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Metcalfe KA, Pal T, Narod SA, Armel S, Shickh S, Buckley K, Walters ST, Brennenstuhl S, Kinney AY. Theory-based behavior change intervention to increase uptake of risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 pathogenic variant: The PREVENT randomized controlled trial. Cancer Med 2023; 12:18246-18257. [PMID: 37602539 PMCID: PMC10524042 DOI: 10.1002/cam4.6417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/22/2023] Open
Abstract
OBJECTIVE To evaluate the effect of a theory-based behavioral intervention delivered by genetic counselors on the uptake of risk-reducing salpingo-oophorectomy (RRSO) at 12 and 24 months by women with a BRCA1 or BRCA2 pathogenic variant (PV) compared to women who received usual care. METHODS In this two-arm, multi-site randomized controlled trial participants were randomized to receive a theoretically-guided behavioral telephone intervention or usual care. Outcome data were collected at 12 and 24 months. Participants in the usual care arm were offered the intervention after 12 months. RESULTS Data on 107 participants were included in the analysis. There was no significant difference in the proportion of women who had a RRSO by 1 year (28.6%- intervention; 22.9%- usual care (p = 0.54)). At 1 year, women who received the intervention had significantly lower mean decisional conflict (pinteraction <0.001) and a higher mean knowledge score at one-year compared to usual care (pinteraction <0.001). At 2 years, 53.9% of participants in the intervention arm had RRSO compared to 32.6% in usual care (p = 0.05). CONCLUSIONS A theory-based behavioral intervention delivered by genetic counselors to women with a BRCA PV who chose not to have the recommended RRSO was effective at reducing decisional conflict and increasing knowledge in women with a BRCA1 or BRCA2 PV.
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Affiliation(s)
- Kelly A. Metcalfe
- Lawrence S. Bloomberg Faculty of NursingUniversity of TorontoTorontoOntarioCanada
- Women's College Research InstituteTorontoOntarioCanada
| | - Tuya Pal
- Vanderbilt‐Ingram Cancer Center at the Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | | | - Susan Armel
- Princess Margaret Cancer CentreTorontoOntarioCanada
| | - Salma Shickh
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoOntarioCanada
| | | | - Scott T. Walters
- University of North Texas Health Science CenterFort WorthTexasUSA
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of NursingUniversity of TorontoTorontoOntarioCanada
| | - Anita Y. Kinney
- Rutgers Cancer Institute of New JerseyNew BrunswickNew JerseyUSA
- Department of Biostatistics and Epidemiology, School of Public HealthRutgers UniversityPiscatawayNew JerseyUSA
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Mohr-Sasson A, Dadon T, Perri T, Rosenblat O, Friedman E, Korach J. Prophylactic salpingectomy with delayed oophorectomy as a two-staged alternative for primary prevention of ovarian cancer in BRCA1/2 mutation carriers: women's point of view. Menopause 2023; 30:476-479. [PMID: 36917763 DOI: 10.1097/gme.0000000000002168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVE This study aimed to determine BRCA -mutation carrier women's interest and acceptability of participating in a study examining prophylactic salpingectomy with delayed oophorectomy (PSDO) as an alternative to the current recommendation for bilateral salpingo-oophorectomy for risk reduction. METHODS This is a cross-sectional questionnaire-based study. All women visiting the high-risk clinics for hereditary breast and ovarian cancer in a single tertiary medical center were asked to complete a questionnaire concerning the two-stage approach from October 2018 to December 2019. Before completing the questionnaire, detailed explanation was given by a senior physician regarding the procedure, related background, possible risks, and benefits. RESULTS The study population included 293 women, of whom 183 (62.4%) were BRCA1 mutation carriers, 97 (33.1%) were BRCA2 mutation carriers, and 13 (4.4%) had unknown familial mutation. Risk-reducing surgery was completed in 160 (55.17%) of the women. First-degree and second-degree family history was reported in 166 (57.24%) and 52 (17.9%) of the women, respectively. Among women surveyed, more than half of the women (n = 66 [51%]) who had yet to undergo risk-reducing surgery reported interest in having PSDO. Similarly, among those who had already received prophylactic surgery, 64 (40%) also considered PSDO to be an acceptable alternative. Multivariate logistic regression analysis found family history of related malignancies to be the only independent factor associated with reduced interest in a study of PSDO (odds ratio, 0.15 [95% confidence interval, 0.29-0.77]; P = 0.02). CONCLUSIONS Overall, BRCA -mutation carrier women indicated interest in PSDO risk-reducing surgery, taking into consideration the potential additional risk. These findings suggest that a clinical study exploring the equivalence of PSDO as alternative treatment is feasible.
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Affiliation(s)
| | - Tal Dadon
- From the Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashome, Ramat Gan, Israel
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Isselhard A, Lautz Z, Rhiem K, Stock S. Assessing Psychological Morbidity in Cancer-Unaffected BRCA1/2 Pathogenic Variant Carriers: A Systematic Review. Curr Oncol 2023; 30:3590-3608. [PMID: 37185387 PMCID: PMC10136916 DOI: 10.3390/curroncol30040274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
Female BRCA1/2 pathogenic variant carriers have an increased lifetime risk for breast and ovarian cancer. Cancer-unaffected women who are newly diagnosed with this pathogenic variant may experience psychological distress because of imminent health threat. No comprehensible review on psychological morbidity in cancer-unaffected BRCA1/2 pathogenic variant carriers is currently available. This review aims to give an overview about all available the studies in which psychological outcomes have been assessed in cancer-unaffected BRCA1/2 pathogenic variant carriers, whether as a primary outcome or secondary measurement. A systematic search across four databases (Web of Science, PubMed, ScienceDirect, and EBSCO) was conducted. Studies had to report on cancer-unaffected pathogenic variant carriers (exclusively or separately) and use a validated measure of psychological morbidity to be eligible. Measures were only included if they were used in at least three studies. The final review consisted of 45 studies from 13 countries. Distress measures, including anxiety and cancer worry, were most often assessed. Most studies found a peak of distress immediately after genetic test result disclosure, with a subsequent decline over the following months. Only some studies found elevated distress in carriers compared to non-carriers in longer follow-ups. Depression was frequently investigated but largely not found to be of clinical significance. Quality of life seemed to be largely unaffected by a positive genetic test result, although there was some evidence that younger women, especially, were less satisfied with their role functioning in life. Body image has been infrequently assessed so far, but the evidence suggested that there may be a decrease in body image after genetic test result disclosure that may decrease further for women who opt for a prophylactic mastectomy. Across all the outcomes, various versions of instruments were used, often limiting the comparability among the studies. Hence, future research should consider using frequently used instruments, as outlined by this review. Finally, while many studies included cancer-unaffected carriers, they were often not reported on separately, which made it difficult to draw specific conclusions about this population.
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Prophylactic Radical Fimbriectomy with Delayed Oophorectomy in Women with a High Risk of Developing an Ovarian Carcinoma: Results of a Prospective National Pilot Study. Cancers (Basel) 2023; 15:cancers15041141. [PMID: 36831483 PMCID: PMC9954021 DOI: 10.3390/cancers15041141] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/07/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
Risk-reducing salpingo-oophorectomy is the gold standard for the prophylaxis of ovarian cancer in high-risk women. Due to significant adverse effects, 20-30% of women delay or refuse early oophorectomy. This prospective pilot study (NCT01608074) aimed to assess the efficacy of radical fimbriectomy followed by a delayed oophorectomy in preventing ovarian and pelvic invasive cancer (the primary endpoint) and to evaluate the safety of both procedures. The key eligibility criteria were pre-menopausal women ≥35 years with a high risk of ovarian cancer who refused a risk-reducing salpingo-oophorectomy. All the surgical specimens were subjected to the SEE-FIM protocol. From January 2012 to October 2014, 121 patients underwent RF, with 51 in an ambulatory setting. Occult neoplasia was found in two cases, with one tubal high-grade serous ovarian carcinoma. Two patients experienced grade 1 intraoperative complications. No early or delayed grade ≥3 post-operative complications occurred. After 7.3 years of median follow-up, no cases of pelvic invasive cancer have been noted. Three of the fifty-two patients developed de novo breast cancer. One BRCA1-mutated woman delivered twins safely. Twenty-five patients underwent menopause, including fifteen who had received chemotherapy for breast cancer, and twenty-three underwent menopause before the delayed oophorectomy, while two did not undergo a delayed oophorectomy at all. Overall, 46 women underwent a delayed oophorectomy. No abnormalities were found in any delayed oophorectomy specimens. Radical fimbriectomy followed by delayed oophorectomy appears to be a safe and well-tolerated risk-reducing approach, which avoids early menopause for patients with a high risk of breast and ovarian cancer.
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Zarbo C, Brugnera A, Frigerio L, Celi C, Compare A, Dessì V, Giordano R, Malandrino C, Sina FP, Strepparava MG, Tessitore IV, Ventura M, Fruscio R. Cancer Anxiety Mediates the Association Between Satisfaction With Medical Communication and Psychological Quality of Life After Prophylactic Bilateral Salpingo-Oophorectomy. Front Psychol 2022; 13:840931. [PMID: 35356354 PMCID: PMC8959915 DOI: 10.3389/fpsyg.2022.840931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/21/2022] [Indexed: 11/30/2022] Open
Abstract
Background Prophylactic Bilateral Salpingo-Oophorectomy (PBSO) reduces the risk of developing ovarian cancer. However, the psychological mechanisms that may affect post-surgery Quality of Life (QoL) among patients who underwent PBSO are still largely unknown. Thus, this study aimed at exploring the direct and indirect associations of satisfaction with medical communication and cancer anxiety on post-surgery QoL among women at high risk of developing ovarian cancer. Method Fifty-nine women (mean age: 50.64 ± 6.7 years) who underwent PBSO took part in this cross-sectional study, filling out a sociodemographic and clinical questionnaire, a battery of validated psychological measures and an ad hoc developed scale for the assessment of cancer anxiety. We first examined the correlations among all variables of interest, and then tested if cancer anxiety mediated the association between satisfaction with medical communication and post-surgery psychological QoL, controlling both for time from surgery and education. Results Post-surgery psychological QoL was unrelated from any sociodemographic or clinical variable. Cancer anxiety had a significant direct negative effect on psychological QoL, while satisfaction with medical communication had a significant positive direct effect on it. Finally, cancer anxiety significantly mediated the association between satisfaction with medical communication and post-surgery psychological QoL. Discussion Results suggest that post-surgery psychological QoL of patients who underwent PBSO may be increased with interventions, delivered in a genetic counselling setting, targeting quality of medical communication and cancer anxiety.
