan, Italy.,Obstetrics and Gynecology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda 12, 20122 Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Festa del Perdono, 20122 Milan, Italy
| | - Emanuela Rabaiotti
- Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Massimo Candiani
- Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Edgardo Somigliana
- Obstetrics and Gynecology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda 12, 20122 Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Festa del Perdono, 20122 Milan, Italy
| |
Collapse
|
19
|
Gschwantler-Kaulich D, Weingartshofer S, Rappaport-Fürhauser C, Zeilinger R, Pils D, Muhr D, Braicu EI, Kastner MT, Tan YY, Semmler L, Sehouli J, Singer CF. Diagnostic markers for the detection of ovarian cancer in BRCA1 mutation carriers. PLoS One 2017; 12:e0189641. [PMID: 29244844 PMCID: PMC5731824 DOI: 10.1371/journal.pone.0189641] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 11/28/2017] [Indexed: 11/18/2022] Open
Abstract
Background Screening for ovarian cancer (OC) in women at high risk consists of a combination of carbohydrate antigen 125 (CA125) and transvaginal ultrasound, despite their low sensitivity and specificity. This could be improved by the combination of several biomarkers, which has been shown in average risk patients but has not been investigated until now in female BRCA mutation carriers. Methods Using a multiplex, bead-based, immunoassay system, we analyzed the concentrations of leptin, prolactin, osteopontin, insulin-like growth factor II, macrophage inhibitory factor, CA125 and human epididymis antigen 4 in 26 healthy wild type women, 26 healthy BRCA1 mutation carriers, 28 wildtype OC patients and 26 OC patients with BRCA1 mutation. Results Using the ROC analysis, we found a high overall sensitivity of 94.3% in differentiating healthy controls from OC patients with comparable results in the wildtype subgroup (sensitivity 92.8%, AUC = 0.988; p = 5.2e-14) as well as in BRCA1 mutation carriers (sensitivity 95.2%, AUC = 0.978; p = 1.7e-15) at an overall specificity of 92.3%. The used algorithm also allowed to identify healthy BRCA1 mutation carriers when compared to healthy wildtype women (sensitivity 88.4%, specificity 80.7%, AUC = 0.895; p = 6e-08), while this was less pronounced in patients with OC (sensitivity 66.7%, specificity 67.8%, AUC = 0.724; p = 0.00065). Conclusion We have developed an algorithm, which can differentiate between healthy women and OC patients and have for the first time shown, that such an algorithm can also be used in BRCA mutation carriers. To clarify a suggested benefit to the existing early detection program, large prospective trials with mainly early stage OC cases are warranted.
Collapse
Affiliation(s)
- Daphne Gschwantler-Kaulich
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria
- * E-mail:
| | - Sigrid Weingartshofer
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria
| | | | - Robert Zeilinger
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria
| | - Dietmar Pils
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics, and Intelligent Systems (CeMSIIS), Medical University of Vienna, Vienna, Austria
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Daniela Muhr
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria
| | - Elena I. Braicu
- Department of Gynecology with Center for Oncological Surgery, European Competence Center for Ovarian Cancer, Charité - Campus Virchow-Klinikum, University Medicine of Berlin, Berlin, Germany
| | - Marie-Therese Kastner
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria
| | - Yen Y. Tan
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria
- QIMR Berghofer Medical Research Institute, Herston QLD, Australia
| | - Lorenz Semmler
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, European Competence Center for Ovarian Cancer, Charité - Campus Virchow-Klinikum, University Medicine of Berlin, Berlin, Germany
| | - Christian F. Singer
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria
| |
Collapse
|
20
|
Malacarne DR, Boyd LR, Long Y, Blank SV. "Best practices in risk reducing bilateral salpingo-oophorectomy: the influence of surgical specialty". World J Surg Oncol 2017; 15:218. [PMID: 29228967 PMCID: PMC5725804 DOI: 10.1186/s12957-017-1282-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 11/23/2017] [Indexed: 11/11/2022] Open
Abstract
Background Risk-reducing bilateral salpingo-oophorectomy (RRBSO) increases survival in patients at high risk of developing ovarian cancer. While many general gynecologists perform this procedure, some argue it should be performed exclusively by specialists. In this retrospective observational study, we identified how often optimal techniques were used and whether surgeons’ training impacted implementation. Methods We used the ACOG guidelines highlighting various aspects of the procedure to determine which elements were consistent with best practices to maximize surgical prophylaxis. All cases of RRBSO from 2006 to 2010 were identified. We abstracted data from the operative and pathology reports to review the techniques employed. Fisher’s exact test and chi-square were utilized to compare differences between groups (InStat, La Jolla, CA). Results Among 263 RRBSOs, 22 were performed by general gynecologists and 241 by gynecologic oncologists. Gynecologic oncologists were more likely to perform pelvic washings—217/241 vs. 10/22 (p < .0001). They were more likely to include a description of the upper abdomen—220/241 vs. 12/22 (p < .0001). Oncologists were more likely to utilize a retroperitoneal approach to skeletonize the infundibulopelvic ligaments—157/241 vs. 3/22 (p < .0001). When operations were performed by oncologists, the specimens were more often completely sectioned—217/241 vs. 16/22 (p = .003). The use of a retroperitoneal approach among gynecologic oncologists increased over the study period (chi-square for trend, p < .0001). There was no visible trend in performance improvement in any other area when looking at either group. Conclusion Gynecologic oncologists are more likely to adhere to best practice techniques when performing RRBSO, though there was room for improvement for both groups.
