In the meantime, "Potential risks and benefits of screening with CA-125 and TVS deserve to be part of the discussion with high risk women, at least for women not considering RRSO
," they said.
Until better screening modalities are available, identifying these women for RRSO is our best method for improving ovarian cancer mortality.
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.
RRM can reduce the risk of breast cancer by as much as 90% for such patients; (38,39) RRSO
yields similar results, reducing the risk of ovarian cancer by 80% to 95% and the risk of breast cancer by 40% to 59%, provided the surgery is performed before the patient is 40 years old.
This mental checkpoint contributed to Sadie's confidence in her decision to undergo RRSO
at age 32, because she was able to return to this metaphor and feel certain that her choice was correct.
Although instability in the estimated magnitude of this risk remains, we believe that the possibility of this cancer should be considered when discussing the advantages and risks of hysterectomy at the time of RRSO
in BRCA1 + women," they wrote.
Testing revealed a BRCA2 germline mutation; the patient elected to undergo an RRSO
, and hysterectomy was performed.
Women were more likely to have occult cancer at RRSO
if they had BRCA 1/2 mutations (odds ratio, 11.3; 95% confidence interval, 1.487.9), abnormal baseline transovarian ultrasound or CA-125 levels (OR, 6.5; 95% CI, 1.8-24.3), or were postmenopausal (OR, 4.0; 95% CI, 1.213.3), they wrote (J.
(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.
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.
"The current report represents, to our knowledge, the first prospective study to evaluate the impact of RRSO
on BRCA-associated breast and gynecologic cancer risk when carriers of BRCA2 mutations are evaluated separately from carriers of BRCAl mutations," they wrote (doi: 10.1200/JCO.2007.13.9626).
The definitive preventive technique is risk-reducing salpingo-oophorectomy (RRSO