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Affiliation(s)
- Cristina Zarbo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Agostino Brugnera
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Luigi Frigerio
- Department of Obstetrics & Gynaecology, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Chiara Celi
- Clinical Psychology Unit, ASST-Monza, Monza, Italy
| | - Angelo Compare
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Valentina Dessì
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Rosalba Giordano
- Department of Obstetrics & Gynaecology, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Chiara Malandrino
- Department of Obstetrics & Gynaecology, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | | | - Maria Grazia Strepparava
- Clinical Psychology Unit, ASST-Monza, Monza, Italy.,Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | | | | | - Robert Fruscio
- Gynaecologic Surgery Unit, ASST-Monza, Monza, Italy.,Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
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Kershaw V, Hickey I, Wyld L, Jha S. The impact of risk reducing bilateral salpingo-oophorectomy on sexual function in BRCA1/2 mutation carriers and women with Lynch syndrome: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021; 265:7-17. [PMID: 34416580 DOI: 10.1016/j.ejogrb.2021.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE In the absence of an effective screening test, women with a high genetic predisposition for ovarian cancer are recommended to undergo risk-reducing bilateral salpingo-oophorectomy (RRBSO) once childbearing is complete. This reduces the risk of ovarian cancer by up to 96%, but can result in undesirable side effects, including menopausal symptoms and sexual dysfunction. We have performed a systematic review and meta-analysis to investigate the effect of RRBSO on sexual function in women at high risk of breast/and or ovarian cancer. METHODS A literature search of the AMED (Allied and complementary medicine), Embase and Medline databases was performed, using search terms including sexual function, risk reducing and oophorectomy. Results were filtered according to the PRISMA protocol. Quality assessment of studies was performed using the Newcastle-Ottawa scale. Data were pooled in meta-analysis. RESULTS There were 21 eligible studies, 10 of which reported sufficient data for meta-analysis. Most studies were retrospective cohort or observational studies. Fifteen of the 21 studies (71%) reported a negative impact of RRBSO on sexual function. Participant numbers ranged from 37 to 1522. Meta-analysis was performed with studies including 3201 patients. This demonstrated that RRBSO has a statistically significant negative impact on sexual function (SMD -0.63, [-0.82, -0.44], p = 0.03). There was a trend towards reduced sexual pleasure and increased discomfort but this did not reach statistical significance. There was minimal change in the frequency of sex. There was a significant increase in vaginal dryness post-RRBSO (SMD 9.25, [3.66, 14.83], p < 0.00001). There was no significant difference in sexual function between pre-menopausal and post-menopausal RRBSO. Hormone replacement therapy (HRT) did not abolish this negative impact. CONCLUSION Sexual function declines post RRBSO, independent of menopausal status. Comprehensive pre-operative counselling regarding anticipated menopausal and sexual symptoms is key to setting realistic patient expectations and minimising post-operative distress. Information and support regarding management of these side effects should be available to all patients.
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Affiliation(s)
- Victoria Kershaw
- Urogynaecology Department, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, United Kingdom.
| | - India Hickey
- Department of Oncology and Metabolism, Sheffield University, Sheffield S10 2SJ, United Kingdom.
| | - Lynda Wyld
- Department of Oncology and Metabolism, Sheffield University, Sheffield S10 2SJ, United Kingdom.
| | - Swati Jha
- Urogynaecology Department, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, United Kingdom.
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7
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Satisfaction with prophylactic risk-reducing salpingo-oophorectomy in BRCA mutation carriers is very high and little dependent on the participants' characteristics at surgery: a prospective study. ACTA ACUST UNITED AC 2021; 28:263-270. [PMID: 33534430 DOI: 10.1097/gme.0000000000001737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE BRCA carriers are recommended to undergo prophylactic risk-reducing salpingo-oophorectomy (RRSO). Possible adverse health impacts of RRSO, particularly when done before natural menopause, can reduce the long-term satisfaction with this risk-reducing strategy. The aim of this study was to prospectively evaluate the level of satisfaction of women undergoing RRSO, also in relation to some specific characteristics at RRSO. METHODS A prospective cohort study was performed in the Modena Family Cancer Clinic of the University Hospital of Modena (Italy). All BRCA1/2 confirmed mutation carriers who decided to undergo RRSO were recruited between 2016 and 2019. RESULTS Fifty-five women (29 BRCA1 and 26 BRCA2) (mean age: 50.4 ± 7.7 years [range 35-79]) were included with a mean follow-up after RRSO of 660.9 days (1.8 years) (range 35-1,688 days) (median: 549 days). No intraepithelial (Serous Tubal Intraepithelial Carcinoma)/invasive cancers were found (0%) at RRSO. No vasomotor symptoms at 1 month after surgery were reported by 11/22 (50%) premenopausal women at RRSO. All women (100%) with new "RRSO-caused" vasomotor symptoms with no previous breast cancer initiated postmenopausal hormone therapy. At the final follow-up the satisfaction rate (0-100 visual analog scale points) of the participants was 96.4 ± 8.6 points (range 62-100). To the question "Would you undergo RRSO again if it was proposed today? (0-100 visual analog scale points)" the answer was 99.4 ± 3.2 points (range 79-100). These scores were in general very high and did not change in the different groups according to pre/postmenopausal status at RRSO, cancer survivors versus healthy women at RRSO, BRCA status, hormone therapy users/nonusers after RRSO, "RRSO-caused" symptoms versus not RRSO-caused (P > 0.05). CONCLUSIONS Findings from this prospective study suggest that satisfaction with RRSO is very high and little dependent on the participants' characteristics at surgery. Women at high risk for ovarian cancer are very satisfied with their choice of risk-reduction strategy.
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Terra L, Hooning MJ, Heemskerk-Gerritsen BAM, van Beurden M, Roeters van Lennep JE, van Doorn HC, de Hullu JA, Mom C, van Dorst EBL, Mourits MJE, Slangen BFM, Gaarenstroom KN, Zillikens MC, Leiner T, van der Kolk L, Collee M, Wevers M, Ausems MGEM, van Engelen K, Berger LP, van Asperen CJ, Gomez-Garcia EB, van de Beek I, Rookus MA, Hauptmann M, Bleiker EM, Schagen SB, Aaronson NK, Maas AHEM, van Leeuwen FE. Long-Term Morbidity and Health After Early Menopause Due to Oophorectomy in Women at Increased Risk of Ovarian Cancer: Protocol for a Nationwide Cross-Sectional Study With Prospective Follow-Up (HARMOny Study). JMIR Res Protoc 2021; 10:e24414. [PMID: 33480862 PMCID: PMC7864779 DOI: 10.2196/24414] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 01/24/2023] Open
Abstract
Background BRCA1/2 mutation carriers are recommended to undergo risk-reducing salpingo-oophorectomy (RRSO) at 35 to 45 years of age. RRSO substantially decreases ovarian cancer risk, but at the cost of immediate menopause. Knowledge about the potential adverse effects of premenopausal RRSO, such as increased risk of cardiovascular disease, osteoporosis, cognitive dysfunction, and reduced health-related quality of life (HRQoL), is limited. Objective The aim of this study is to assess the long-term health effects of premenopausal RRSO on cardiovascular disease, bone health, cognitive functioning, urological complaints, sexual functioning, and HRQoL in women with high familial risk of breast or ovarian cancer. Methods We will conduct a multicenter cross-sectional study with prospective follow-up, nested in a nationwide cohort of women at high familial risk of breast or ovarian cancer. A total of 500 women who have undergone RRSO before 45 years of age, with a follow-up period of at least 10 years, will be compared with 250 women (frequency matched on current age) who have not undergone RRSO or who have undergone RRSO at over 55 years of age. Participants will complete an online questionnaire on lifestyle, medical history, cardiovascular risk factors, osteoporosis, cognitive function, urological complaints, and HRQoL. A full cardiovascular assessment and assessment of bone mineral density will be performed. Blood samples will be obtained for marker analysis. Cognitive functioning will be assessed objectively with an online neuropsychological test battery. Results This study was approved by the institutional review board in July 2018. In February 2019, we included our first participant. As of November 2020, we had enrolled 364 participants in our study. Conclusions Knowledge from this study will contribute to counseling women with a high familial risk of breast/ovarian cancer about the long-term health effects of premenopausal RRSO. The results can also be used to offer health recommendations after RRSO. Trial Registration ClinicalTrials.gov NCT03835793; https://clinicaltrials.gov/ct2/show/NCT03835793. International Registered Report Identifier (IRRID) DERR1-10.2196/24414
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Affiliation(s)
- Lara Terra
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Maartje J Hooning
- Department of Medical Oncology, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Marc van Beurden
- Department of Gynaecology, Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | | | - Helena C van Doorn
- Department for Gynaecologic Oncology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Joanne A de Hullu
- Department for Gynaecology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Constantijne Mom
- Department of Gynaecology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Eleonora B L van Dorst
- Department for Gynaecologic Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marian J E Mourits
- Department for Gynaecologic Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Brigitte F M Slangen
- Department for Gynaecology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Katja N Gaarenstroom
- Department of Gynaecology, Leiden University Medical Center, Leiden, Netherlands
| | - M Carola Zillikens
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Tim Leiner
- Department Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Lizet van der Kolk
- Family Cancer Clinic, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Margriet Collee
- Department for Clinical Genetics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Marijke Wevers
- Department for Clinical Genetics, Radboud University Medical Center, Nijmegen, Netherlands
| | - Margreet G E M Ausems
- Division of Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Klaartje van Engelen
- Department for Clinical Genetics, Amsterdam University Medical Centers, Vrije University Amsterdam, Amsterdam, Netherlands
| | - Lieke Pv Berger
- Department of Genetics, University Medical Center Groningen, Groningen, Netherlands
| | - Christi J van Asperen
- Department for Clinical Genetics, Leiden University Medical Center, Leiden, Netherlands
| | | | - Irma van de Beek
- Department for Clinical Genetics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Matti A Rookus
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Michael Hauptmann
- Brandenburg Medical School Theodor Fontane, Institute of Biostatistics and Registry Research, Neuruppin, Germany
| | - Eveline M Bleiker
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Sanne B Schagen
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Neil K Aaronson
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Flora E van Leeuwen
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
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Crandall CJ, Diamant AL, Maglione M, Thurston RC, Sinsheimer J. Genetic Variation and Hot Flashes: A Systematic Review. J Clin Endocrinol Metab 2020; 105:dgaa536. [PMID: 32797194 PMCID: PMC7538102 DOI: 10.1210/clinem/dgaa536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/10/2020] [Indexed: 12/26/2022]
Abstract
CONTEXT Approximately 70% of women report experiencing vasomotor symptoms (VMS, hot flashes and/or night sweats). The etiology of VMS is not clearly understood but may include genetic factors. EVIDENCE ACQUISITION We searched PubMed and Embase in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. We included studies on associations between genetic variation and VMS. We excluded studies focused on medication interventions or prevention or treatment of breast cancer. EVIDENCE SYNTHESIS Of 202 unique citations, 18 citations met the inclusion criteria. Study sample sizes ranged from 51 to 17 695. Eleven of the 18 studies had fewer than 500 participants; 2 studies had 1000 or more. Overall, statistically significant associations with VMS were found for variants in 14 of the 26 genes assessed in candidate gene studies. The cytochrome P450 family 1 subfamily A member 1 (CYP1B1) gene was the focus of the largest number (n = 7) of studies, but strength and statistical significance of associations of CYP1B1 variants with VMS were inconsistent. A genome-wide association study reported statistically significant associations between 14 single-nucleotide variants in the tachykinin receptor 3 gene and VMS. Heterogeneity across trials regarding VMS measurement methods and effect measures precluded quantitative meta-analysis; there were few studies of each specific genetic variant. CONCLUSIONS Genetic variants are associated with VMS. The associations are not limited to variations in sex-steroid metabolism genes. However, studies were few and future studies are needed to confirm and extend these findings.
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Affiliation(s)
- Carolyn J Crandall
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - Allison L Diamant
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | | | - Rebecca C Thurston
- University of Pittsburgh School of Medicine & Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Janet Sinsheimer
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
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Boerner T, Long Roche K. Salpingectomy for the Risk Reduction of Ovarian Cancer: Is It Time for a Salpingectomy-alone Approach? J Minim Invasive Gynecol 2020; 28:403-408. [PMID: 33038519 DOI: 10.1016/j.jmig.2020.09.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/28/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To summarize published evidence supporting current strategies for the prevention of epithelial ovarian cancer in women with a genetic, elevated risk for the development of this disease, as well as the emerging data on the novel salpingectomy with delayed oophorectomy (SDO) strategy. Furthermore, we will explore whether salpingectomy alone is a viable risk-reducing strategy for these women. We will also discuss current national guidelines for risk-reducing surgery based on patients' individual genetic predisposition. DATA SOURCES MEDLINE, PubMed, EMBASE, and the Cochrane Database, with a focus on randomized controlled trials and large prospective, observational studies. METHODS OF STUDY SELECTION The key search terms for our review included Medical Subject Headings: "salpingectomy," "ovarian cancer," and "risk-reducing surgery." TABULATION, INTEGRATION, AND RESULTS The fallopian tube is now well established as the site of origin for most ovarian cancers, particularly high-grade serous carcinomas. This finding has led to the development of new preventive surgical techniques, such as SDO, which may be associated with fewer side effects. However, until the results of ongoing trials are reported and the impact of SDO on ovarian cancer risk reduction is established, it should not be recommended outside of clinical trials, and bilateral salpingo-oophorectomy remains the treatment of choice for risk-reducing surgery, especially in women with a genetic, high risk for ovarian cancer. CONCLUSION The decision to undergo risk-reducing surgery among women with an elevated risk for ovarian cancer should be made after comprehensive consultation and individually based on genetic predisposition, childbearing status, and personal preference.