Collapse
Affiliation(s)
- Dominique R Malacarne
- Department of Obstetrics and Gynecology, New York University School of Medicine, 462 1st Avenue, Rm 9 E2, New York, NY, 10016, USA.
| | - Leslie R Boyd
- Department of Obstetrics and Gynecology, New York University School of Medicine, 462 1st Avenue, Rm 9 E2, New York, NY, 10016, USA
| | - Yang Long
- Department of Obstetrics and Gynecology, New York University School of Medicine, 462 1st Avenue, Rm 9 E2, New York, NY, 10016, USA
| | - Stephanie V Blank
- Department of Obstetrics and Gynecology, New York University School of Medicine, 462 1st Avenue, Rm 9 E2, New York, NY, 10016, USA
| |
Collapse
|
21
|
Abstract
Ovarian cancer remains to be the most lethal of all gynecologic malignancies. There is no effective screening test proven to reduce the mortality associated with this disease. Costs of treating ovarian cancer are substantial and among the highest of all cancer types. Therefore, it is essential to pursue strategies to prevent ovarian cancer that are cost-effective in the context of our health care system. There are 2 subgroups of women for whom ovarian cancer prevention strategies have been evaluated for effectiveness and costs: (1) general population at risk, and (2) BRCA mutation carriers with a high lifetime risk.
Collapse
|
22
|
Hereditary Ovarian Cancer and Risk Reduction. Best Pract Res Clin Obstet Gynaecol 2017; 41:31-48. [DOI: 10.1016/j.bpobgyn.2016.10.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 10/11/2016] [Accepted: 10/15/2016] [Indexed: 01/13/2023]
|
23
|
Baldwin LA, Chen Q, Tucker TC, White CG, Ore RN, Huang B. Ovarian Cancer Incidence Corrected for Oophorectomy. Diagnostics (Basel) 2017; 7:E19. [PMID: 28368298 PMCID: PMC5489939 DOI: 10.3390/diagnostics7020019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 03/01/2017] [Accepted: 03/18/2017] [Indexed: 01/01/2023] Open
Abstract
Current reported incidence rates for ovarian cancer may significantly underestimate the true rate because of the inclusion of women in the calculations who are not at risk for ovarian cancer due to prior benign salpingo-oophorectomy (SO). We have considered prior SO to more realistically estimate risk for ovarian cancer. Kentucky Health Claims Data, International Classification of Disease 9 (ICD-9) codes, Current Procedure Terminology (CPT) codes, and Kentucky Behavioral Risk Factor Surveillance System (BRFSS) Data were used to identify women who have undergone SO in Kentucky, and these women were removed from the at-risk pool in order to re-assess incidence rates to more accurately represent ovarian cancer risk. The protective effect of SO on the population was determined on an annual basis for ages 5-80+ using data from the years 2009-2013. The corrected age-adjusted rates of ovarian cancer that considered SO ranged from 33% to 67% higher than age-adjusted rates from the standard population. Correction of incidence rates for ovarian cancer by accounting for women with prior SO gives a better understanding of risk for this disease faced by women. The rates of ovarian cancer were substantially higher when SO was taken into consideration than estimates from the standard population.
Collapse
Affiliation(s)
- Lauren A Baldwin
- The Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Kentucky College of Medicine, 800 Rose Street, 330 Whitney-Hendrickson Building, Lexington, KY 40536, USA.
| | - Quan Chen
- Division of Cancer Biostatistics, College of Public Health & Biostatistics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, KY 40506, USA.
| | - Thomas C Tucker
- Department of Epidemiology, College of Public Health & Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, KY 40506, USA.
| | - Connie G White
- Kentucky Department for Public Health, Frankfort, KY 40601, USA.
| | - Robert N Ore
- The Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Kentucky College of Medicine, 800 Rose Street, 330 Whitney-Hendrickson Building, Lexington, KY 40536, USA.
| | - Bin Huang
- Division of Cancer Biostatistics, College of Public Health & Biostatistics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, KY 40506, USA.
| |
Collapse
|
24
|
Occult and subsequent cancer incidence following risk-reducing surgery in BRCA mutation carriers. Gynecol Oncol 2016; 143:231-235. [PMID: 27623252 DOI: 10.1016/j.ygyno.2016.08.336] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 08/24/2016] [Accepted: 08/31/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To report the frequency and features of occult carcinomas and the incidence of subsequent cancers following risk-reducing salpingo-oophorectomy (RRSO) in BRCA mutation carriers. METHODS 257 consecutive women with germline BRCA mutations who underwent RRSO between January 1, 2000 and December 31, 2014 were identified in an Institutional Review Board approved study. All patients were asymptomatic with normal physical exams, CA 125 values, and imaging studies preoperatively, and had at least 12months of follow-up post-RRSO. All patients had comprehensive adnexal sectioning performed. Patient demographics and clinico-pathologic characteristics were extracted from medical and pathology records. RESULTS The cohort included 148 BRCA1, 98 BRCA2, 6 BRCA not otherwise specified (NOS), and 5 BRCA1 and 2 mutation carriers. Occult carcinoma was seen in 14/257 (5.4%) of patients: 9 serous tubal intraepithelial carcinomas (STIC), 3 tubal cancers, 1 ovarian cancer, and 1 endometrial cancer. Three patients (1.2%) with negative pathology at RRSO subsequently developed primary peritoneal serous carcinoma (PPSC), and 2 of 9 patients (22%) with STIC subsequently developed pelvic serous carcinoma. 110 women (43%) were diagnosed with breast cancer prior to RRSO, and 14 of the remaining 147 (9.5%) developed breast cancer following RRSO. Median follow-up of the cohort was 63months. CONCLUSION In this cohort, 5.4% of asymptomatic BRCA mutation carriers had occult carcinomas at RRSO, 86% of which were tubal in origin. The risk of subsequent PPSC for women with benign adnexa at RRSO is low; however, the risk of pelvic serous carcinoma among women with STIC is significantly higher.
