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Sasse SA, Lee SS, Rajeev P, Sharma SR, Kahan T, Pothuri B. Concurrent uterine surgery and uptake of hormone therapy in patients undergoing bilateral salpingo-oophorectomy for risk-reducing or therapeutic indications. Gynecol Oncol 2023; 179:131-137. [PMID: 37988946 DOI: 10.1016/j.ygyno.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE This study aimed to analyze factors associated with concurrent uterine surgery in patients undergoing bilateral salpingo-oophorectomy (BSO) for risk reducing or therapeutic purposes. Additionally, trends in surgical choice and uptake of post-operative hormone therapy (HT) were examined. METHODS A 10-year retrospective study was conducted on patients who underwent risk-reducing or therapeutic BSO at one institution. Multinomial regression analysis of patient and case characteristics was performed evaluating associations with surgery type (BSO, BSO and hysterectomy, or BSO and endometrial sampling). Trends in surgery type and uptake of HT post operatively are described. RESULTS Among the study sample of 643 patients, 140 (22%) patients underwent therapeutic BSO for a history of hormone receptor (HR) positive breast cancer, while the remainder underwent risk-reducing BSO due to a pathogenic variant and/or family history. Pathogenic variants included BRCA1 (141, 40%) BRCA2 (173, 49%), and Lynch syndrome genes (15, 4%). Regression analysis revealed significant associations between concurrent hysterectomy and Black race (RR = 3.55, CI = 1.51-8.38, p = 0.004), history of HR positive breast cancer (RR = 1.88, CI = 1.03-3.42, p = 0.04), and surgeon (Surgeon 1, RR = 2.43, CI = 1.36-4.35, p = 0.003). Among eligible patients under age 51, 36% initiated HT. Over the study period, concurrent hysterectomy rates declined while endometrial sampling increased. CONCLUSIONS Rates of hysterectomy declined over the study period and slightly more than one-third of eligible patients utilized post-operative HT. Further research on concurrent uterine surgery is needed to establish standardized treatment recommendations in the risk-reducing and therapeutic BSO population. Additionally, education regarding the benefits of postoperative HT in eligible patients is warranted.
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Affiliation(s)
- Simone A Sasse
- Department of Obstetrics and Gynecology, New York University Langone Health Center, New York, NY, USA
| | - Sarah S Lee
- Department of Obstetrics and Gynecology, New York University Langone Health Center, New York, NY, USA
| | - Pournami Rajeev
- Department of Obstetrics and Gynecology, New York University Langone Health Center, New York, NY, USA
| | - Sneha R Sharma
- Department of Obstetrics and Gynecology, New York University Langone Health Center, New York, NY, USA
| | - Tamara Kahan
- Department of Obstetrics and Gynecology, New York University Langone Health Center, New York, NY, USA
| | - Bhavana Pothuri
- Department of Obstetrics and Gynecology, New York University Langone Health Center, New York, NY, USA; Department of Medicine, New York University Langone Health Medical Center, Laura & Isaac Perlmutter Cancer Center, New York, NY, USA.
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Kang OJ, Lee SW, Kim JH, Park JY, Suh DS, Kim DY, Kim JH, Kim YM, Kim YT. Pathological findings and long-term prognosis in Korean BRCA1/2 mutation carriers undergoing risk-reducing salpingo-oophorectomy. Int J Gynecol Cancer 2023; 33:1743-1749. [PMID: 37541685 DOI: 10.1136/ijgc-2023-004618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023] Open
Abstract
OBJECTIVE Our study aimed to evaluate the incidence of pathological findings in asymptomatic Korean patients with BRCA1/2 pathogenic variants who underwent risk-reducing salpingo-oophorectomy and to assess their long-term prognosis. METHODS We retrospectively analyzed the medical records of patients with a germinal BRCA1/2 pathologic variant who had undergone risk-reducing salpingo-oophorectomy at Asan Medical Center (Seoul, Korea) between January 2013 and December 2020. All pathologic reports were made based on the sectioning and extensively examining the fimbriated end of the fallopian tube (SEE/FIM) protocol. RESULTS Out of 243 patients who underwent risk-reducing salpingo-oophorectomy, 121 (49.8%) had a BRCA1 mutation, 119 (48.9%) had a BRCA2 mutation, and three (1.2%) had both mutations. During the procedure, four (3.3%) patients with a BRCA1 mutation were diagnosed with serous tubal intraepithelial carcinoma (STIC) or serous tubal intraepithelial lesion (STIL), and another four patients (3.3%) were diagnosed with occult cancer despite no evidence of malignancy on preoperative ultrasound. In the BRCA2 mutation group, we found one (0.8%) case of STIC, but no cases of STIL or occult cancer. During the median follow-up period of 98 months (range, 44-104) for STIC and 54 months (range, 52-56) for STIL, none of the patients diagnosed with these precursor lesions developed primary peritoneal carcinomatosis. CONCLUSIONS Risk-reducing salpingo-oophorectomy, in asymptomatic Korean patients with BRCA1/2 pathogenic variants, detected ovarian cancer and precursor lesions, including STIC or STIL. Furthermore, our follow-up period did not reveal any instances of primary peritoneal carcinomatosis, suggesting a limited body of evidence supporting the imperative need for adjuvant treatment in patients diagnosed with these precursor lesions during risk-reducing salpingo-oophorectomy.