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Affiliation(s)
- Thomas Boerner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (all authors); Department of Obstetrics and Gynecology, Weill Cornell Medical College (Dr. Long Roche), New York, New York
| | - Kara Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (all authors); Department of Obstetrics and Gynecology, Weill Cornell Medical College (Dr. Long Roche), New York, New York.
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Llaneza-Suarez C, Eiriz-Eirin M, Llaneza P. Arterial palmar arch occlusion in a woman with Raynaud's disease taking oral combined menopausal hormone therapy: A case report. Case Rep Womens Health 2020; 27:e00206. [PMID: 32373479 PMCID: PMC7191182 DOI: 10.1016/j.crwh.2020.e00206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 11/16/2022] Open
Abstract
Patients with surgical menopause often present to their primary care provider with menopausal symptoms. Here we present an unusual case of palmar arch artery occlusion in a 55-year-old woman with primary Raynaudˈs disease taking oral combined menopausal hormone therapy after surgical menopause for endometriosis. She was successfully treated with intravenous infusion of prostaglandin E1 and nitroglycerin patches over two weeks. Menopausal hormone therapy was stopped and her vasomotor symptoms did not recur. A case of palmar arch artery occlusion in a woman with primary Raynaudˈs disease taking oral combined menopausal hormone therapy is discussed. Presentation was pain, swelling and redness in the distal phalanx of the first right finger. Palmar arch artery occlusion was diagnosed with sonography and arteriography. The finger lesion resolved after treatment with intravenous infusion of prostaglandin E1 and nitroglycerin patches over two weeks.
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Stanisz M, Panczyk M, Kurzawa R, Grochans E. The Effect of Prophylactic Adnexectomy on the Quality of Life and Psychosocial Functioning of Women with the BRCA1/BRCA2 Mutations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16244995. [PMID: 31818005 PMCID: PMC6950418 DOI: 10.3390/ijerph16244995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 12/21/2022]
Abstract
The main purpose of this study was to analyze the effect of risk-reducing salpingo-oophorectomy (RRSO) on the quality of life (QoL) and psychosocial functioning of patients with the BRCA1/BRCA2 mutations. This survey-based study was conducted using the Blatt-Kupperman Index, the Women’s Health Questionnaire, the Perceived Stress Scale, the State-Trait Anxiety Inventory, the Beck Depression Inventory-II, and the authors’ questionnaire. All calculations were done using Statistica 13.3. The QoL after RRSO was statistically significantly lower in most domains compared with the state before surgery. The greatest decline in the QoL was observed in the vasomotor symptoms domain (d = 0.953) and the smallest in the memory/concentration domain (d = 0.167). We observed a statistically significant decrease in the level of anxiety as a state (d = 0.381), as well as a statistically significant increase in the severity of climacteric symptoms (d = 0.315) and depressive symptoms (d = 0.125). Prophylactic surgeries of the reproductive organs have a negative effect on the QoL and psychosocial functioning of women with the BRCA1/2 mutations, as they increase the severity of depressive and climacteric symptoms. At the same time, these surgeries reduce anxiety as a state, which may be associated with the elimination of cancerophobia.
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Affiliation(s)
- Marta Stanisz
- Department of Gynecology and Reproductive Health, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland; (M.S.); (R.K.)
| | - Mariusz Panczyk
- Department of Education and Research in Health Sciences, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Rafał Kurzawa
- Department of Gynecology and Reproductive Health, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland; (M.S.); (R.K.)
- Center of Gynecology and Treatmemt for Infertility “Vitrolive”, al. Wojska Polskiego 103, 70-483 Szczecin, Poland
| | - Elżbieta Grochans
- Department of Nursing, Pomeranian Medical University in Szczecin; ul. Żołnierska 48, 71-210 Szczecin, Poland
- Correspondence: ; Tel.: +48-91-4800-910
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Jeffers L, Reid J, Fitzsimons D, Morrison PJ, Dempster M. Interventions to improve psychosocial well-being in female BRCA-mutation carriers following risk-reducing surgery. Cochrane Database Syst Rev 2019; 10:CD012894. [PMID: 31595976 PMCID: PMC6784162 DOI: 10.1002/14651858.cd012894.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Women who carry a pathogenic mutation in either a BRCA1 DNA repair associated or BRCA2 DNA repair associated (BRCA1 or BRCA2) gene have a high lifetime risk of developing breast and tubo-ovarian cancer. To manage this risk women may choose to undergo risk-reducing surgery to remove breast tissue, ovaries, and fallopian tubes. Surgery should increase survival, but can impact women's lives adversely at the psychological and psychosexual levels. Interventions to facilitate psychological adjustment and improve quality of life post risk-reducing surgery are needed. OBJECTIVES To examine psychosocial interventions in female BRCA carriers who have undergone risk-reducing surgery and to evaluate the effectiveness of such interventions on psychological adjustment and quality of life. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE and Embase via Ovid, CINAHL, PsycINFO, Web of Science up to April 2019 and Scopus up to January 2018. We also handsearched abstracts of scientific meetings and other relevant publications. SELECTION CRITERIA We included randomised controlled trials (RCT), non-randomised studies (NRS), prospective and retrospective cohort studies and interventional studies using baseline and postintervention analyses in female BRCA carriers who have undergone risk-reducing surgery. DATA COLLECTION AND ANALYSIS Two review authors independently assessed eligibility studies for inclusion in the review. We used standard methodological procedures expected by Cochrane. MAIN RESULTS We screened 4956 records from the searches, selecting 34 unique studies for full-text scrutiny, of which two met the inclusion criteria: one RCT and one NRS. The included studies assessed 113 female BRCA carriers who had risk-reducing surgery, but there was attrition, and outcome data were not available for all participants at final study assessments. We assessed the RCT as at a high risk of bias whilst the NRS did not have a control group. Our GRADE assessment of the studies was very low-certainty due to the paucity of data and methodological shortcomings of the studies. The primary outcome of quality of life was only measured in the RCT and that was specific to the menopause. Both studies reported on psychological distress and sexual function. Neither study measured body image, perhaps because this is most often associated with risk-reducing mastectomy rather than oophorectomy.The RCT (66 participants recruited with 48 followed to 12 months) assessed the short- and long-term effects of an eight-week mindfulness-based stress reduction (MBSR) training programme on quality of life, sexual functioning, and sexual distress in female BRCA carriers (n = 34) in a specialised family cancer clinic in the Netherlands compared to female BRCA carriers (n = 32) who received usual care. Measurements on the Menopause-Specific Quality of Life Questionnaire (MENQOL) showed some improvement at 3 and 12 months compared to the usual care group. At 3 months the mean MENQOL scores were 3.5 (95% confidence interval (CI) 3.0 to 3.9) and 3.8 (95% CI 3.3 to 4.2) for the MBSR and usual care groups respectively, whilst at 12 months the corresponding values were 3.6 (95% CI 3.1 to 4.0) and 3.9 (95% CI 3.5 to 4.4) (1 study; 48 participants followed up at 12 months). However, these results should be interpreted with caution due to the very low-certainty of the evidence, where a lower score is better. Other outcome measures on the Female Sexual Function Index and the Female Sexual Distress Scale showed no significant differences between the two groups. Our GRADE assessment of the evidence was very low-certainty due to the lack of blinding of participants and personnel, attrition bias and self-selection (as only one-third of eligible women chose to participate in the study) and serious imprecision due to the small sample size and wide 95% CI.The NRS comprised 37 female BRCA carriers selected from three Boston-area hospitals who had undergone a novel sexual health intervention following risk-reducing salpingo-oophorectomy (RRSO) without a history of tubo-ovarian cancer. The intervention consisted of targeted sexual-health education, body awareness and relaxation training, and mindfulness-based cognitive therapy strategies, followed by two sessions of tailored telephone counselling. This was a single-arm study without a control group. Our GRADE assessment of the evidence was very low-certainty, and as there was no comparison group in the included study, we could not estimate a relative effect. The study reported change in psychosexual adjustment from baseline to postintervention (median 2.3 months) using measures of Female Sexual Function Index (n = 34), which yielded change with a mean of 3.91, standard deviation (SD) 9.12, P = 0.018 (1 study, 34 participants; very low-certainty evidence). The Brief Symptom Inventory, Global Severity Index yielded a mean change of 3.92, SD 5.94, P < 0.001. The Sexual Self-Efficacy Scale yielded change with a mean of 12.14, SD 20.56, P < 0.001. The Sexual Knowledge Scale reported mean change of 1.08, SD 1.50, P < 0.001 (n = 36). Participant satisfaction was measured by questionnaire, and 100% participants reported that they enjoyed taking part in the psychoeducation group and felt "certain" or "very certain" that they had learned new skills to help them cope with the sexual side effects of RRSO. AUTHORS' CONCLUSIONS The effect of psychosocial interventions on quality of life and emotional well-being in female BRCA carriers who undergo risk-reducing surgery is uncertain given the very low methodological quality in the two studies included in the review. The absence of such interventions highlights the need for partnership between researchers and clinicians in this specific area to take forward the patient-reported outcomes and develop interventions to address the psychosocial issues related to risk-reducing surgery in female BRCA carriers, particularly in this new era of genomics, where testing may become more mainstream and many more women are identified as gene carriers.
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Affiliation(s)
- Lisa Jeffers
- Regional Medical Genetics CentreMedical GeneticsBelfast Health and Social Care TrustLisburn RoadBelfastUKBT9 7AB
| | - Joanne Reid
- Queen's University BelfastSchool of Nursing and Midwifery10 Malone RoadBelfastUKBT9 5BN
| | - Donna Fitzsimons
- Queen's University BelfastSchool of Nursing and Midwifery10 Malone RoadBelfastUKBT9 5BN
| | - Patrick J Morrison
- Regional Medical Genetics CentreMedical GeneticsBelfast Health and Social Care TrustLisburn RoadBelfastUKBT9 7AB
- Queen's University BelfastCentre for Cancer Research and Cell Biology97 Lisburn RoadBelfastUKBT9 7AE
| | - Martin Dempster
- Queen's University BelfastSchool of PsychologyUniversity RoadBelfastNorthern IrelandUKBT7 1NN
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Kotsopoulos J, Gronwald J, Karlan BY, Huzarski T, Tung N, Moller P, Armel S, Lynch HT, Senter L, Eisen A, Singer CF, Foulkes WD, Jacobson MR, Sun P, Lubinski J, Narod SA. Hormone Replacement Therapy After Oophorectomy and Breast Cancer Risk Among BRCA1 Mutation Carriers. JAMA Oncol 2019; 4:1059-1065. [PMID: 29710224 DOI: 10.1001/jamaoncol.2018.0211] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Prophylactic bilateral salpingo-oophorectomy is recommended for BRCA1 mutation carriers to prevent ovarian cancer. Whether or not hormone replacement therapy (HRT) initiated after oophorectomy is associated with an increased risk of breast cancer has not been evaluated in a prospective study. Objective To determine the association between HRT use and BRCA1-associated breast cancer. Design, Setting, and Participants A prospective, longitudinal cohort study of BRCA1 and BRCA2 mutation carriers from 80 participating centers in 17 countries was conducted between 1995 and 2017 with a mean follow-up of 7.6 years. Participants had sought genetic testing for a BRCA1 or BRCA2 mutation because of a personal or family history of breast and/or ovarian cancer. Carriers of BRCA1 mutation with no personal medical history of cancer who underwent bilateral oophorectomy following enrollment were eligible for the cohort study. Exposures A follow-up questionnaire was administered every 2 years to obtain detailed information on HRT use. A left-truncated Cox proportional hazard analysis was used to estimate the hazard ratios (HRs) and 95% CIs associated with the initiation of HRT use postoophorectomy. Main Outcomes and Measures Incident breast cancer. Results A total of 872 BRCA1 mutation carriers with a mean postoophorectomy follow-up period of 7.6 years (range, 0.4-22.1) were included in this study. Mean (SD) age of participants was 43.4 (8.5) years. Among these, 92 (10.6%) incident breast cancers were diagnosed. Overall, HRT use after oophorectomy was not associated with an increased risk of breast cancer. The HR was 0.97 (95% CI, 0.62-1.52; P = .89) for ever use of any type of HRT vs no use; however, the effects of estrogen alone and combination hormonal therapy were different. After 10 years of follow-up, the cumulative incidence of breast cancer among women who used estrogen-alone HRT was 12% compared with 22% among women who used estrogen plus progesterone HRT (absolute difference, 10%; log rank P = .04). Conclusions and Relevance These findings suggest that use of estrogen after oophorectomy does not increase the risk of breast cancer among women with a BRCA1 mutation and should reassure BRCA1 mutation carriers considering preventive surgery that HRT is safe. The possible adverse effect of progesterone-containing HRT warrants further study.