Collapse
|
25
|
Ludwig KK, Neuner J, Butler A, Geurts JL, Kong AL. Risk reduction and survival benefit of prophylactic surgery in BRCA mutation carriers, a systematic review. Am J Surg 2016; 212:660-669. [PMID: 27649974 DOI: 10.1016/j.amjsurg.2016.06.010] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/28/2016] [Accepted: 06/17/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Mutations in BRCA1 or BRCA2 genes results in an elevated risk for developing both breast and ovarian cancers over the lifetime of affected carriers. General surgeons may be faced with questions about surgical risk reduction and survival benefit of prophylactic surgery. METHODS A systematic literature review was performed using the electronic databases PubMed, OVID MEDLINE, and Scopus comparing prophylactic surgery vs observation with respect to breast and ovarian cancer risk reduction and mortality in BRCA mutation carriers. RESULTS Bilateral risk-reducing mastectomy provides a 90% to 95% risk reduction in BRCA mutation carriers, although the data do not demonstrate improved mortality. The reduction in ovarian and breast cancer risks using risk-reducing bilateral salpingo-oophorectomy has translated to improvement in survival. CONCLUSIONS Clinical management of patients at increased risk for breast cancer requires consideration of risk, patient preference, and quality of life.
Collapse
Affiliation(s)
- Kandice K Ludwig
- Department of Surgery, Indiana University School of Medicine, Carmel, IN, USA
| | - Joan Neuner
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Annabelle Butler
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA
| | - Jennifer L Geurts
- Human and Molecular Genetics Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Amanda L Kong
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
| |
Collapse
|
26
|
Weitzel JN. The Genetics of Breast Cancer: What the Surgical Oncologist Needs to Know. Surg Oncol Clin N Am 2016; 24:705-32. [PMID: 26363538 DOI: 10.1016/j.soc.2015.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This article summarizes the impact of germline predisposition to breast cancer on the surgical management of breast cancer and breast cancer risk. Surgical implications of germline predisposition to breast cancer are now more nuanced due to the application of increasingly more complicated next-generation sequencing-based tests. The rapid pace of change will continue to challenge paradigms for genetic cancer risk assessment, which can influence the medical and surgical management of breast cancer risk as well as strategies for screening and for risk reduction.
Collapse
Affiliation(s)
- Jeffrey N Weitzel
- Division of Clinical Cancer Genetics, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010, USA.
| |
Collapse
|
27
|
Lefringhouse JR, Neward E, Ueland FR, Baldwin LA, Miller RW, DeSimone CP, Kryscio RJ, van Nagell JR, Pavlik EJ. Probability of fallopian tube and ovarian detection with transvaginal ultrasonography in normal women. ACTA ACUST UNITED AC 2016; 12:303-11. [PMID: 27189894 PMCID: PMC5384515 DOI: 10.2217/whe.15.111] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: Some ovarian malignancies may originate in the fallopian tube. The feasibility of ultrasonographically visualizing the fallopian tube is presented. Methods: In total, 549 normal women participated in the fallopian tube visualization trial, while ovarian visualization was studied in 43,521. Chi-square analysis, t-tests and multivariate analysis determined significance and interactions. Results: Ovaries were observed in 82.7% while fallopian tubes were detected in 77.2% of women and 85.2% of the time when an ovary was detected. Age, BMI or parity was not significantly different when one or both fallopian tubes were visualized. Elevated BMI had slightly greater influence than age in limiting visualization of the fallopian tubes in multivariate analysis. Conclusion: Fallopian tubes can often be identified sonographically. Ovarian visualization provides the strongest indicator favoring fallopian tube detection. Thus, ultrasonographic examinations for adnexal cancer could include evaluation of fallopian tubes even in women >60 years and in women with BMI ≥25.
