Randall: My approach in the asymptomatic, postmenopausal patient is much like that for the premenopausal one: RRSO for known genetic mutation carriers, genetic testing for potential carriers, and the option to use ultrasound and CA 125 monitoring in the rest.
In women with significant family history (ovarian cancer in more than 1 first-degree relative), RRSO might be considered in those who are medically fit for surgery.
40) Notably, hormone therapy use after RRSO
in women with a gene mutation has not been found to increase the risk of breast cancer.
Having created a situation in which her decision to remain childless was not only accepted, but embraced, Trixie completed RRBM at age 27 and was actively considering RRSO
10) A recent prospective study by Kauff et al, (11) in which more than 1000 women who carried a deleterious BRCA1 or BRCA2 mutation self-selected RRSO or observation, showed that the type of protection offered by RRSO may specifically depend on whether the patient carries a BRCA1 or BRCA 2 mutation.
Occult carcinoma is present in 2% to 17% of RRSO specimens.
Key clinical point: Older postmenopausal women, BRCA 1/2 mutation carriers, and women with abnormal cancer 125 (CA-125) serum levels or transovarian ultrasound results were significantly more likely to have occult invasive cancers diagnosed when they underwent RRSO.
Major finding: Significant predictors of invasive cancer at the time of RRSO included BRCA 1/2 mutations (odds ratio, 11.
The "time at risk" for participants began after both receipt of genetic testing results and RRSO, and the participants were followed annually by questionnaires and medical records review.
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.
The findings are a "strong confirmation that RRSO remains the most effective risk-reduction strategy" for the prevention of BRCAl-associated gynecologic cancer, noted the authors.
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).