Outcome of risk-reducing salpingo-oophorectomy in BRCA carriers and women of unknown mutation status


Prof U Menon, Gynaecological Cancer Research Centre, EGA Institute for Women’s Health, First floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK. Email u.menon@ucl.ac.uk


Please cite this paper as: Manchanda R, Abdelraheim A, Johnson M, Rosenthal A, Benjamin E, Brunell C, Burnell M, Side L, Gessler S, Saridogan E, Oram D, Jacobs I, Menon U. Outcome of risk-reducing salpingo-oophorectomy in BRCA carriers and women of unknown mutation status. BJOG 2011;118:814–824.

Objective  To compare surgical outcomes and occult cancer rates at risk-reducing salpingo-oophorectomy in BRCA carriers and high-risk women who had not undergone genetic testing.

Design  Prospective cohort study.

Setting  Tertiary high-risk familial gynaecological cancer clinic.

Population  Women undergoing risk-reducing salpingo-oophorectomy between January 2005 and November 2009.

Methods  Women at high-risk of ovarian/tubal cancer were identified on the basis of the inclusion criteria for the UK Familial Ovarian Cancer Screening Study. Risk management options discussed with 1456 high-risk women included risk-reducing salpingo-oophorectomy. A strict histopathological protocol with serial slicing was used to assess tubes and ovaries.

Results  In total, 308 high-risk women (191 with unknown mutation status; 117 known BRCA1/BRCA2 carriers) chose risk-reducing surgery; 94.5% of procedures were performed laparoscopically. The surgical complication rate was 3.9% (95% CI 2.0–6.7). Four ovarian and ten tubal occult invasive/in situ cancers were found. The overall occult invasive cancer rate was 5.1% (95% CI 1.9–10.83) in BRCA1/BRCA2 carriers and 1.05% (95% CI 0.13–3.73) in untested women. When tubal in situ cancers were included, the overall rate was 4.55% (95% CI 2.5–7.5). Two untested women with tubal carcinoma in situ were subsequently found to be BRCA carriers. The median ages of BRCA carriers (58 years; IQR 13.4 years) and untested women (49.5 years; IQR 20.6 years) with occult invasive/in situ cancer were not significantly different (= 0.454).

Conclusions  Both high-risk women of unknown mutation status and BRCA carriers have a significant (although higher in the latter group) rate of occult invasive/in situ tubal/ovarian cancer, with a similar age distribution at detection. The data has important implications for counselling high-risk women on the likelihood of occult malignancy and perioperative complications at risk-reducing salpingo-oophorectomy. Women with occult disease should be offered genetic testing.