Collapse
Affiliation(s)
- Jason R Lefringhouse
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Kentucky Chandler Medical Center-Markey Cancer Center, Lexington, KY 40536-0293, USA
| | - Erin Neward
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Kentucky Chandler Medical Center-Markey Cancer Center, Lexington, KY 40536-0293, USA
| | - Frederick R Ueland
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Kentucky Chandler Medical Center-Markey Cancer Center, Lexington, KY 40536-0293, USA
| | - Lauren A Baldwin
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Kentucky Chandler Medical Center-Markey Cancer Center, Lexington, KY 40536-0293, USA
| | - Rachel W Miller
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Kentucky Chandler Medical Center-Markey Cancer Center, Lexington, KY 40536-0293, USA
| | - Christopher P DeSimone
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Kentucky Chandler Medical Center-Markey Cancer Center, Lexington, KY 40536-0293, USA
| | - Richard J Kryscio
- Department of Statistics, University of Kentucky, Lexington, KY 40536-0293, USA
| | - John R van Nagell
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Kentucky Chandler Medical Center-Markey Cancer Center, Lexington, KY 40536-0293, USA
| | - Edward J Pavlik
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Kentucky Chandler Medical Center-Markey Cancer Center, Lexington, KY 40536-0293, USA
| |
Collapse
|
28
|
Paluch-Shimon S, Pagani O, Partridge AH, Bar-Meir E, Fallowfield L, Fenlon D, Friedman E, Gelmon K, Gentilini O, Geraghty J, Harbeck N, Higgins S, Loibl S, Moser E, Peccatori F, Raanani H, Kaufman B, Cardoso F. Second international consensus guidelines for breast cancer in young women (BCY2). Breast 2016; 26:87-99. [DOI: 10.1016/j.breast.2015.12.010] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 12/19/2015] [Indexed: 11/12/2022] Open
|
29
|
Snyder CL, Casey MJ, Lynch HT. Should risk-reducing surgery in women from hereditary breast ovarian cancer families be confined to removal of the fallopian tubes with ovarian conservation? WOMENS HEALTH 2015; 11:423-7. [PMID: 26246179 DOI: 10.2217/whe.15.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Carrie L Snyder
- Department of Preventive Medicine & Public Health, Creighton University, HLSB Room 202, 2500 California Plaza, Omaha, NE 68178, USA
| | - Murray Joseph Casey
- Department of Preventive Medicine & Public Health, Creighton University, HLSB Room 202, 2500 California Plaza, Omaha, NE 68178, USA.,Department of Obstetrics & Gynecology, Creighton University, Omaha, NE 68178, USA
| | - Henry T Lynch
- Department of Preventive Medicine & Public Health, Creighton University, HLSB Room 202, 2500 California Plaza, Omaha, NE 68178, USA.,Department of Internal Medicine, Creighton University, Omaha, NE 68178, USA
| |
Collapse
|
30
|
Begum J, Ghose S, Palai P, Rathod S. Primary Fallopian Tube Carcinoma with the Classical Clinical Features: A Case Report. J Gynecol Surg 2015. [DOI: 10.1089/gyn.2014.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jasmina Begum
- Department of Obstetrics and Gynecology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - Seetesh Ghose
- Department of Obstetrics and Gynecology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - Pallavee Palai
- Department of Obstetrics and Gynecology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - Setu Rathod
- Department of Obstetrics and Gynecology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| |
Collapse
|
31
|
Sherman ME, Piedmonte M, Mai PL, Ioffe OB, Ronnett BM, Van Le L, Ivanov I, Bell MC, Blank SV, DiSilvestro P, Hamilton CA, Tewari KS, Wakeley K, Kauff ND, Yamada SD, Rodriguez G, Skates SJ, Alberts DS, Walker JL, Minasian L, Lu K, Greene MH. Pathologic findings at risk-reducing salpingo-oophorectomy: primary results from Gynecologic Oncology Group Trial GOG-0199. J Clin Oncol 2014; 32:3275-83. [PMID: 25199754 DOI: 10.1200/jco.2013.54.1987] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Risk-reducing salpingo-oophorectomy (RRSO) lowers mortality from ovarian/tubal and breast cancers among BRCA1/2 mutation carriers. Uncertainties persist regarding potential benefits of RRSO among high-risk noncarriers, optimal surgical age, and anatomic origin of clinically occult cancers detected at surgery. To address these topics, we analyzed surgical treatment arm results from Gynecologic Oncology Group Protocol-0199 (GOG-0199), the National Ovarian Cancer Prevention and Early Detection Study. PARTICIPANTS AND METHODS This analysis included asymptomatic high-risk women age ≥ 30 years who elected RRSO at enrollment. Women provided risk factor data and underwent preoperative cancer antigen 125 (CA-125) serum testing and transvaginal ultrasound (TVU). RRSO specimens were processed according to a standardized tissue processing protocol and underwent central pathology panel review. Research-based BRCA1/2 mutation testing was performed when a participant's mutation status was unknown at enrollment. Relationships between participant characteristics and diagnostic findings were assessed using univariable statistics and multivariable logistic regression. RESULTS Invasive or intraepithelial ovarian/tubal/peritoneal neoplasms were detected in 25 (2.6%) of 966 RRSOs (BRCA1 mutation carriers, 4.6%; BRCA2 carriers, 3.5%; and noncarriers, 0.5%; P < .001). In multivariable models, positive BRCA1/2 mutation status (P = .0056), postmenopausal status (P = .0023), and abnormal CA-125 levels and/or TVU examinations (P < .001) were associated with detection of clinically occult neoplasms at RRSO. For 387 women with negative BRCA1/2 mutation testing and normal CA-125 levels, findings at RRSO were benign. CONCLUSION Clinically occult cancer was detected among 2.6% of high-risk women undergoing RRSO. BRCA1/2 mutation, postmenopausal status, and abnormal preoperative CA-125 and/or TVU were associated with cancer detection at RRSO. These data can inform management decisions among women at high risk of ovarian/tubal cancer.
