Outcome of risk-reducing salpingo-oophorectomy in ... [BJOG. 2011] - PubMed result

BJOG. 2011 Mar 10. doi: 10.1111/j.1471-0528.2011.02920.x. [Epub ahead of print]

Outcome of risk-reducing salpingo-oophorectomy in BRCA carriers and women of unknown mutation status.

Manchanda R, Abdelraheim A, Johnson M, Rosenthal A, Benjamin E, Brunell C, Burnell M, Side L, Gessler S, Saridogan E, Oram D, Jacobs I, Menon U.

Department of Gynaecological Oncology, EGA Institute for Women's Health, UCL, London, UK Department of Gynaecological Oncology, Barts and the London Hospital, London, UK Department of Obstetrics and Gynaecology, ElMinia University Hospitals, ElMinia, Egypt Department of Pathology, Cancer Institute, Rockefeller Building, UCL, London, UK Department of Radiology Department of Gynaecology, University College London Hospital (UCLH), London, UK.


Abstract
Please cite this paper as: Manchanda R, Abdelraheim A, Johnson M, Rosenthal A, Benjamin E, Brunell C, Burnell M, Side L, Gessler S, Saridogan E, Oram D, Jacobs I, Menon U. Outcome of risk-reducing salpingo-oophorectomy in BRCA carriers and women of unknown mutation status. BJOG 2011; DOI: 10.1111/j.1471-0528.2011.02920.x. Objective  To compare surgical outcomes and occult cancer rates at risk-reducing salpingo-oophorectomy in BRCA carriers and high-risk women who had not undergone genetic testing. Design  Prospective cohort study. Setting  Tertiary high-risk familial gynaecological cancer clinic. Population  Women undergoing risk-reducing salpingo-oophorectomy between January 2005 and November 2009. Methods  Women at high-risk of ovarian/tubal cancer were identified on the basis of the inclusion criteria for the UK Familial Ovarian Cancer Screening Study. Risk management options discussed with 1456 high-risk women included risk-reducing salpingo-oophorectomy. A strict histopathological protocol with serial slicing was used to assess tubes and ovaries. Results  In total, 308 high-risk women (191 with unknown mutation status; 117 known BRCA1/BRCA2 carriers) chose risk-reducing surgery; 94.5% of procedures were performed laparoscopically. The surgical complication rate was 3.9% (95% CI 2.0-6.7). Four ovarian and ten tubal occult invasive/in situ cancers were found. The overall occult invasive cancer rate was 5.1% (95% CI 1.9-10.83) in BRCA1/BRCA2 carriers and 1.05% (95% CI 0.13-3.73) in untested women. When tubal in situ cancers were included, the overall rate was 4.55% (95% CI 2.5-7.5). Two untested women with tubal carcinoma in situ were subsequently found to be BRCA carriers. The median ages of BRCA carriers (58 years; IQR 13.4 years) and untested women (49.5 years; IQR 20.6 years) with occult invasive/in situ cancer were not significantly different (P = 0.454). Conclusions  Both high-risk women of unknown mutation status and BRCA carriers have a significant (although higher in the latter group) rate of occult invasive/in situ tubal/ovarian cancer, with a similar age distribution at detection. The data has important implications for counselling high-risk women on the likelihood of occult malignancy and perioperative complications at risk-reducing salpingo-oophorectomy. Women with occult disease should be offered genetic testing.

© 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.
PMID: 21392246 [PubMed - as supplied by publisher]

Outcome of risk-reducing salpingo-oophorectomy in ... [BJOG. 2011] - PubMed result