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Affiliation(s)
- Joanne Kotsopoulos
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jacek Gronwald
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Beth Y Karlan
- Gynecology Oncology, Cedars Sinai Medical Center, Los Angeles, California
| | - Tomasz Huzarski
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Nadine Tung
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Pal Moller
- Inherited Cancer Research Group, The Norwegian Radium Hospital, Department for Medical Genetics, Department of Tumor Biology, Institute of Cancer Research, The Norwegian Radium Hospital; Oslo University Hospital, Oslo, Norway
| | - Susan Armel
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, Ontario, Canada
| | - Henry T Lynch
- Department of Preventive Medicine and Public Health, Creighton University School of Medicine, Omaha, Nebraska
| | - Leigha Senter
- Division of Human Genetics, the Ohio State University Medical Center, Comprehensive Cancer Center, Columbus
| | - Andrea Eisen
- Toronto-Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
| | - Christian F Singer
- Department of Obstetrics and Gynecology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - William D Foulkes
- Program in Cancer Genetics, Department of Oncology and Human Genetics, McGill University, Montréal, Quebec, Canada
| | - Michelle R Jacobson
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Ping Sun
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Jan Lubinski
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Steven A Narod
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Owens DK, Davidson KW, Krist AH, Barry MJ, Cabana M, Caughey AB, Doubeni CA, Epling JW, Kubik M, Landefeld CS, Mangione CM, Pbert L, Silverstein M, Simon MA, Tseng CW, Wong JB. Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer: US Preventive Services Task Force Recommendation Statement. JAMA 2019; 322:652-665. [PMID: 31429903 DOI: 10.1001/jama.2019.10987] [Citation(s) in RCA: 261] [Impact Index Per Article: 52.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Potentially harmful mutations of the breast cancer susceptibility 1 and 2 genes (BRCA1/2) are associated with increased risk for breast, ovarian, fallopian tube, and peritoneal cancer. For women in the United States, breast cancer is the most common cancer after nonmelanoma skin cancer and the second leading cause of cancer death. In the general population, BRCA1/2 mutations occur in an estimated 1 in 300 to 500 women and account for 5% to 10% of breast cancer cases and 15% of ovarian cancer cases. OBJECTIVE To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on risk assessment, genetic counseling, and genetic testing for BRCA-related cancer. EVIDENCE REVIEW The USPSTF reviewed the evidence on risk assessment, genetic counseling, and genetic testing for potentially harmful BRCA1/2 mutations in asymptomatic women who have never been diagnosed with BRCA-related cancer, as well as those with a previous diagnosis of breast, ovarian, tubal, or peritoneal cancer who have completed treatment and are considered cancer free. In addition, the USPSTF reviewed interventions to reduce the risk for breast, ovarian, tubal, or peritoneal cancer in women with potentially harmful BRCA1/2 mutations, including intensive cancer screening, medications, and risk-reducing surgery. FINDINGS For women whose family or personal history is associated with an increased risk for harmful mutations in the BRCA1/2 genes, or who have an ancestry associated with BRCA1/2 gene mutations, there is adequate evidence that the benefits of risk assessment, genetic counseling, genetic testing, and interventions are moderate. For women whose personal or family history or ancestry is not associated with an increased risk for harmful mutations in the BRCA1/2 genes, there is adequate evidence that the benefits of risk assessment, genetic counseling, genetic testing, and interventions are small to none. Regardless of family or personal history, the USPSTF found adequate evidence that the overall harms of risk assessment, genetic counseling, genetic testing, and interventions are small to moderate. CONCLUSIONS AND RECOMMENDATION The USPSTF recommends that primary care clinicians assess women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or who have an ancestry associated with BRCA1/2 gene mutations with an appropriate brief familial risk assessment tool. Women with a positive result on the risk assessment tool should receive genetic counseling and, if indicated after counseling, genetic testing. (B recommendation) The USPSTF recommends against routine risk assessment, genetic counseling, or genetic testing for women whose personal or family history or ancestry is not associated with potentially harmful BRCA1/2 gene mutations. (D recommendation).
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Affiliation(s)
| | - Douglas K Owens
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Stanford University, Stanford, California
| | - Karina W Davidson
- Feinstein Institute for Medical Research at Northwell Health, Manhasset, New York
| | - Alex H Krist
- Fairfax Family Practice Residency, Fairfax, Virginia
- Virginia Commonwealth University, Richmond
| | | | | | | | | | | | | | | | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | | | | | - Chien-Wen Tseng
- University of Hawaii, Honolulu
- Pacific Health Research and Education Institute, Honolulu, Hawaii
| | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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Clinical background and outcomes of risk-reducing salpingo-oophorectomy for hereditary breast and ovarian cancers in Japan. Int J Clin Oncol 2019; 24:1105-1110. [DOI: 10.1007/s10147-019-01456-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 04/23/2019] [Indexed: 01/13/2023]
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Concerns and Expectations of Risk-Reducing Surgery in Women with Hereditary Breast and Ovarian Cancer Syndrome. J Clin Med 2019; 8:jcm8030313. [PMID: 30841601 PMCID: PMC6463153 DOI: 10.3390/jcm8030313] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/21/2019] [Accepted: 02/28/2019] [Indexed: 11/16/2022] Open
Abstract
Hereditary Breast and Ovarian Cancer syndrome (HBOC) carriers face complex decisions, which might affect their fertility and body image. Using an anonymous 40-items questionnaire we evaluated the expectations and concerns about Risk-Reducing Surgery (RRS) in 204 carriers. Participants are well-informed about the options to manage cancer risk, and women with previous cancer are more concerned with screening failure. Satisfaction with RR Mastectomy is high, even if many carriers are unsatisfied with reconstructed breast feel and nipple-areola complex tactile sensation and those with previous breast cancer report a change in their sexual habits. The decrease of libido and vaginal dryness are the most complained symptoms after RR Salpingo-Oophorectomy. Nevertheless, most carriers would choose RRS again, due to cancer risk or screening-related stress reduction. Women who deferred RRS are more afraid of menopausal symptoms and cancer risk than those who had undergone or declined surgery. Women who declined RRS feel well-informed and trust screening procedures. In conclusion, HBOC carriers consider themselves well-informed and able to choose the best option for their condition, would choose RRS again because of cancer risk and screening-related stress reduction, and those who delay RRS face a higher preoperative level of concern and need support.
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Carvalho JP, Baracat EC, Carvalho FM. Ovarian Cancer Previvors: How to manage these patients? Clinics (Sao Paulo) 2019; 74:e1343. [PMID: 31340254 PMCID: PMC6636587 DOI: 10.6061/clinics/2019/e1343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 06/12/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jesus Paula Carvalho
- Disciplina de Ginecologia, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Edmund Chada Baracat
- Disciplina de Ginecologia, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Filomena Marino Carvalho
- Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Jacobson M, Bernardini M, Sobel ML, Kim RH, McCuaig J, Allen L. No. 366-Gynaecologic Management of Hereditary Breast and Ovarian Cancer. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1497-1510. [DOI: 10.1016/j.jogc.2018.05.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Jacobson M, Bernardini M, Sobel ML, Kim RH, McCuaig J, Allen L. No 366 - Prise en charge gynécologique du cancer du sein et de l'ovaire héréditaire. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1511-1527. [DOI: 10.1016/j.jogc.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Stuursma A, van Driel C, Wessels N, de Bock G, Mourits M. Severity and duration of menopausal symptoms after risk-reducing salpingo-oophorectomy. Maturitas 2018; 111:69-76. [DOI: 10.1016/j.maturitas.2018.01.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 01/05/2018] [Accepted: 01/12/2018] [Indexed: 01/03/2023]
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Meadows R, Padamsee TJ, Paskett ED. Distinctive psychological and social experiences of women choosing prophylactic oophorectomy for cancer prevention. Health Care Women Int 2018; 39:595-616. [PMID: 29319429 DOI: 10.1080/07399332.2018.1424855] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Women known to have significantly elevated ovarian cancer risk due to genetic mutations or family history can reduce this risk by surgically removing both ovaries and fallopian tubes (RRBSO, risk-reducing bilateral salpingo-oophorectomy). We used interpretive phenomenological analysis (IPA) to explore the psychosocial experiences of women who chose RRBSO for cancer prevention. We extended the traditional use of IPA to compare the experiences of women who chose RRBSO for cancer prevention to those of women who underwent similar gynecologic surgery for benign indications. The analysis resulted in three superordinate themes describing women's psychosocial experiences related to RRBSO: (a) psychological facets of cancer risk (b) social support and (c) shared medical decision making. Findings illustrate that women choosing RRBSO for cancer prevention experience heightened psychosocial challenges before and after surgery compared to women undergoing surgery for benign indication. Furthermore, they may need distinct types of information and support from healthcare providers.