Collapse
Affiliation(s)
- Mark E Sherman
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Marion Piedmonte
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Phuong L Mai
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Olga B Ioffe
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Brigitte M Ronnett
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Linda Van Le
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Iouri Ivanov
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Maria C Bell
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Stephanie V Blank
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Paul DiSilvestro
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Chad A Hamilton
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Krishnansu S Tewari
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Katie Wakeley
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Noah D Kauff
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - S Diane Yamada
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Gustavo Rodriguez
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Steven J Skates
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - David S Alberts
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Joan L Walker
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Lori Minasian
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Karen Lu
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX
| | - Mark H Greene
- Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX.
| |
Collapse
|
32
|
First international consensus guidelines for breast cancer in young women (BCY1). Breast 2014; 23:209-20. [PMID: 24767882 DOI: 10.1016/j.breast.2014.03.011] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 03/25/2014] [Accepted: 03/25/2014] [Indexed: 01/23/2023] Open
Abstract
The 1st International Consensus Conference for Breast Cancer in Young Women (BCY1) took place in November 2012, in Dublin, Ireland organized by the European School of Oncology (ESO). Consensus recommendations for management of breast cancer in young women were developed and areas of research priorities were identified. This manuscript summarizes these international consensus recommendations, which are also endorsed by the European Society of Breast Specialists (EUSOMA).
Collapse
|
33
|
Mai PL, Loud JT, Greene MH. A major step forward for BRCA1/2-related cancer risk management. J Clin Oncol 2014; 32:1531-3. [PMID: 24687832 DOI: 10.1200/jco.2013.54.8925] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Phuong L Mai
- National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Jennifer T Loud
- National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Mark H Greene
- National Cancer Institute, National Institutes of Health, Rockville, MD
| |
Collapse
|
34
|
Estrogen controls the survival of BRCA1-deficient cells via a PI3K-NRF2-regulated pathway. Proc Natl Acad Sci U S A 2014; 111:4472-7. [PMID: 24567396 DOI: 10.1073/pnas.1324136111] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Mutations in the tumor suppressor BRCA1 predispose women to breast and ovarian cancers. The mechanism underlying the tissue-specific nature of BRCA1's tumor suppression is obscure. We previously showed that the antioxidant pathway regulated by the transcription factor NRF2 is defective in BRCA1-deficient cells. Reactivation of NRF2 through silencing of its negative regulator KEAP1 permitted the survival of BRCA1-null cells. Here we show that estrogen (E2) increases the expression of NRF2-dependent antioxidant genes in various E2-responsive cell types. Like NRF2 accumulation triggered by oxidative stress, E2-induced NRF2 accumulation depends on phosphatidylinositol 3-kinase-AKT activation. Pretreatment of mammary epithelial cells (MECs) with the phosphatidylinositol 3-kinase inhibitor BKM120 abolishes the capacity of E2 to increase NRF2 protein and transcriptional activity. In vivo the survival defect of BRCA1-deficient MECs is rescued by the rise in E2 levels associated with pregnancy. Furthermore, exogenous E2 administration stimulates the growth of BRCA1-deficient mammary tumors in the fat pads of male mice. Our work elucidates the basis of the tissue specificity of BRCA1-related tumor predisposition, and explains why oophorectomy significantly reduces breast cancer risk and recurrence in women carrying BRCA1 mutations.
Collapse
|
35
|
Powell CB. Risk reducing salpingo-oophorectomy for BRCA mutation carriers: Twenty years later. Gynecol Oncol 2014; 132:261-3. [DOI: 10.1016/j.ygyno.2014.01.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 07/09/2013] [Indexed: 10/25/2022]
|
36
|
Oliveira C, Duarte H, Bartosch C, Fernandes D. Small fallopian tube carcinoma with extensive upper abdominal dissemination: a case report. J Med Case Rep 2013; 7:252. [PMID: 24199600 PMCID: PMC3835416 DOI: 10.1186/1752-1947-7-252] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 09/09/2013] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Fallopian tube carcinoma is a rare gynecological malignancy with low accuracy detection preoperatively. The symptoms are unspecific and imaging can be misleading. Since it was first described in 1847, there have been only a little over 2000 case reports. CASE PRESENTATION This case report describes a 66-year-old Caucasian woman who presented with progressive diffuse abdominal pain, without other symptoms. After abdominopelvic magnetic resonance imaging, she was sent to the Portuguese Oncology Institute of Oporto with the suspicion of peritoneal carcinomatosis of unknown primary tumor. Due to a pelvic palpable mass (calcified giant uterine fibroid) she was directed to the Gynecology team. Surgery was performed and a large mass in her upper abdomen was identified. The extemporary examination revealed a high-grade adenocarcinoma. During surgery a small change of color and consistency of her left fallopian tube was noted and unilateral adnexectomy was performed. After pathologic and immunohistochemistry tests, the diagnosis of fallopian tube carcinoma with peritoneal dissemination was made. CONCLUSIONS This case is very unique in the way that a small primary fallopian tube carcinoma was able to disseminate to the upper abdominal quadrant with little pelvic dissemination. The symptoms and imaging were unspecific. Although a rare occurrence, we should not forget fallopian tube carcinoma in the differential diagnosis of peritoneal carcinomatosis, even in the absence of Latzke's triad.
