Highlights
- •Multi-institutional study of high risk variant carriers after risk reducing procedure
- •Receiving hormonal therapy after a risk reductive procedure was not associated with increased risk of malignancy.
- •There were no subsequent gynecologic carcinomas identified in either group.
- •Being younger and undergoing other risk reductive procedures increased use of hormonal therapy.
Abstract
Objectives
This study aimed to assess the association between hormone replacement therapy and
the incidence of subsequent malignancies in patients who underwent risk-reducing salpingo-oophorectomy
and had mutations predisposing them to Müllerian cancers.
Methods
This Institutional Review Board-approved retrospective study was performed at five
academic institutions. Women were included if they were age 18–51 years, had one or
more confirmed germline highly penetrant pathogenic variants, and underwent risk-reducing
salpingo-oophorectomy. Patients with a prior malignancy were excluded. Clinicodemographic
data were collected by chart review. Patients with no documented contact for one year
prior to study termination were called to confirm duration of hormone use and occurrence
of secondary outcomes. Hormone replacement therapy included any combination of estrogen
or progesterone.
Results
Data were analyzed for 159 women, of which 82 received hormone replacement therapy
and 77 did not. In both groups an average of 6 years since risk reduction had passed.
The patients treated with hormone replacement therapy did not have a higher risk of
subsequent malignancy than those not treated with hormone replacement therapy (6 out
of 82 vs. 7 out of 77, P = .68). Patients who received hormone replacement therapy were younger than those
who did not receive hormone replacement therapy (39.0 vs. 43.9 years, P < .01) and were more likely to have undergone other risk reductive procedures including
mastectomy and/or hysterectomy, though this difference was not statistically significant
(69.5% vs. 55.8%, P = .07).
Conclusions
In this multi-institution retrospective study of data from patients with high-risk
variant carriers who underwent risk-reducing salpingo-oophorectomy, there was no statistically
significant difference in the incidence of malignancy between women who did and did
not receive hormone replacement therapy.
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
- Prophylactic and risk-reducing bilateral Salpingo-oophorectomy: recommendations based on risk of ovarian cancer.Obstet. Gynecol. 2010; 116: 733-743
- NCCN Guidelines Insights: Genetic/Familial High-Risk Assessment: Breast and Ovarian, Version 2.2017.15. 2017: 9 (1)
- NCCN Guidelines Insights: Genetic/Familial High-Risk Assessment: Colorectal, Version 3.2017.15. 2017: 1465 (12)
- A prospective study of risk-reducing Salpingo-oophorectomy and longitudinal CA-125 screening among women at increased genetic risk of ovarian Cancer: design and baseline characteristics: a gynecologic oncology group study.Cancer Epidemiology, Biomarkers & Prevention : A Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology. 2008; 17: 594-604
- Prophylactic salpingectomy and delayed oophorectomy as an alternative for BRCA mutation carriers.Obstet. Gynecol. 2013; 121: 14-24
- Risks and benefits of estrogen plus progestin in healthy postmenopausal WomenPrincipal results from the Women’s Health Initiative randomized controlled trial.JAMA. 2002; 288: 321-333
- Hormone therapy and the risk of breast cancer in BRCA1 mutation carriers.J. Natl. Cancer Inst. 2008; 100: 1361-1367
- Hormone replacement therapy after oophorectomy and breast Cancer risk among BRCA1 mutation carriers.JAMA Oncology. 2018; 4: 1059-1065
- Is hormone replacement therapy safe in women with a BRCA mutation? A systematic review of the contemporary literature.Am. J. Clin. Oncol. 2018; 41: 313-315
- Hormone replacement therapy after risk reducing salpingo-oophorectomy in patients with BRCA1 or BRCA2 mutations; a systematic review of risks and benefits.Gynecol. Oncol. 2019; 153: 192-200
- Decisions about prophylactic gynecologic surgery: a qualitative study of the experience of female Lynch syndrome mutation carriers.Hered Cancer Clin Pract. 2015; 13: 10
- Hormone replacement therapy after prophylactic risk-reducing salpingo-oophorectomy and breast cancer risk in BRCA1 and BRCA2 mutation carriers: a meta-analysis.Crit. Rev. Oncol. Hematol. 2018; 132: 111-115
- Estrogen receptor status in BRCA1 and BRCA2-related breast cancer: the influence of age, grade, and histological type.Clin. Cancer Res. 2004; 10: 2029-2034
- BRCA germline mutations in Jewish women with uterine serous papillary carcinoma.Gynecol. Oncol. 2004; 92: 521-524
- The risk of endometrial cancer in women with BRCA1 and BRCA2 mutations. A prospective study.Gynecol. Oncol. 2007; 104: 7-10
- Risk of endometrial carcinoma associated with BRCA mutation.Gynecol. Oncol. 2001; 80: 395-398
- Uterine cancer after risk-reducing Salpingo-oophorectomy without hysterectomy in women with BRCA mutations uterine cancer after risk-reducing Salpingo-oophorectomy uterine cancer after risk-reducing Salpingo-oophorectomy.JAMA Oncology. 2016; 2: 1434-1440
- Endometrial cancer and lynch syndrome: clinical and pathologic considerations.Cancer Control. 2009; 16: 14-22
- Lynch syndrome presenting as endometrial cancer.Clin. Chem. 2014; 60: 111
- WISP: A Prospective, Multi-Center Trial of Salpingectomy with Delayed Oophorectomy Versus Risk Reducing Salpingo-Oophorectomy in Women at Increased Risk for Hereditary Ovarian Cancer Paper Presented at: 50th Annual Meeting of the Society of Gynecologic Oncology; March 16–19, 2019.2019 (Honolulu, Hawaii)
- Bilateral salpingectomy with delayed oophorectomy for ovarian cancer risk reduction: a pilot study in women with BRCA1/2 mutations.Gynecol. Oncol. 2018; 150: 79-84
. M.P. Steenbeek MGH, D. TUBA group, R.P.M.G. Hermens and J.A. de Hullu. Worry and regret in the prospective multicentre TUBA study in BRCA1/2 mutation carriers. Paper Presented at: 50th Annual Meeting of the Society of Gynecologic Oncology; March 16–19, 2019, 2019; (Honolulu, Hawaii).
Article info
Publication history
Published online: March 03, 2020
Accepted:
February 24,
2020
Received in revised form:
February 22,
2020
Received:
November 27,
2019
Footnotes
☆Grant support: REDCap: Supported by Clinical and Translational Science Award (CTSA) Grant [UL1 TR000448] and Siteman Comprehensive Cancer Center and NCI Cancer Center Support Grant P30 CA091842.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