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Affiliation(s)
- Rachel Meadows
- a Division of Epidemiology, College of Public Health, Comprehensive Cancer Center , the Ohio State University , Columbus , Ohio , USA
| | - Tasleem J Padamsee
- b Division of Health Services Management and Policy, College of Public Health, Comprehensive Cancer Center , The Ohio State University , Columbus , Ohio , USA
| | - Electra D Paskett
- c Department of Internal Medicine, Division of Epidemiology, College of Medicine, College of Public Health, Comprehensive Cancer Center , The Ohio State University , Columbus , Ohio , USA
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Jeffers L, Reid J, Fitzsimons D, Morrison PJ, Dempster M. Interventions to improve psychosocial well-being in female BRCA
-mutation carriers following risk-reducing surgery. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [DOI: 10.1002/14651858.cd012894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Lisa Jeffers
- Regional Medical Genetics Centre; Medical Genetics; Belfast Health and Social Care Trust Lisburn Road Belfast UK BT9 7AB
| | - Joanne Reid
- Queen's University Belfast; School of Nursing and Midwifery; 10 Malone Road Belfast UK BT9 5BN
| | - Donna Fitzsimons
- Queen's University Belfast; School of Nursing and Midwifery; 10 Malone Road Belfast UK BT9 5BN
| | - Patrick J Morrison
- Regional Medical Genetics Centre; Medical Genetics; Belfast Health and Social Care Trust Lisburn Road Belfast UK BT9 7AB
- The Queen's University Belfast; Centre for Cancer Research and Cell Biology; 97 Lisburn Road Belfast UK BT9 7AE
| | - Martin Dempster
- Queen's University Belfast; School of Psychology; University Road Belfast Northern Ireland UK BT7 1NN
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Patient Satisfaction and Nipple-Areola Sensitivity After Bilateral Prophylactic Mastectomy and Immediate Implant Breast Reconstruction in a High Breast Cancer Risk Population: Nipple-Sparing Mastectomy Versus Skin-Sparing Mastectomy. Ann Plast Surg 2017; 77:145-52. [PMID: 26076217 DOI: 10.1097/sap.0000000000000366] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prophylactic skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) both are associated with major risk reduction in women with high breast cancer risk. Skin-sparing mastectomy followed by nipple-areola complex (NAC) reconstruction is standard of care, but NSM is increasingly being performed. Preservation of the NAC in NSM may increase patient satisfaction. Therefore, we measured NAC sensitivity after NSM and compared patient satisfaction as well as body image after SSM with NSM. METHODS Women who underwent prophylactic bilateral SSM or NSM and immediate implant breast reconstruction between 2002 and 2012 were eligible. Patient satisfaction was assessed using the Breast-Q reconstruction questionnaire, body image using Hopwood's body image scale (BIS), and satisfaction with the (reconstructed) NAC using a study-specific questionnaire. In the NSM group, NAC sensitivity was assessed using Semmes Weinstein monofilaments with a 5-point scale and compared with NAC sensitivity in a nonoperated control group. RESULTS The SSM group comprised 25 women (50 SSMs) and the NSM group 20 women (39 NSMs). Median follow-up was 65 months in the SSM group compared with 27 months in the NSM group (P < 0.01). In univariable analyses, Breast-Q scores were favorable in the SSM group compared with the NSM group with trends for higher "satisfaction with breasts" (66.2 vs 56.6; P = 0.06) and "satisfaction with outcome" (76.1 vs 61.5; P = 0.09). Mean BIS score of 7.1/30 in the SSM group and 9.3/30 in the NSM group (P = 0.35). Adjusted for follow-up, there were no significant differences in Breast-Q scores, nor in BIS scores. Interestingly, satisfaction with the (reconstructed) NAC was similar after SSM and NSM. Nipple-areola complex sensitivity was lower in the NSM group (mean score, 1.9; 95% confidence interval, 1.5-2.3) compared with the control group (mean score, 4.7; 95% confidence interval, 4.6-4.9; P < 0.01). CONCLUSIONS Breast-Q scores regarding satisfaction with breasts and overall outcome were in favor of the SSM group. Residual NAC sensitivity after NSM was low. This suggests that SSM followed by NAC reconstruction is a balanced alternative to NSM. We observed no significant differences in body image and NAC-specific satisfaction between the NSM and SSM groups.
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Webber L, Anderson RA, Davies M, Janse F, Vermeulen N. HRT for women with premature ovarian insufficiency: a comprehensive review. Hum Reprod Open 2017; 2017:hox007. [PMID: 30895225 PMCID: PMC6276684 DOI: 10.1093/hropen/hox007] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 04/24/2017] [Accepted: 06/08/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Premature ovarian insufficiency (POI), often and misleadingly referred to as ‘premature menopause’, is defined as a loss of ovarian activity before the age of 40 years and is characterized by irregular or absent periods and reduced fertility. Symptoms include those associated with the natural menopause (night sweats and vaginal dryness), and with the long-term adverse effects of estrogen deficiency (osteoporosis and cardiovascular disease): the latter is believed to explain the shorter life expectancy associated with POI. OBJECTIVE AND RATIONALE The objective of the current review was to collect all relevant studies supporting recommendations on the indications, treatment options, and risks of hormone replacement therapy (HRT) (estrogen, progestogens and androgens) for women with POI. SEARCH METHODS The current review was written based on the best available evidence on the topic collected for the recently published ESHRE guideline on the management of women with POI. PUBMED/MEDLINE and the Cochrane library were searched in a stepwise approach. Relevant references were summarized in evidence tables, with assessment of the quality. OUTCOMES HRT is strongly recommended for women with POI, mainly for vasomotor and genito-urinary symptom relief. In addition, HRT has been shown to have a role in bone protection and probably also in primary prevention of cardiovascular disease. There is little evidence on the optimal type, regimen and dose of HRT; patient preference for route and method of administration of each component of HRT must be considered when prescribing, as should contraceptive needs. In women with POI, physiological replacement of estrogen (and progesterone) is essential for their health, and the controversies that surround the use of HRT in postmenopausal women do not apply. LIMITATIONS, REASONS FOR CAUTION N/A. WIDER IMPLICATIONS New areas of study on HRT for women with POI should focus on life expectancy, quality of life and neurological function. Furthermore, randomized controlled trials comparing transdermal estradiol with oral estrogens with regard to efficacy, patient satisfaction and side effects are urgently needed. STUDY FUNDING/COMPETING INTERESTS The authors received no funding for the review. The costs for the development of the ESHRE guideline were covered by ESHRE. The authors have no conflicts of interest to disclose.
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Affiliation(s)
- Lisa Webber
- Department of Women's Health, University College London Hospitals, London NW1 2PG, UK
| | - Richard A Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Melanie Davies
- Department of Women's Health, University College London Hospitals, London NW1 2PG, UK
| | - Femi Janse
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht 3584 CX, The Netherlands
| | - Nathalie Vermeulen
- European Society of Human Reproduction and Embryology (ESHRE), Grimbergen B-1852, Belgium
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Tschernichovsky R, Goodman A. Risk-Reducing Strategies for Ovarian Cancer in BRCA Mutation Carriers: A Balancing Act. Oncologist 2017; 22:450-459. [PMID: 28314837 PMCID: PMC5388383 DOI: 10.1634/theoncologist.2016-0444] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 12/22/2016] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The objective of this study was to review the role of bilateral salpingo-oophorectomy in BRCA mutation (mBRCA) carriers and alternative interventions in risk reduction of ovarian cancer (OC). MATERIALS AND METHODS A systematic review using PubMed, MEDLINE, EMBASE, and the Cochrane library was conducted to identify studies of different strategies to prevent OC in mBRCA carriers, including bilateral salpingo-oophorectomy, prophylactic salpingectomy with delayed oophorectomy, intensive surveillance, and chemoprevention. RESULTS Risk-reducing bilateral salpingo-oophorectomy is an effective intervention, but its associated morbidity is substantial and seems to curtail uptake rates among the target population. Although there is much interest and a strong theoretical basis for salpingectomy with delayed oophorectomy, data on its clinical application are scarce with regard to screening, the use of an algorithmic protocol has recently shown favorable albeit indefinite results in average-risk postmenopausal women. Its incorporation into studies focused on high-risk women might help solidify a future role for screening as a bridge to surgery. The use of oral contraceptives for chemoprevention is well supported by epidemiologic studies. However, there is a lack of evidence for advocating any of the other agents proposed for this purpose, including nonsteroidal anti-inflammatory drugs, vitamin D, and retinoids. CONCLUSION Further studies are needed before salpingectomy with delayed oophorectomy or intensive surveillance can be offered as acceptable, less morbid alternatives to upfront oophorectomy for mBRCA carriers. The Oncologist 2017;22:450-459 IMPLICATIONS FOR PRACTICE: Risk-reducing bilateral salpingo-oophorectomy is currently the most effective method for reducing the risk of ovarian cancer in BRCA mutation (mBRCA) carriers. Unfortunately, it is associated with significant short- and long-term morbidity, stemming from reduced circulating estrogen. In recent years, much research has been devoted to evaluating less morbid alternatives, especially multimodal cancer screening and prophylactic salpingectomy with delayed oophorectomy. This review describes the present state of the art, with the aim of informing the counseling provided to mBRCA carriers on this complicated issue and encouraging additional research to facilitate the incorporation of such alternatives into routine practice.
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Affiliation(s)
| | - Annekathryn Goodman
- Division of Gynecologic Oncology
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Siyam T, Ross S, Campbell S, Eurich DT, Yuksel N. The effect of hormone therapy on quality of life and breast cancer risk after risk-reducing salpingo-oophorectomy: a systematic review. BMC Womens Health 2017; 17:22. [PMID: 28320467 PMCID: PMC5359830 DOI: 10.1186/s12905-017-0370-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 03/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is unclear if the use of hormone therapy (HT) in carriers of BRCA mutations improves the quality of life (QOL) without increasing the risk of breast cancer following a risk-reducing salpingo-oophorectomy (RRSO). Our objective was to assess the effect of HT on QOL and breast cancer risk, after RRSO. METHODS We searched MEDLINE, EMBASE, CINHAL, and others, from inception to July 22, 2016, to identify relevant studies. Two reviewers independently screened identified records for controlled trials and observational studies that addressed the effect of HT on QOL and breast cancer risk in women with BRCA mutations, post RRSO. Two reviewers independently extracted data on populations, interventions, comparators, outcomes, and methodological quality. Studies addressing the same outcome were synthesized using written evidence summaries or tables. RESULTS Of the 1,059 records identified, 13 met our inclusion criteria. All studies were observational. Six studies assessed the effect on QOL. Of these, 3 showed improvement in QOL with HT use. The risk of breast cancer was evaluated in 4 studies. The mean duration of follow-up was 2.6 years (range 0.1-19.1). The risk of breast cancer did not change with HT use in all 4 studies. CONCLUSIONS Cumulative evidence from our review suggests that short-term HT use following RRSO improves QOL. The effect on breast cancer risk is still unclear. There are too few long-term studies to draw any strong conclusions. The need for future well-designed RCTs for more established evidence is imperative.
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Affiliation(s)
- Tasneem Siyam
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB T6G 1C9 Canada
| | - Sue Ross
- Cavarzan Chair in Mature Women’s Health Research, Department of Obstetrics and Gynecology, Rm 5S131 Lois Hole Hospital/Robbins Pavilion Royal Alexandra Hospital, 10240 Kingsway Ave, Edmonton, AB T5H 3V9 Canada
| | - Sandra Campbell
- 2K4.01 WC Mackenzie Health Science Center, University of Alberta, Edmonton, AB T6G 2R7 Canada
| | - Dean T. Eurich
- School of Public Health, 2-040 Li Ka Shing HRIF, University of Alberta, Edmonton, AB T6G 2E1 Canada
| | - Nesé Yuksel
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB T6G 1C9 Canada
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Mahat-Shamir M, Possick C. The experience of women carriers of BRCA mutations following risk-reducing surgery: A cultural perspective. Health Care Women Int 2016; 38:344-360. [PMID: 27926354 DOI: 10.1080/07399332.2016.1267182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In this qualitative study, we examine the experience of 13 Jewish Israeli women carriers of BRCA mutations following risk-reducing surgery. Thematic analysis of in-depth, semi-structured interview texts yielded three themes: (a) dialectic of vulnerability and control, (b) presentation of self as a "normal" woman, and (c) genetic chain of negative life events and guilt. Aspects of Israeli culture impacting participants' experiences are: personal and collective responsibility, the shift toward consumerism, and pro-natal ideology. The findings may be useful for health practitioners working with other nationalities with similar cultural characteristics and to prompt practitioners to explore their own and their patients' perceptions regarding women's risk-reducing surgery and genetic illnesses.