Collapse
Affiliation(s)
- Carolina Oliveira
- Oncological Gynecology Department, Instituto Português de Oncologia do Porto, Rua Dr, António Bernardino de Almeida, 4200-072 Porto, Portugal.
| | | | | | | |
Collapse
|
37
|
Reitsma W, Mourits MJE, de Bock GH, Hollema H. Endometrium is not the primary site of origin of pelvic high-grade serous carcinoma in BRCA1 or BRCA2 mutation carriers. Mod Pathol 2013; 26:572-8. [PMID: 23080033 DOI: 10.1038/modpathol.2012.169] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Serous endometrial intraepithelial carcinoma has been proposed to be a potential precursor lesion of pelvic high-grade serous carcinoma. If true, an increased incidence of uterine papillary serous carcinomas would be expected in BRCA1 and BRCA2 mutation carriers, who are at high-risk of developing pelvic high-grade serous carcinoma. This study explored particularly the occurrence of uterine papillary serous carcinoma, as well as other endometrial cancers, following risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 germline mutation attending a tertiary multidisciplinary clinic. A consecutive series of women with a BRCA1 or BRCA2 mutation who had undergone risk-reducing salpingo-oophorectomy without hysterectomy at the University Medical Center Groningen from January 1996 until March 2012 were followed prospectively. They were crossed with the histopathology list of endometrial cancer diagnoses reported by the Dutch nationwide pathology database PALGA. To assess the risk of endometrial cancer, a standardized incidence ratio was calculated comparing the observed with the expected number of endometrial cancer cases. Overall, 201 BRCA1 and 144 BRCA2 mutation carriers at a median age of 50 years (range, 32-78) were analyzed. After a median follow-up period of 6 years, after risk-reducing salpingo-oophorectomy, two cases of endometrial cancer were diagnosed, whereas the expected number was 0.94 cases (standardized incidence ratio 2.13; 95% confidence interval 0.24-7.69; P=0.27). Both endometrial cancer cases were of the endometrioid histological subtype. We showed that the incidence of endometrial cancer following risk-reducing salpingo-oophorectomy, especially uterine papillary serous carcinoma, in women at high-risk of developing pelvic high-grade serous carcinoma is not increased. On the basis of our data, the hypothesis of serous endometrial intraepithelial carcinoma being an important precursor lesion of pelvic high-grade serous carcinoma seems unlikely. There is no need to add a prophylactic hysterectomy to risk-reducing salpingo-oophorectomy in BRCA1 or BRCA2 mutation carriers.
Collapse
Affiliation(s)
- Welmoed Reitsma
- Department of Gynecologic Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | | |
Collapse
|
38
|
Prophylactic Salpingectomy and Delayed Oophorectomy as an Alternative for BRCA Mutation Carriers. Obstet Gynecol 2013; 121:14-24. [DOI: 10.1097/aog.0b013e3182783c2f] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
39
|
Gianaroli L, Racowsky C, Geraedts J, Cedars M, Makrigiannakis A, Lobo RA. Best practices of ASRM and ESHRE: a journey through reproductive medicine. Fertil Steril 2012; 98:1380-94. [PMID: 23102857 DOI: 10.1016/j.fertnstert.2012.07.1164] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 07/25/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND The American Society for Reproductive Medicine (ASRM) and the European Society of Human Reproduction and Embryology (ESHRE) are the two largest societies in the world whose members comprise the major experts and professionals working in the field of reproductive medicine and embryology. These societies have never before had a joint scientific meeting. METHOD(S) A 3-day meeting was planned and took place in March of 2012. The goal was to present and debate key topics, as well as modes of practice in reproductive medicine and to discuss recent developments in the field. RESULT(S) Presentations by members of ASRM and ESHRE were of three types: 'state of the art' lectures, 'back-to-back' presentations of two points of view and debates. CONCLUSION(S) For the first time, ASRM and ESHRE held a joint meeting where a special emphasis was given to presentations on the hottest topics in the field. Although different opinions and approaches sometimes exist on the two sides of the Atlantic, an appreciation and acceptance of these differences was evident, and there was more commonality than divergence of opinion.
Collapse
Affiliation(s)
- Luca Gianaroli
- Reproductive Medicine Unit, S.I.S.Me.R., Bologna, Italy.
| | | | | | | | | | | |
Collapse
|
40
|
Gianaroli L, Racowsky C, Geraedts J, Cedars M, Makrigiannakis A, Lobo R. Best practices of ASRM and ESHRE: a journey through reproductive medicine. Hum Reprod 2012; 27:3365-79. [PMID: 23097354 DOI: 10.1093/humrep/des338] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The American Society for Reproductive Medicine (ASRM) and the European Society of Human Reproduction and Embryology (ESHRE) are the two largest societies in the world whose members comprise the major experts and professionals working in the field of reproductive medicine and embryology. These societies have never before had a joint scientific meeting. METHODS A 3-day meeting was planned and took place in March of 2012. The goal was to present and debate key topics, as well as modes of practice in reproductive medicine and to discuss recent developments in the field. RESULTS Presentations by members of ASRM and ESHRE were of three types: 'state of the art' lectures, 'back-to-back' presentations of two points of view and debates. CONCLUSIONS For the first time, ASRM and ESHRE held a joint meeting where a special emphasis was given to presentations on the hottest topics in the field. Although different opinions and approaches sometimes exist on the two sides of the Atlantic, an appreciation and acceptance of these differences was evident, and there was more commonality than divergence of opinion.
