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Jones NL, Schulkin J, Urban RR, Wright JD, Burke WM, Hou JY, McElwain CA, Tergas AI. Physicians' Perspectives and Practice Patterns Toward Opportunistic Salpingectomy in High- and Low-Risk Women. Cancer Invest 2016; 35:51-61. [PMID: 28029807 DOI: 10.1080/07357907.2016.1242597] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Opportunistic bilateral salpingectomy (OBS) has been proposed as an ovarian cancer risk-reducing strategy. METHODS A survey was emailed to 300 members of the American College of Obstetricians and Gynecologists. RESULTS 125 (42%) surveys were returned: 60% female, 88% generalists, 67% private practice. Only 36% correctly identified the lifetime risk of ovarian cancer, only 23% understood the risk-reducing benefit of bilateral salpingo-oophorectomy. 75% perform salpingectomy during hysterectomy, 26-53% use for sterilization depending on approach. Concerns were increased operative time and complications. For BRCA mutations, 64% recommend BSO, 12% recommend a two-step risk-reducing strategy, and 14% refer to gynecologic oncology. CONCLUSIONS We identified broad support and factors limiting willingness to perform OBS.
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Affiliation(s)
- Nathaniel L Jones
- a Department of Obstetrics and Gynecology , Columbia University College of Physicians and Surgeons , New York , New York , USA.,b New York Presbyterian Hospital , New York , New York , USA
| | - Jay Schulkin
- c Department of Obstetrics and Gynecology , University of Washington , Seattle , Washington , USA.,d Research Department , American College of Obstetricians and Gynecologists , Washington, DC , USA
| | - Renata R Urban
- c Department of Obstetrics and Gynecology , University of Washington , Seattle , Washington , USA
| | - Jason D Wright
- a Department of Obstetrics and Gynecology , Columbia University College of Physicians and Surgeons , New York , New York , USA.,b New York Presbyterian Hospital , New York , New York , USA.,e Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons , New York , New York , USA
| | - William M Burke
- a Department of Obstetrics and Gynecology , Columbia University College of Physicians and Surgeons , New York , New York , USA.,b New York Presbyterian Hospital , New York , New York , USA.,e Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons , New York , New York , USA
| | - June Y Hou
- a Department of Obstetrics and Gynecology , Columbia University College of Physicians and Surgeons , New York , New York , USA.,b New York Presbyterian Hospital , New York , New York , USA.,e Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons , New York , New York , USA
| | - Cora A McElwain
- d Research Department , American College of Obstetricians and Gynecologists , Washington, DC , USA
| | - Ana I Tergas
- a Department of Obstetrics and Gynecology , Columbia University College of Physicians and Surgeons , New York , New York , USA.,b New York Presbyterian Hospital , New York , New York , USA.,e Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons , New York , New York , USA.,f Department of Epidemiology , Mailman School of Public Health, Columbia University , New York , New York , USA
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Daly MB, Dresher CW, Yates MS, Jeter JM, Karlan BY, Alberts DS, Lu KH. Salpingectomy as a means to reduce ovarian cancer risk. Cancer Prev Res (Phila) 2015; 8:342-8. [PMID: 25586903 DOI: 10.1158/1940-6207.capr-14-0293] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 12/29/2014] [Indexed: 12/21/2022]
Abstract
Bilateral salpingo-oophorectomy (BSO) has become the standard-of-care for risk reduction in women at hereditary risk of ovarian cancer. Although this procedure significantly decreases both the incidence of and mortality from ovarian cancer, it affects quality of life, and the premature cessation of ovarian function may have long-term health hazards. Recent advances in our understanding of the molecular pathways of ovarian cancer point to the fallopian tube epithelium as the origin of most high-grade serous cancers (HGSC). This evolving appreciation of the role of the fallopian tube in HGSC has led to the consideration of salpingectomy alone as an option for risk management, especially in premenopausal women. In addition, it is postulated that bilateral salpingectomy with ovarian retention (BSOR), may have a public health benefit for women undergoing benign gynecologic surgery. In this review, we provide the rationale for salpingectomy as an ovarian cancer risk reduction strategy.
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Affiliation(s)
- Mary B Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
| | - Charles W Dresher
- Department of Translational Outcomes Research Group of the Translational Research Program of the Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Melinda S Yates
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joanne M Jeter
- Department of Medicine, University of Arizona, Tucson, Arizona
| | - Beth Y Karlan
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Karen H Lu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Fakkert IE, Mourits MJE, Jansen L, van der Kolk DM, Meijer K, Oosterwijk JC, van der Vegt B, Greuter MJW, de Bock GH. Breast Cancer Incidence After Risk-Reducing Salpingo-Oophorectomy in BRCA1 and BRCA2 Mutation Carriers. Cancer Prev Res (Phila) 2012; 5:1291-7. [PMID: 23009828 DOI: 10.1158/1940-6207.capr-12-0190] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Premenopausal risk-reducing salpingo-oophorectomy (RRSO) in BRCA1/2 mutation carriers effectively reduces ovarian cancer risk, but also reduces breast cancer risk. Breast cancer risk reductions up to 50% have been reported for both BRCA1 and BRCA2 mutation carriers, but recent prospective studies were not able to reproduce this finding for BRCA1 mutation carriers. Breast cancer incidence after RRSO was assessed in a consecutive series of 104 BRCA1 and 58 BRCA2 mutation carriers. On the basis of data from our own centre, and assuming a 50% risk reduction through RRSO at premenopausal age, we expected to find 8 breast cancers (range 6-10) in this population for the reported screening period (532 women-years). In 162 carriers with a median age of 41 years at RRSO, 13 incident breast cancers were diagnosed. In BRCA1 mutation carriers, 12 incident breast cancers were found compared with 5 (range 3-6) expected and in BRCA2 mutation carriers 1 breast cancer was found compared with 3 (range 2-5) expected. Breast cancer incidence after premenopausal RRSO is still high, especially in BRCA1 mutation carriers. Previously reported breast cancer risk reductions up to 50% were not confirmed. As a consequence, continued intensive screening for breast cancer is warranted in BRCA1 and BRCA2 mutation carriers after RRSO.
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Affiliation(s)
- Ingrid E Fakkert
- University Medical Center Groningen, University of Groningen, Department of Epidemiology, Groningen, The Netherlands
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