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Affiliation(s)
| | - Chaya Possick
- a School of Social Work, Ariel University , Ariel , Israel
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Tran G, Helm M, Litton J. Current Approach to Breast Cancer Risk Reduction for Women with Hereditary Predispositions to Breast Cancer. CURRENT BREAST CANCER REPORTS 2016. [DOI: 10.1007/s12609-016-0220-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lee YJ, Lee SW, Kim KR, Jung KH, Lee JW, Kim YM. Pathologic findings at risk-reducing salpingo-oophorectomy (RRSO) in germline BRCA mutation carriers with breast cancer: significance of bilateral RRSO at the optimal age in germline BRCA mutation carriers. J Gynecol Oncol 2016; 28:e3. [PMID: 27670257 PMCID: PMC5165071 DOI: 10.3802/jgo.2017.28.e3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 07/26/2016] [Accepted: 07/26/2016] [Indexed: 01/11/2023] Open
Abstract
Objective Most BRCA1/2 carriers do not undergo risk-reducing salpingo-oophorectomy (RRSO) by the recommended age. This study aimed to find the incidence of precursor lesions and cancer after RRSO. Methods We retrospectively reviewed breast cancer patients identified as BRCA mutation carriers who underwent RRSO at Asan Medical Center, Seoul, Korea, from 2010 to 2014. From 2013, all cases were examined according to the Sectioning and Extensively Examining the Fimbria (SEE/FIM) protocol and underwent immunohistochemically staining. RRSO was performed in 63 patients, 27 in 2010 to 2012 and 36 in 2013 to 2014. Results The median age at RRSO was 46.5 years (range, 32 to 73 years). Occult invasive cancer was detected in eight patients, of ovarian origin in five and of tubal origin in three. All occult invasive cancer cases with metastasis were detected in patients older than 40 years. Of the 36 patients from the 2013 to 2014 cohort, seven showed p53 overexpression, one showed Ki-67 overexpression, two showed serous tubal intraepithelial carcinoma, and three showed occult cancer. The detection rate of precursor lesions or cancer was 36.1% (13/36). In the analysis according to age, precursor lesions were more common in BRCA1 mutation carriers younger than 40 years old (66.7% vs. 20.0%). In BRCA2 mutation carriers, precursor lesions were only detected in those older than 40 years of age, indicating the possible faster occurrence of precursor lesions in BRCA1 mutation carriers. Conclusion Many patients still tend to delay RRSO until after they are 40 years old. Our findings support the significance of RRSO before the age of 40 in germline BRCA mutation carriers.
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Affiliation(s)
- Young Jae Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Wha Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Kyu Rae Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Hae Jung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Won Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Man Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Guidozzi F. Hormone therapy after prophylactic risk-reducing bilateral salpingo-oophorectomy in women who have BRCA gene mutation. Climacteric 2016; 19:419-22. [PMID: 27426853 DOI: 10.1080/13697137.2016.1209396] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Women with a BRCA1 or BRCA2 gene mutation have substantially higher risk for developing not only breast and ovarian cancers, but also for primary peritoneal, Fallopian tube, colonic, pancreatic cancers, uterine papillary serous adenocarcinoma and malignant melanoma. The risk for ovarian cancer ranges from 39 to 49% by 70 years of age in BRCA1 mutation carriers and from 11 to 18% for those with a BRCA2 mutation, whilst breast cancer increases similarly within women who have either the BRCA1 mutation or the BRCA2 mutation, from about 20% in women in their forties, 37% by the age of 50 years, 55% by 60 years and more than 70% by the age of 70 years. Prophylactic risk-reducing bilateral salpingo-oophorectomy (RRBSO) provides significantly greater benefits with the view of reducing the risk for gynecological and breast cancer (decreasing ovarian cancer risk by 85-95%, breast cancer risk by about 53-68% and removes occult or undetected cancers in 2-18% of such women) compared to other conservative options, namely screening/surveillance or use of chemopreventative agents. RRBSO will result in significant menopausal symptoms, increased risk for bone mineral loss, increasing risk for osteopenia and osteoporosis, and cognitive dysfunction. Risk for cardiovascular disease is also increased if the procedure is performed in women less than 50 years of age. This article analyzes the role of RRBSO in women with BRCA1/BRCA2 mutations with no personal history of breast cancer and the impact of hormone therapy on risk for breast and gynecological cancers if used after the procedure to alleviate the resulting menopausal symptoms.
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Affiliation(s)
- F Guidozzi
- a Department of Obstetrics and Gynaecology, Faculty of Health Sciences , University of Witwatersrand , Parktown , Johannesburg , South Africa
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Sabatini ME, Ellisen LW. Women's Health Issues for BRCA Mutation Carriers. Am Soc Clin Oncol Educ Book 2016; 35:14-7. [PMID: 27249681 DOI: 10.1200/edbk_100001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Mary E Sabatini
- From the Department of Obstetrics and Gynecology, Harvard Medical School, Massachusetts General Hospital, Boston, MA; Breast Medical Oncology, Harvard Medical School, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Leif W Ellisen
- From the Department of Obstetrics and Gynecology, Harvard Medical School, Massachusetts General Hospital, Boston, MA; Breast Medical Oncology, Harvard Medical School, Massachusetts General Hospital Cancer Center, Boston, MA
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Obermair A, Youlden D, Baade P, Janda M. Do breast cancer survivors benefit from prophylactic removal of uterus and ovaries? A population-based data linkage replication study. Asia Pac J Clin Oncol 2016; 13:68-78. [PMID: 27230709 DOI: 10.1111/ajco.12508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 12/11/2015] [Accepted: 01/13/2016] [Indexed: 11/27/2022]
Abstract
AIM Our previous population-based research found prophylactic surgery (hysterectomy and bilateral salpingo-oophorectomy [BSO]) halved the mortality risk for premenopausal breast cancer patients. Here we aim to replicate findings in a Western Australia dataset. METHOD Data from the Western Australia Cancer Registry of 15 395 women 20-79 years diagnosed with primary breast cancer (1997-2011) was categorized into four groups: neither hysterectomy nor BSO, hysterectomy only, BSO only, or hysterectomy + BSO. We fitted flexible parametric breast cancer-specific and overall survival models with 95% confidence intervals (also known as Royston-Parmar models) to assess the impact of prophylactic surgery. RESULTS A total of 12 630 (82.0%) patients had no surgery, 1799 (11.7%) had a hysterectomy only, 337 (2.2%) had BSO only and 629 (4.1%) had both a hysterectomy and BSO. For all-causes mortality, unadjusted 10-year survival was highest for women who had either a hysterectomy + BSO (84.7%) or a hysterectomy only (84.2%). After adjusting for covariates, the survival advantage compared to women without any surgery remained significant for the hysterectomy only group (hazard ratio [HR] = 0.89; 95% confidence interval [CI], 0.81-0.98; P = 0.02). A similar pattern emerged in breast cancer-specific survival with significantly improved survival for women who had a hysterectomy only (HR = 0.83; 95% CI, 0.74-0.94; P = 0.003). However, for non-breast cancer-related survival, having a BSO alone increased risk of death (HR = 1.83; 95% CI, 1.14-2.93; P = 0.01). CONCLUSION We observed significantly improved overall and breast cancer-specific survival among women who had a hysterectomy only, but increased non-breast cancer-related risk after BSO only. Breast cancer patients must weigh up pros and cons of prophylactic surgery.
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Affiliation(s)
- Andreas Obermair
- School of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Danny Youlden
- Cancer Council Queensland, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Peter Baade
- Cancer Council Queensland, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Monika Janda
- Institute for Health and Biomedical Innovation, School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia
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Prophylactic salpingectomy and prophylactic salpingoophorectomy for adnexal high-grade serous epithelial carcinoma: A reappraisal. Surg Oncol 2015; 24:335-44. [DOI: 10.1016/j.suronc.2015.09.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/27/2015] [Accepted: 09/30/2015] [Indexed: 01/22/2023]
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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
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Stabile C, Gunn A, Sonoda Y, Carter J. Emotional and sexual concerns in women undergoing pelvic surgery and associated treatment for gynecologic cancer. Transl Androl Urol 2015; 4:169-85. [PMID: 26816823 PMCID: PMC4708131 DOI: 10.3978/j.issn.2223-4683.2015.04.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/20/2015] [Indexed: 12/29/2022] Open
Abstract
The surgical management of gynecologic cancer can cause short- and long-term effects on sexuality, emotional well being, reproductive function, and overall quality of life (QoL). Fortunately, innovative approaches developed over the past several decades have improved oncologic outcomes and reduced treatment sequelae; however, these side effects of treatment are still prevalent. In this article, we provide an overview of the various standard-of-care pelvic surgeries and multimodality cancer treatments (chemotherapy and radiation therapy) by anatomic site and highlight the potential emotional and sexual consequences that can influence cancer survivorship and QoL. Potential screening tools that can be used in clinical practice to identify some of these concerns and treatment side effects and possible solutions are also provided. These screening tools include brief assessments that can be used in the clinical care setting to assist in the identification of problematic issues throughout the continuum of care. This optimizes quality of care, and ultimately, QoL in these women. Prospective clinical trials with gynecologic oncology populations should include patient-reported outcomes to identify subgroups at risk for difficulties during and following treatment for early intervention.
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Walker JL, Powell CB, Chen LM, Carter J, Bae Jump VL, Parker LP, Borowsky ME, Gibb RK. Society of Gynecologic Oncology recommendations for the prevention of ovarian cancer. Cancer 2015; 121:2108-20. [PMID: 25820366 DOI: 10.1002/cncr.29321] [Citation(s) in RCA: 180] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 12/22/2014] [Accepted: 01/20/2015] [Indexed: 12/25/2022]
Abstract
Mortality from ovarian cancer may be dramatically reduced with the implementation of attainable prevention strategies. The new understanding of the cells of origin and the molecular etiology of ovarian cancer warrants a strong recommendation to the public and health care providers. This document discusses potential prevention strategies, which include 1) oral contraceptive use, 2) tubal sterilization, 3) risk-reducing salpingo-oophorectomy in women at high hereditary risk of breast and ovarian cancer, 4) genetic counseling and testing for women with ovarian cancer and other high-risk families, and 5) salpingectomy after childbearing is complete (at the time of elective pelvic surgeries, at the time of hysterectomy, and as an alternative to tubal ligation). The Society of Gynecologic Oncology has determined that recent scientific breakthroughs warrant a new summary of the progress toward the prevention of ovarian cancer. This review is intended to emphasize the importance of the fallopian tubes as a potential source of high-grade serous cancer in women with and without known genetic mutations in addition to the use of oral contraceptive pills to reduce the risk of ovarian cancer.
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Affiliation(s)
- Joan L Walker
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - C Bethan Powell
- Northern California Gynecologic Cancer Program, Kaiser Permanente San Francisco, San Francisco, California
| | - Lee-May Chen
- Gynecology/Oncology Division, University of California San Francisco/Mt. Zion Cancer Center, San Francisco, California
| | - Jeanne Carter
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Victoria L Bae Jump
- Division of Gynecologic Oncology, University of North Carolina, Chapel Hill, North Carolina
| | | | - Mark E Borowsky
- Helen F. Graham Cancer Center, Christiana Care Health System, Newark, Delaware
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Ovarian cancer survival by tumor dominance, a surrogate for site of origin. Cancer Causes Control 2015; 26:601-8. [PMID: 25771796 DOI: 10.1007/s10552-015-0547-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/27/2015] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Recent studies suggest that a proportion of ovarian tumors may actually originate in the distal fallopian tube. The objective of this study was to examine the relationship between dominance (a surrogate for site of origin) and survival, following a diagnosis of epithelial ovarian cancer. METHODS We classified 1,386 tumors as dominant (putatively originating in the ovary) and non-dominant (putatively originating in the fallopian tube), using parameters obtained from pathology reports. Dominant tumors were restricted to one ovary or one involved ovary that exceeded the other in dimension by at least twofold, while non-dominant tumors were identified as having a greater likelihood of a tubal origin if the disease was equally distributed across the ovaries. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) associated with dominance. RESULTS Non-dominant tumors were more likely to be serous, stage III/IV, and be associated with a BRCA1/2 mutation, increasing parity and use of estrogen hormone replacement therapy (p ≤ 0.01). In contrast, 46 and 26% of the dominant tumors were serous and endometrioid, respectively, with a more even distribution of stage (p < 0.0001). Women with a non-dominant tumor had an increased risk of death compared to women with a dominant tumor (multivariate HR 1.28; 95% CI 1.02-1.60). Findings were similar in our analysis restricted to serous only subtypes (HR 1.28; 95% CI 1.01-1.63). CONCLUSION These preliminary findings suggest significantly worse survival among women diagnosed with a tumor putatively arising from fallopian tube.