Collapse
Affiliation(s)
- L Gianaroli
- Reproductive Medicine Unit, SIS MeR, Bologna, Italy.
| | | | | | | | | | | |
Collapse
|
41
|
Improving mutation notification when new genetic information is identified in research: a trial of two strategies in familial breast cancer. Genet Med 2012; 15:187-94. [PMID: 22975758 DOI: 10.1038/gim.2012.115] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The Kathleen Cuningham Foundation Consortium for Research into Familial Aspects of Breast Cancer (kConFab) is a large-scale research study that notifies participants when new, personally relevant, information is discovered. In 2009, the (kConFab) instituted an intensive notification process to ensure at-risk individuals were effectively notified. This study (i) evaluated the impact of intensive notification on genetic testing uptake; (ii) identified those most likely to undergo testing postnotification; and (iii) identified those most likely to acknowledge that they had been notified. METHODS Clinical/demographic data were retrieved from the (kConFab) database. Logistic regression analyses were conducted to identify potential predictors of testing uptake and notification acknowledgment using IBM SPSS. RESULTS A total of 155 of 1,812 individuals underwent testing after standard notification (8.6%). In comparison, 23/291 individuals (7.9%) notified using the "intensive" approach underwent testing (χ(2) = 0.14; P = 0.71). After controlling for notification process, females and participants with a previous cancer were most likely to have undergone testing (P < 0.006). Older individuals (50+ years) were most likely to acknowledge they had been notified (P = 0.038). CONCLUSION Increasing the intensity of participant follow-up did not increase genetic testing uptake. The challenge to effectively notify participants, and increase the proportion whose risk is managed clinically, remains, particularly for males and individuals unaffected by cancer.Genet Med 2013:15(3):187-194.
Collapse
|
42
|
Maxwell KN, Domchek SM. Prophylactic Mastectomy and Risk-Reducing Salpingo-oophorectomy in BRCA1/2 Mutation Carriers. CURRENT BREAST CANCER REPORTS 2012. [DOI: 10.1007/s12609-012-0086-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
43
|
Support of the 'fallopian tube hypothesis' in a prospective series of risk-reducing salpingo-oophorectomy specimens. Eur J Cancer 2012; 49:132-41. [PMID: 22921157 DOI: 10.1016/j.ejca.2012.07.021] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 07/07/2012] [Accepted: 07/26/2012] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To determine the prevalence, localisation and type of occult (non)invasive cancer in risk-reducing salpingo-oophorectomy (RRSO) specimens in BRCA-mutation carriers and high-risk women from BRCA-negative families. METHODS A consecutive series of RRSO specimens of asymptomatic, screen-negative high-risk women were prospectively collected in our tertiary multidisciplinary cancer clinic from January 2000 until March 2012. All high-risk women in this study underwent genetic testing on BRCA-mutations. The surgico-pathological protocol comprised complete resection of ovaries and fallopian tubes, transverse sectioning at 2-3 mm (sectioning and extensively examining the fimbrial end [SEE-FIM] protocol from 2006) and double independent pathology review of morphologically deviant sections. RESULTS Three hundred and sixty RRSOs were performed in 188 BRCA1-carriers, 115 BRCA2-carriers and 57 BRCA-negative women at a median age of 44.0 years. Four occult invasive cancers were detected in BRCA-carriers (1.3%, 95%-confidence interval (CI) 0.03-2.61), all in BRCA1-carriers >40 years of age. All cancers, of which two tubal and two ovarian cancers, were FIGO-stage I/II. Three non-invasive serous intraepithelial carcinomas (STICs) were detected in BRCA-carriers (1.0%, 95%-CI 0.00-2.10). In BRCA-negative women one STIC was found (1.8%, 95%-CI 0.00-5.16), however she carried an unclassified variant in BRCA2. Total follow-up after RRSO was 1691 woman-years, in which one BRCA1-carrier developed peritoneal cancer (0.3%, 95%-CI 0.00-0.82). CONCLUSIONS A low prevalence of occult invasive cancer (1.1%) was found in young asymptomatic, screen-negative women at increased ovarian cancer risk undergoing RRSO. This study adds to the advice to perform RRSO in BRCA1-carriers before the age of 40. Our findings support the hypothesis of the fallopian tube as the primary site of origin of pelvic high-grade serous cancer.
