Major finding: Significant predictors of invasive cancer at the time of RRSO included BRCA 1/2 mutations (odds ratio, 11.
Data source: Analysis of data from 996 high-risk women who chose RRSO as part of a nonrandomized prospective clinical trial (Gynecologic Oncology Group 0199, or GOG 0199) of the National Ovarian Cancer Prevention and Early Detection Study.
Although this study is one of the largest prospective studies to date to look at the likelihood of high-risk uterine cancer among BRCA-positive patients who undergo RRSO without hysterectomy, it has a number of limitations, such as possible misclassification of rare uterine cancer subtypes in the SEER database and possible confounding by tamoxifen exposure.
Indeed, it would be premature at this point to recommend routine hysterectomy along with RRSO women with BRCA1 mutations; the decision regarding hysterectomy at the time of RRSO may depend on the patient's age, prior cancer history, and other risk factors, senior author Dr.
Hysterectomy at the time of RRSO is not recommended because of risks associated with the procedure, including bleeding and infection risks, as well the potential for long-term problems with bladder, bowel, and sexual function, and also because uterine cancers that develop after RRSO have been thought to generally be low risk, according to the press statement.
Occult carcinoma is present in 2% to 17% of RRSO specimens.
19 Although the protocol was created for BRCA-positive RRSO specimens, we currently apply a modification of this protocol to any prophylactic salpingo-oophorectomy specimen (regardless of known BRCA status) as well as all staging oophorectomies.
As with the gross examination, the histologic findings in RRSO sections can be subtle.
In RRSO specimens, progressive epithelial changes are often present in the fallopian tube.
A total of 792 participants were followed for a mean of 39 months for gynecologic cancer, 509 of whom had undergone RRSO and 283 of whom had not (surveillance-only group).
12 for developing gynecologic cancer after RRSO, reported the authors.
When invasive and noninvasive breast cancers were examined independently, RRSO appeared to be more protective against noninvasive breast cancer (HR 0.