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

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

    Research output: Contribution to journalArticlepeer-review

    Abstract

    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 RCOG.
    Original languageEnglish
    Pages (from-to)814-824
    Number of pages10
    JournalBJOG: An International Journal of Obstetrics and Gynaecology
    Volume118
    Issue number7
    DOIs
    Publication statusPublished - Jun 2011

    Keywords

    • BRCA
    • occult cancer
    • ovarian cancer
    • risk-reducing salpingo-oophorectomy
    • tubal cancer
    • unknown mutation status

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