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Affiliation(s)
- Ok-Ju Kang
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Shin-Wha Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ju-Hyun Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jeong-Yeol Park
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dae-Shik Suh
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dae-Yeon Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jong-Hyeok Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yong-Man Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young-Tak Kim
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
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Nomura H, Abe A, Fusegi A, Yoshimitsu T, Misaka S, Murakami A, Matsumoto T, Tsumura S, Kanno M, Aoki Y, Netsu S, Omi M, Tanigawa T, Okamoto S, Omatsu K, Yunokawa M, Kanao H, Habano E, Arakawa H, Kaneko K, Ueki A, Haruyama Y, Inari H, Ueno T. Impact of the coverage of risk-reducing salpingo-oophorectomy by the national insurance system for women with BRCA pathogenic variants in Japan. Sci Rep 2023; 13:1018. [PMID: 36658289 PMCID: PMC9852267 DOI: 10.1038/s41598-023-28304-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
To determine the impact of the coverage of risk-reducing salpingo-oophorectomy (RRSO) and mastectomy (RRM) as well as genetic testing for BRCA pathogenic variants by the national insurance system in Japan. We compared the clinical background of women who underwent RRSO at our institution before and after its coverage by the national insurance system. Those who underwent RRSO between January 2017 and December 2019 and between April 2020 and March 2022 were classified as Period. A and B, respectively. Overall, 134 women underwent RRSO during the study period. In Period A and B, 45 and 89 women underwent RRSO for the study period was 36 and 24 months, respectively. Compared with Period A, the number of women who underwent RRSO per month increased by threefold in Period B (p < 0.01). In addition, the number of women who underwent surgery for breast cancer along with RRSO increased in Period B (p < 0.01). Although the number of women who underwent concurrent RRM with RRSO in Period B increased, the difference was not statistically significant. Compared with Period A, the number of women diagnosed with BRCA pathogenic variant increased by 3.9-fold, and the proportion of women who underwent concurrent hysterectomy at the time of RRSO decreased from 66 to 7.9% in Period B (p < 0.01). Owing to the introduction of the national insurance system, the number of women who underwent RRSO and concurrent surgery for breast cancer at the time of RRSO increased in Japan.
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Affiliation(s)
- Hidetaka Nomura
- Department of Gynecology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto-Ku, Tokyo, 135-8550, Japan.
| | - Akiko Abe
- Department of Gynecology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto-Ku, Tokyo, 135-8550, Japan
| | - Atsushi Fusegi
- Department of Gynecology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto-Ku, Tokyo, 135-8550, Japan
| | - Teruyuki Yoshimitsu
- Department of Gynecology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto-Ku, Tokyo, 135-8550, Japan
| | - Satoki Misaka
- Department of Gynecology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto-Ku, Tokyo, 135-8550, Japan
| | - Atsushi Murakami
- Department of Gynecology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto-Ku, Tokyo, 135-8550, Japan
| | - Tsuyoshi Matsumoto
- Department of Gynecology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto-Ku, Tokyo, 135-8550, Japan
| | - Shiho Tsumura
- Department of Gynecology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto-Ku, Tokyo, 135-8550, Japan
| | - Motoko Kanno
- Department of Gynecology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto-Ku, Tokyo, 135-8550, Japan
| | - Yoichi Aoki
- Department of Gynecology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto-Ku, Tokyo, 135-8550, Japan
| | - Sachiho Netsu
- Department of Gynecology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto-Ku, Tokyo, 135-8550, Japan
| | - Makiko Omi
- Department of Gynecology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto-Ku, Tokyo, 135-8550, Japan
| | - Terumi Tanigawa
- Department of Gynecology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto-Ku, Tokyo, 135-8550, Japan
| | - Sanshiro Okamoto
- Department of Gynecology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto-Ku, Tokyo, 135-8550, Japan
| | - Kohei Omatsu
- Department of Gynecology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto-Ku, Tokyo, 135-8550, Japan
| | - Mayu Yunokawa
- Department of Gynecology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto-Ku, Tokyo, 135-8550, Japan
| | - Hiroyuki Kanao
- Department of Gynecology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto-Ku, Tokyo, 135-8550, Japan
| | - Eri Habano
- Department of Clinical Genetics, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hiromi Arakawa
- Department of Clinical Genetics, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Keika Kaneko
- Department of Clinical Genetics, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Arisa Ueki
- Department of Clinical Genetics, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yurie Haruyama
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hitoshi Inari
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takayuki Ueno
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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