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Abstract
OBJECTIVE BRCA1/2 mutation carriers have greatly elevated lifetime risks of breast, ovarian, and fallopian tube cancers. Bilateral prophylactic salpingo-oophorectomy is recommended to prevent cancer in these women. As it is often performed before natural menopause, it may be accompanied by menopausal symptoms, impaired quality of life, and increased cardiovascular risk. METHODS In this review, we describe the indications, timing, and implications of salpingo-oophorectomy for BRCA-positive women, with a special focus on the risks and benefits of hormone therapy (HT). Furthermore, retrospective and prospective trials of HT in BRCA mutation carriers undergoing prophylactic salpingo-oophorectomy are debated. RESULTS Hormonal deprivation after prophylactic salpingo-oophorectomy may negatively impact health and quality of life; most women experience menopausal symptoms shortly after surgical operation. Literature data suggest that HT generally reduces vasomotor symptoms related to surgical menopause, improving sexual functioning without affecting survival. CONCLUSIONS Despite the limitations of retrospective and prospective observational studies, short-term HT seems to improve quality of life and does not seem to have an adverse effect on oncologic outcomes in BRCA1 and BRCA2 mutation carriers without a personal history of breast cancer. Therefore, randomized and larger trials are urgently needed.
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Bober SL, Recklitis CJ, Bakan J, Garber JE, Patenaude AF. Addressing sexual dysfunction after risk-reducing salpingo-oophorectomy: effects of a brief, psychosexual intervention. J Sex Med 2014; 12:189-97. [PMID: 25311333 DOI: 10.1111/jsm.12713] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Women at high risk for ovarian cancer due to BRCA1 or BRCA2 mutation or family history are recommended to undergo risk-reducing salpingo-oophorectomy (RRSO) after age 35 or completion of childbearing. This potentially life-saving surgery leads to premature menopause, frequently resulting in distressing and unaddressed sexual dysfunction. AIM To pilot a novel sexual health intervention for women with BRCA1/2 mutations who previously underwent RRSO a using a single-arm trial. Feasibility and primary outcomes including sexual dysfunction and psychological distress were assessed. METHODS This single-arm trial included a one-time, half-day educational session comprised of targeted sexual health education, body awareness and relaxation training, and mindfulness-based cognitive therapy strategies, followed by two sessions of tailored telephone counseling. Assessments were completed at baseline and 2 months postintervention. MAIN OUTCOME MEASURE Study end points include feasibility and effectiveness as reported by the participant. RESULTS Thirty-seven women completed baseline and postintervention assessments. At baseline, participants had a mean age of 44.4 (standard deviation [SD] = 3.9) years and mean duration of 3.8 (SD = 2.7) years since RRSO. Overall sexual functioning (P = 0.018), as well as desire (P = 0.003), arousal (P = 0.003), satisfaction (P = 0.028), and pain (P = 0.018), improved significantly. There were significant reductions in somatization (P = 0.029) and anxiety scores (P < 0.001), and, overall, for the Global Severity Index (P < 0.001) of the Brief Symptom Inventory. Sexual self-efficacy and sexual knowledge also improved significantly from baseline to postintervention (both P < 0.001). Women were highly satisfied with the intervention content and reported utilizing new skills to manage sexual dysfunction. CONCLUSIONS This intervention integrates elements of cognitive behavioral therapy with sexual health education to address a much-neglected problem after RRSO. Results from this promising single-arm study provide preliminary data to move toward conducting a randomized, controlled trial.
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Affiliation(s)
- Sharon L Bober
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Chirurgie annexielle prophylactique des femmes à risque héréditaire : vers de nouvelles pistes ? ONCOLOGIE 2014. [DOI: 10.1007/s10269-014-2451-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hirschberg AM, Chan-Smutko G, Pirl WF. Psychiatric implications of cancer genetic testing. Cancer 2014; 121:341-60. [PMID: 25234846 DOI: 10.1002/cncr.28879] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/17/2014] [Accepted: 04/24/2014] [Indexed: 12/21/2022]
Abstract
As genetic testing for hereditary cancer syndromes has transitioned from research to clinical settings, research regarding its accompanying psychosocial effects has grown. Men and women being tested for hereditary cancer syndromes may experience some psychological distress while going through the process of testing or after carrier status is identified. Psychological distress appears to decrease over the course of the first year and it is typically not clinically significant. Longer term studies show mixed results with some mutation carriers continuing to experience elevated distress. Baseline distress is the greatest risk factor for both immediate (weeks-12 months) and long-term psychological distress (18 mo-8 years post genetic testing). In addition to baseline psychological distress, other risk factors can be identified to help identify individuals who may need psychosocial interventions during the genetic testing process. The challenges of providing clinical care to the growing population of individuals identified to be at increased risk for heritable cancers present opportunities for research and new models of care.
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Schenberg T, Mitchell G. Prophylactic bilateral salpingectomy as a prevention strategy in women at high-risk of ovarian cancer: a mini-review. Front Oncol 2014; 4:21. [PMID: 24575389 PMCID: PMC3918654 DOI: 10.3389/fonc.2014.00021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 01/26/2014] [Indexed: 12/23/2022] Open
Abstract
Risk-reducing bilateral salpingo-oophorectomy is a proven strategy to reduce the risk of serous ovarian cancer associated with germline BRCA mutations. It is most effective when performed before natural menopause, but it will render a woman prematurely menopausal. The tubal hypothesis of serous ovarian cancer brings with it the possibility of the alternative surgical approach in younger women comprising of risk-reducing bilateral salpingectomy while conserving their ovaries until nearer the age of natural menopause, when a delayed bilateral oophorectomy can be performed. This article will review the evidence behind the tubal hypothesis of serous ovarian cancer and explore the opportunities for translating this into clinical cancer prevention practice.
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Affiliation(s)
- Tess Schenberg
- The Western Health Public Hospital, Melbourne, VIC, Australia
| | - Gillian Mitchell
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Cancer Centre Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
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Goldfarb S, Mulhall J, Nelson C, Kelvin J, Dickler M, Carter J. Sexual and reproductive health in cancer survivors. Semin Oncol 2014; 40:726-44. [PMID: 24331193 DOI: 10.1053/j.seminoncol.2013.09.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
As patients live longer after cancer diagnosis and treatment, attention to symptoms and quality of life (QoL) are of increasing importance both during treatment and throughout survivorship. Two complications of multi-modal cancer treatment that can profoundly affect both men and women are sexual dysfunction and infertility. Survivors at highest risk for treatment-related sexual dysfunction are those with tumors that involve the sexual or pelvic organs and those whose treatment affects the hormonal systems mediating sexual function. Sexual dysfunction may not abate without appropriate intervention. Therefore, early identification and treatment strategies are essential. Likewise, multiple factors contribute to the risk of infertility from cancer treatment and many cancer patients of reproductive age would prefer to maintain their fertility, if possible. Fortunately, advances in reproductive technology have created options for young newly diagnosed patients to preserve their ability to have a biologic child. This paper will focus on the sexual and reproductive problems encountered by cancer survivors and discuss some treatment options.
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Affiliation(s)
- Shari Goldfarb
- Departments of Medicine and Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY.; Department of Medicine, Weill Cornell Medical College, New York, NY..
| | - John Mulhall
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Christian Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Joanne Kelvin
- Office of Physician-In-Chief Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Maura Dickler
- Department of Medicine, Weill Cornell Medical College, New York, NY.; Department of Medicine Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Jeanne Carter
- Departments of Surgery and Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY
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Valentini A, Finch A, Lubiński J, Byrski T, Ghadirian P, Kim-Sing C, Lynch HT, Ainsworth PJ, Neuhausen SL, Greenblatt E, Singer C, Sun P, Narod SA. Chemotherapy-induced amenorrhea in patients with breast cancer with a BRCA1 or BRCA2 mutation. J Clin Oncol 2013; 31:3914-9. [PMID: 23980083 PMCID: PMC3805929 DOI: 10.1200/jco.2012.47.7893] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the likelihood of long-term amenorrhea after treatment with chemotherapy in women with breast cancer who carry a BRCA1 or BRCA2 mutation. PATIENTS AND METHODS We conducted a multicenter survey of 1,954 young women with a BRCA1 or BRCA2 mutation who were treated for breast cancer. We included premenopausal women who were diagnosed with invasive breast cancer between 26 and 47 years of age. We determined the age of onset of amenorrhea after breast cancer for women who were and were not treated with chemotherapy, alone or with tamoxifen. We considered chemotherapy-induced amenorrhea to have occurred when the patient experienced ≥ 2 years of amenorrhea, commencing within 2 years of initiating chemotherapy, with no resumption of menses. RESULTS Of the 1,426 women who received chemotherapy, 35% experienced long-term amenorrhea. Of the 528 women who did not receive chemotherapy, 5.3% developed long-term amenorrhea. The probabilities of chemotherapy-induced amenorrhea were 7.2% for women diagnosed before age 30 years, 33% for women age 31 to 44 years, and 79% for women diagnosed after age 45 years (P trend < .001). The probability of induced amenorrhea was higher for women who received tamoxifen than for those who did not (52% v 29%; P < .001). CONCLUSION Age at treatment and use of tamoxifen are important predictors of chemotherapy-induced amenorrhea in women who carry a BRCA1 or BRCA2 mutation. The risk of induced long-term amenorrhea does not seem to be greater among mutation carriers than among women who do not carry a mutation.