Collapse
|
44
|
|
45
|
Kiely BE, Friedlander ML, Milne RL, Stanhope L, Russell P, Jenkins MA, Weideman P, McLachlan SA, Grant P, Hopper JL, Phillips KA. Adequacy of risk-reducing gynaecologic surgery in BRCA1 or BRCA2 mutation carriers and other women at high risk of pelvic serous cancer. Fam Cancer 2012; 10:505-14. [PMID: 21424757 PMCID: PMC3175342 DOI: 10.1007/s10689-011-9435-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The aim of this study was to describe the type of risk-reducing gynaecologic surgery (RRGS) and the extent of pathological evaluation being undertaken for Australasian women at high familial risk of pelvic serous cancer. Surgical and pathology reports were reviewed for women with BRCA1/BRCA2 mutations, or a family history of breast and ovarian cancer, who underwent RRGS between 1998 and 2008. "Adequate" surgery was defined as complete removal of all ovarian and extra-uterine fallopian tube tissue. "Adequate" pathology was defined as paraffin embedding of all removed ovarian and tubal tissue. Predictors of adequacy were assessed using logistic regression. There were 201 women, including 173 mutation carriers, who underwent RRGS. Of these, 91% had adequate surgery and 23% had adequate pathology. Independent predictors of adequate surgery were surgeon type (OR = 20; 95% CI 2-167; P = 0.005 for gynaecologic oncologists versus general gynaecologists), more recent surgery (OR = 1.33/year; 95% CI 1.07-1.67; P = 0.012) and younger patient age (OR = 0.93/year of age; 95% CI 0.87-0.99; P = 0.028). Independent predictors of adequate pathology were more recent surgery (OR = 1.26/year; 95% CI 1.06-1.49; P = 0.008) and surgeon type (OR = 3.1; 95% CI 1.4-6.7; P = 0.004 for gynaecologic oncologists versus general gynaecologists). Four serous ovarian cancers and one endometrioid endometrial cancer were detected during surgery or pathological examination. In conclusion Australasian women attending a specialist gynaecologic oncologist for RRGS are most likely to have adequate surgery and pathological examination. Additional education of clinicians and consumers is needed to ensure optimal surgery and pathology in these women.
Collapse
Affiliation(s)
- B E Kiely
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett St, Melbourne, VIC, 8006, Australia
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Risk-reducing salpingo-oophorectomy (RRSO) in BRCA mutation carriers: experience with a consecutive series of 111 patients using a standardized surgical-pathological protocol. Int J Gynecol Cancer 2011; 21:846-51. [PMID: 21670699 DOI: 10.1097/igc.0b013e31821bc7e3] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Women carriers of BRCA mutations often have occult malignancy found at the time of risk-reducing bilateral salpingo-oophorectomy (RRSO). We report outcomes in 111 consecutive BRCA-positive women who had RRSO using a rigorous surgical-pathological protocol from 1996 to 2008. METHOD We identified risk factors associated with finding an occult malignancy at RRSO with outcomes followed for a median of 61 months. RESULTS A total of 111 BRCA carriers elected RRSO, 10 patients [9.1%] had 14 sites of occult neoplasia. Two patients had invasive serous fallopian tube carcinoma (TSC) only, 1 patient had invasive serous ovarian carcinoma (OSC) only, 5 patients had tubal intraepithelial carcinoma (TIC) only, and 2 patients had multifocal lesions of the ovary (OSC) and TIC. Occult ovarian carcinomas were only detected in BRCA1 patients, and all BRCA2 carcinomas involved only the fallopian tube. The odds of finding occult carcinoma is 4 times greater (odds ratio, 4.3; 95% confidence interval, 1.06-20.7) in women older than 50 than in younger ones (P=0.023). A history of invasive breast cancer was associated with a reduced risk of occult carcinoma (odds ratio, 0.2; 95% confidence interval, 0.05-0.85). In median follow-up of 5 years, recurrence rate after detection of an occult carcinoma was 10% and the risk for primary peritoneal carcinoma was less than 1%. CONCLUSION A rigorous surgical protocol with meticulous pathologic review at RRSO yielded an overall detection rate of 9.1% for occult gynecological carcinoma in BRCA mutation carriers followed by a multidisciplinary team at a single institution. Primary peritoneal carcinoma after RRSO is rare.
Collapse
|
47
|
Yates MS, Meyer LA, Deavers MT, Daniels MS, Keeler ER, Mok SC, Gershenson DM, Lu KH. Microscopic and early-stage ovarian cancers in BRCA1/2 mutation carriers: building a model for early BRCA-associated tumorigenesis. Cancer Prev Res (Phila) 2011; 4:463-70. [PMID: 21278312 DOI: 10.1158/1940-6207.capr-10-0266] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Risk-reducing salpingo-oophorectomy (RRSO) is the cornerstone of ovarian cancer prevention in BRCA1/2 mutation carriers. Occult fallopian tube and ovarian cancers have been reported in a small percentage of BRCA1/2 mutation carriers undergoing RRSO. Here, we review our single-institution experience with RRSO in BRCA1/2 mutation carriers to characterize cases of microscopic cancers in these patients. At the time of RRSO, 7.9% of BRCA1 mutation carriers were diagnosed with microscopic fallopian tube or ovarian cancers and no cases were diagnosed in BRCA2 mutation carriers. The majority of the microscopic cancers include cases that were confined to the fallopian tubes, although there were also cases involving ovaries only or peritoneal washings only. This suggests that the site of origin may be in the ovary, fallopian tube, or peritoneum for BRCA-associated serous cancers. However, an analysis of early-stage (stages I and II) ovarian and fallopian tube cancers diagnosed in BRCA1/2 mutation carriers confirms that the ovary is a preferred site for tumor growth with 11 of 14 early-stage cancers having a dominant ovarian mass. Overall, these data suggest that cancer initiation may occur in the ovary, fallopian tube, or peritoneum, but tumor growth and progression are favored in the ovary. We present an updated model for BRCA1/2 mutation-associated ovarian and fallopian tube carcinogenesis, which may aid in identifying improved prevention strategies for high-risk women who delay or decline RRSO.
Collapse
Affiliation(s)
- Melinda S Yates
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77230, USA
| | | | | | | | | | | | | | | |
Collapse
|