Highlights
- •BRCA mutation carriers are willing to participate in a PSDO trial.
- •The majority of participants found potential PSDO study risks to be acceptable.
- •These results suggest that adequate accrual for a clinical trial of PSDO is possible.
Abstract
Objective
Given the emerging evidence for the fimbria as the site of origin for many serous
carcinomas in BRCA mutation carriers, consideration is being given in studying prophylactic
salpingectomy with delayed oophorectomy (PSDO) as a risk-reducing surgery. We aimed
to determine the interest in a study of PSDO among these women.
Methods
We evaluated the results of an online survey conducted by Facing Our Risk of Cancer
Empowered (FORCE), a patient advocacy group, from October 2010 to August 2012. Premenopausal
BRCA mutation carriers with no history of ovarian cancer or prior bilateral salpingo-oophorectomy
(BSO) were included.
Results
Of the 204 women meeting inclusion criteria, median age was 35 years, 92.5% were white, 25.7% were Jewish, and 16.7% had a history of breast cancer.
Overall, 34.3% reported interest in a study of salpingectomy, 35.3% were unsure, and
30.4% were not interested in the study. Women noted the possibility of lowering ovarian
cancer risk without menopause as a compelling reason to participate (83.8%). Reasons
for not participating in a salpingectomy study included surgical complications (46.6%),
potential ovarian damage (42.2%), planning BSO soon (32.4%), and surgical costs (32.8%).
Acceptable study risks included the need for two surgeries (77.2%), possibility of
not lowering ovarian cancer risk (68%), and disruption of ovarian blood supply (66.5%).
Conclusions
One-third of BRCA mutation carriers indicated definite interest in a PSDO study. Potential
study risks were acceptable to most women. These findings suggest that patient accrual
for a clinical trial of prophylactic salpingectomy with delayed oophorectomy is possible.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gynecologic OncologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cancer statistics.CA Cancer J Clin. 2013; 63: 11-30
- Clinical relevance of hereditary ovarian cancer.in: Lu K.H. Hereditary Gynecologic Cancer: Risk, Prevention, and Management. Informa Healthcare, New York2008: 1-13
- SGO committee statement: Society of Gynecologic Oncologists Education Committee statement on risk assessment for inherited gynecologic cancer predispositions.Gynecol Oncol. 2007; 107: 159-162
- SEER Cancer Statistics Review, 1975–2009.National Cancer Institute, Bethesda, MD2013 ([p. based on November 2011 SEER data submission])
- Genetic/Familial High-risk Assessment: Breast and Ovarian. NCNN Clinical Practice Guidelines in Oncology V12013.NCCN, Fort Washington (PA)2013
- Risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 mutation.N Engl J Med. 2002; 346: 1601-1615
- Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations.N Engl J Med. 2002; 346: 1616-1622
- Risk-reducing salpingo-oophorectomy for the prevention of BRCA1- and BRCA2-associated breast and gynecologic cancer: a multicenter, prospective study.J Clin Oncol. 2008; 26: 1331-1337
- Salpingo-oophorectomy and the risk of ovarian, fallopian tube, and peritoneal cancers in women with a BRCA1 or BRCA2 mutation.JAMA. 2006; 296: 185-192
- Mortality after bilateral salpingo-oophorectomy in BRCA1 and BRCA2 mutation carriers: a prospective cohort study.Lancet Oncol. 2006; 7: 223-229
- Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality.JAMA. 2010; 304: 967-975
- Prophylactic oophorectomy in premenopausal women and long-term health.Menopause Int. 2008; 14: 111-116
- Increased risk of cognitive impairment or dementia in women who underwent oophorectomy before menopause.Neurology. 2007; 69: 1074-1083
- Survival patterns after oophorectomy in premenopausal women: a population-based cohort study.Lancet Oncol. 2006; 7: 821-828
- The impact of prophylactic salpingo-oophorectomy on menopausal symptoms and sexual function in women who carry a BRCA mutation.Gynecol Oncol. 2011; 121: 163-168
- Primary fallopian tube malignancies in BRCA-positive women undergoing surgery for ovarian cancer risk reduction.J Clin Oncol. 2007; 25: 3985-3990
- Pathologic findings in prophylactic oophorectomy specimens in high-risk women.Gynecol Oncol. 2002; 87: 52-56
- The tubal fimbria is a preferred site for early adenocarcinoma in women with familial ovarian cancer syndrome.Am J Surg Pathol. 2006; 30: 230-236
- Clinical and pathologic findings of prophylactic salpingo-oophorectomies in 159 BRCA1 and BRCA2 carriers.Gynecol Oncol. 2006; 100: 58-64
- Risk-reducing salpingo-oophorectomy in BRCA mutation carriers: role of serial sectioning in the detection of occult malignancy.J Clin Oncol. 2005; 23: 127-132
- Occult ovarian tumors in women with BRCA1 or BRCA2 mutations undergoing prophylactic oophorectomy.J Clin Oncol. 2000; 18: 2728-2732
- Occult carcinoma in prophylactic oophorectomy specimens: prevalence and association with BRCA germline mutation status.Am J Surg Pathol. 2001; 25: 1283-1289
- Microscopic and early-stage ovarian cancers in BRCA1/2 mutation carriers: building a model for early BRCA-associated tumorigenesis.Cancer Prev Res. 2011; 4: 463-470
- Surgical implications of the potential new tubal pathway for ovarian carcinogenesis.J Minim Invasive Gynecol. 2013; 20: 153-159
- Risk-reducing salpingectomy as preventative strategy for pelvic serous cancer.Int J Gynecol Cancer. 2013; 23: 417-421
- Prophylactic salpingectomy and delayed oophorectomy as an alternative for BRCA mutation carriers.Obstet Gynecol. 2013; 121: 14-24
- Radical fimbriectomy: a reasonable temporary risk-reducing surgery for selected women with a germ-line mutation of BRCA1 or 2 genes? Rationale and preliminary development.Gynecol Oncol. 2011; 121: 472-476
- Short-term effects of salpingectomy during laparoscopic hysterectomy on ovarian reserve: a pilot randomized controlled trial.Fertil Steril. 2013; 100: 1704-1708
- Prophylactic salpingectomy in premenopausal low-risk women for ovarian cancer: primum non nocere.Gynecol Oncol. 2013; 129: 448-451
- Breast cancer risk following bilateral oophorectomy in BRCA1 and BRCA2 mutation carriers: an international case–control study.J Clin Oncol. 2005; 23: 7491-7496
Article info
Publication history
Published online: March 14, 2014
Accepted:
February 20,
2014
Received:
December 11,
2013
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