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Affiliation(s)
- Adriana Valentini
- Adriana Valentini, Amy Finch, Ping Sun, and Steven A. Narod, Women's College Research Institute; Ellen Greenblatt, Centre for Fertility and Reproductive Health, Mount Sinai Hospital, University of Toronto, Toronto; Peter J. Ainsworth, London Regional Cancer Program, London, Ontario; Parviz Ghadirian, Research Center of the University of Montreal Hospital Centre, Montreal, Quebec; Charmaine Kim-Sing, BC Cancer Agency, Vancouver, British Columbia, Canada; Henry T. Lynch, Creighton University School of Medicine, Omaha, NE; Susan L. Neuhausen, Beckman Research Institute, City of Hope, Duarte, CA; Jan Lubiński and Tomasz Byrski, Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; and Christian Singer, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Amy Finch
- Adriana Valentini, Amy Finch, Ping Sun, and Steven A. Narod, Women's College Research Institute; Ellen Greenblatt, Centre for Fertility and Reproductive Health, Mount Sinai Hospital, University of Toronto, Toronto; Peter J. Ainsworth, London Regional Cancer Program, London, Ontario; Parviz Ghadirian, Research Center of the University of Montreal Hospital Centre, Montreal, Quebec; Charmaine Kim-Sing, BC Cancer Agency, Vancouver, British Columbia, Canada; Henry T. Lynch, Creighton University School of Medicine, Omaha, NE; Susan L. Neuhausen, Beckman Research Institute, City of Hope, Duarte, CA; Jan Lubiński and Tomasz Byrski, Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; and Christian Singer, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Jan Lubiński
- Adriana Valentini, Amy Finch, Ping Sun, and Steven A. Narod, Women's College Research Institute; Ellen Greenblatt, Centre for Fertility and Reproductive Health, Mount Sinai Hospital, University of Toronto, Toronto; Peter J. Ainsworth, London Regional Cancer Program, London, Ontario; Parviz Ghadirian, Research Center of the University of Montreal Hospital Centre, Montreal, Quebec; Charmaine Kim-Sing, BC Cancer Agency, Vancouver, British Columbia, Canada; Henry T. Lynch, Creighton University School of Medicine, Omaha, NE; Susan L. Neuhausen, Beckman Research Institute, City of Hope, Duarte, CA; Jan Lubiński and Tomasz Byrski, Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; and Christian Singer, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Tomasz Byrski
- Adriana Valentini, Amy Finch, Ping Sun, and Steven A. Narod, Women's College Research Institute; Ellen Greenblatt, Centre for Fertility and Reproductive Health, Mount Sinai Hospital, University of Toronto, Toronto; Peter J. Ainsworth, London Regional Cancer Program, London, Ontario; Parviz Ghadirian, Research Center of the University of Montreal Hospital Centre, Montreal, Quebec; Charmaine Kim-Sing, BC Cancer Agency, Vancouver, British Columbia, Canada; Henry T. Lynch, Creighton University School of Medicine, Omaha, NE; Susan L. Neuhausen, Beckman Research Institute, City of Hope, Duarte, CA; Jan Lubiński and Tomasz Byrski, Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; and Christian Singer, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Parviz Ghadirian
- Adriana Valentini, Amy Finch, Ping Sun, and Steven A. Narod, Women's College Research Institute; Ellen Greenblatt, Centre for Fertility and Reproductive Health, Mount Sinai Hospital, University of Toronto, Toronto; Peter J. Ainsworth, London Regional Cancer Program, London, Ontario; Parviz Ghadirian, Research Center of the University of Montreal Hospital Centre, Montreal, Quebec; Charmaine Kim-Sing, BC Cancer Agency, Vancouver, British Columbia, Canada; Henry T. Lynch, Creighton University School of Medicine, Omaha, NE; Susan L. Neuhausen, Beckman Research Institute, City of Hope, Duarte, CA; Jan Lubiński and Tomasz Byrski, Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; and Christian Singer, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Charmaine Kim-Sing
- Adriana Valentini, Amy Finch, Ping Sun, and Steven A. Narod, Women's College Research Institute; Ellen Greenblatt, Centre for Fertility and Reproductive Health, Mount Sinai Hospital, University of Toronto, Toronto; Peter J. Ainsworth, London Regional Cancer Program, London, Ontario; Parviz Ghadirian, Research Center of the University of Montreal Hospital Centre, Montreal, Quebec; Charmaine Kim-Sing, BC Cancer Agency, Vancouver, British Columbia, Canada; Henry T. Lynch, Creighton University School of Medicine, Omaha, NE; Susan L. Neuhausen, Beckman Research Institute, City of Hope, Duarte, CA; Jan Lubiński and Tomasz Byrski, Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; and Christian Singer, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Henry T. Lynch
- Adriana Valentini, Amy Finch, Ping Sun, and Steven A. Narod, Women's College Research Institute; Ellen Greenblatt, Centre for Fertility and Reproductive Health, Mount Sinai Hospital, University of Toronto, Toronto; Peter J. Ainsworth, London Regional Cancer Program, London, Ontario; Parviz Ghadirian, Research Center of the University of Montreal Hospital Centre, Montreal, Quebec; Charmaine Kim-Sing, BC Cancer Agency, Vancouver, British Columbia, Canada; Henry T. Lynch, Creighton University School of Medicine, Omaha, NE; Susan L. Neuhausen, Beckman Research Institute, City of Hope, Duarte, CA; Jan Lubiński and Tomasz Byrski, Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; and Christian Singer, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Peter J. Ainsworth
- Adriana Valentini, Amy Finch, Ping Sun, and Steven A. Narod, Women's College Research Institute; Ellen Greenblatt, Centre for Fertility and Reproductive Health, Mount Sinai Hospital, University of Toronto, Toronto; Peter J. Ainsworth, London Regional Cancer Program, London, Ontario; Parviz Ghadirian, Research Center of the University of Montreal Hospital Centre, Montreal, Quebec; Charmaine Kim-Sing, BC Cancer Agency, Vancouver, British Columbia, Canada; Henry T. Lynch, Creighton University School of Medicine, Omaha, NE; Susan L. Neuhausen, Beckman Research Institute, City of Hope, Duarte, CA; Jan Lubiński and Tomasz Byrski, Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; and Christian Singer, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Susan L. Neuhausen
- Adriana Valentini, Amy Finch, Ping Sun, and Steven A. Narod, Women's College Research Institute; Ellen Greenblatt, Centre for Fertility and Reproductive Health, Mount Sinai Hospital, University of Toronto, Toronto; Peter J. Ainsworth, London Regional Cancer Program, London, Ontario; Parviz Ghadirian, Research Center of the University of Montreal Hospital Centre, Montreal, Quebec; Charmaine Kim-Sing, BC Cancer Agency, Vancouver, British Columbia, Canada; Henry T. Lynch, Creighton University School of Medicine, Omaha, NE; Susan L. Neuhausen, Beckman Research Institute, City of Hope, Duarte, CA; Jan Lubiński and Tomasz Byrski, Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; and Christian Singer, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ellen Greenblatt
- Adriana Valentini, Amy Finch, Ping Sun, and Steven A. Narod, Women's College Research Institute; Ellen Greenblatt, Centre for Fertility and Reproductive Health, Mount Sinai Hospital, University of Toronto, Toronto; Peter J. Ainsworth, London Regional Cancer Program, London, Ontario; Parviz Ghadirian, Research Center of the University of Montreal Hospital Centre, Montreal, Quebec; Charmaine Kim-Sing, BC Cancer Agency, Vancouver, British Columbia, Canada; Henry T. Lynch, Creighton University School of Medicine, Omaha, NE; Susan L. Neuhausen, Beckman Research Institute, City of Hope, Duarte, CA; Jan Lubiński and Tomasz Byrski, Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; and Christian Singer, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Christian Singer
- Adriana Valentini, Amy Finch, Ping Sun, and Steven A. Narod, Women's College Research Institute; Ellen Greenblatt, Centre for Fertility and Reproductive Health, Mount Sinai Hospital, University of Toronto, Toronto; Peter J. Ainsworth, London Regional Cancer Program, London, Ontario; Parviz Ghadirian, Research Center of the University of Montreal Hospital Centre, Montreal, Quebec; Charmaine Kim-Sing, BC Cancer Agency, Vancouver, British Columbia, Canada; Henry T. Lynch, Creighton University School of Medicine, Omaha, NE; Susan L. Neuhausen, Beckman Research Institute, City of Hope, Duarte, CA; Jan Lubiński and Tomasz Byrski, Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; and Christian Singer, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ping Sun
- Adriana Valentini, Amy Finch, Ping Sun, and Steven A. Narod, Women's College Research Institute; Ellen Greenblatt, Centre for Fertility and Reproductive Health, Mount Sinai Hospital, University of Toronto, Toronto; Peter J. Ainsworth, London Regional Cancer Program, London, Ontario; Parviz Ghadirian, Research Center of the University of Montreal Hospital Centre, Montreal, Quebec; Charmaine Kim-Sing, BC Cancer Agency, Vancouver, British Columbia, Canada; Henry T. Lynch, Creighton University School of Medicine, Omaha, NE; Susan L. Neuhausen, Beckman Research Institute, City of Hope, Duarte, CA; Jan Lubiński and Tomasz Byrski, Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; and Christian Singer, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Steven A. Narod
- Adriana Valentini, Amy Finch, Ping Sun, and Steven A. Narod, Women's College Research Institute; Ellen Greenblatt, Centre for Fertility and Reproductive Health, Mount Sinai Hospital, University of Toronto, Toronto; Peter J. Ainsworth, London Regional Cancer Program, London, Ontario; Parviz Ghadirian, Research Center of the University of Montreal Hospital Centre, Montreal, Quebec; Charmaine Kim-Sing, BC Cancer Agency, Vancouver, British Columbia, Canada; Henry T. Lynch, Creighton University School of Medicine, Omaha, NE; Susan L. Neuhausen, Beckman Research Institute, City of Hope, Duarte, CA; Jan Lubiński and Tomasz Byrski, Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; and Christian Singer, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Stan DL, Shuster LT, Wick MJ, Swanson CL, Pruthi S, Bakkum-Gamez JN. Challenging and complex decisions in the management of the BRCA mutation carrier. J Womens Health (Larchmt) 2013; 22:825-34. [PMID: 23987739 PMCID: PMC4047843 DOI: 10.1089/jwh.2013.4407] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Women afflicted by the hereditary breast and ovarian cancer syndrome face complex decisions regarding medical interventions aimed at reducing their risk of ovarian and breast cancer, interventions which in turn may interfere with their fertility and cause early menopause. This review addresses selected topics of importance and controversy in the management of the BRCA mutation carrier, such as psychological well-being and quality of life, breast and ovarian cancer screening, risk-reducing interventions for breast cancer and ovarian cancer, the issue of hysterectomy at the time of the risk-reducing salpingo-oophorectomy, health consequences of early surgical menopause, and safety of hormonal therapy after oophorectomy. The information presented is based on an extensive review of the literature on the selected topics and on the expertise of our multidisciplinary team.
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Affiliation(s)
- Daniela L. Stan
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Lynne T. Shuster
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Myra J. Wick
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Casey L. Swanson
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Sandhya Pruthi
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
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Carter J, Stabile C, Gunn A, Sonoda Y. The physical consequences of gynecologic cancer surgery and their impact on sexual, emotional, and quality of life issues. J Sex Med 2013; 10 Suppl 1:21-34. [PMID: 23387909 DOI: 10.1111/jsm.12002] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Surgical management of gynecologic cancer can cause short- and long-term effects on sexuality, reproductive function, and overall quality of life (QOL) (e.g., sexual dysfunction, infertility, lymphedema). However, innovative approaches developed over the past several decades have improved oncologic outcomes and reduced treatment sequelae. AIM To provide an overview of the standards of care and major advancements in gynecologic cancer surgery, with a focus on their direct physical impact, as well as emotional, sexual, and QOL issues. This overview will aid researchers and clinicians in the conceptualization of future clinical care strategies and interventions to improve sexual/vaginal/reproductive health and QOL in gynecologic cancer patients. MAIN OUTCOME MEASURES Comprehensive overview of the literature on gynecologic oncology surgery. METHODS Conceptual framework for this overview follows the current standards of care and recent surgical approaches to treat gynecologic cancer, with a brief overview describing primary management objectives and the physical, sexual, and emotional impact on patients. Extensive literature support is provided. RESULTS The type and radicality of surgical treatment for gynecologic cancer can influence sexual function and play a significant role in QOL. Psychological, sexual, and QOL outcomes improve as surgical procedures continue to evolve. Procedures for fertility preservation, laparoscopy, sentinel lymph node mapping, and robotic and risk-reducing surgery have advanced the field while reducing treatment sequelae. Nevertheless, interventions that address sexual and vaginal health issues are limited. CONCLUSIONS It is imperative to consider QOL and sexuality during the treatment decision-making process. New advances in detection and treatment exist; however, psycho-educational interventions and greater patient-physician communication to address sexual and vaginal health concerns are warranted. Large, prospective clinical trials including patient-reported outcomes are needed in gynecologic oncology populations to identify subgroups at risk. Future study designs need clearly defined samples to gain insight about sexual morbidity and foster the development of targeted interventions.
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Affiliation(s)
- Jeanne Carter
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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Meaney-Delman D, Bellcross CA. Hereditary breast/ovarian cancer syndrome: a primer for obstetricians/gynecologists. Obstet Gynecol Clin North Am 2013; 40:475-512. [PMID: 24021253 DOI: 10.1016/j.ogc.2013.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
An understanding of the diagnosis and clinical management of hereditary breast and ovarian cancer syndrome (HBOC) is essential for obstetricians/gynecologists. This article provides practical information regarding collecting a family history, cancer risk assessment and genetic testing, BRCA-associated cancer prognosis and treatment, screening recommendations, and prevention strategies. Through appropriate cancer risk assessment, women with BRCA1/2 mutations can be identified, and screening and prevention strategies can be used before a diagnosis of cancer occurs. Women's health providers with a strong working knowledge of HBOC are able to improve the quality of care for women and families impacted by BRCA1/2 mutations.
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Affiliation(s)
- Dana Meaney-Delman
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 49 Jesse Hill Jr Drive, Atlanta, GA 30303, USA.
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50
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Gopie JP, Mureau MAM, Seynaeve C, ter Kuile MM, Menke-Pluymers MBE, Timman R, Tibben A. Body image issues after bilateral prophylactic mastectomy with breast reconstruction in healthy women at risk for hereditary breast cancer. Fam Cancer 2012; 12:479-87. [DOI: 10.1007/s10689-012-9588-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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