Outcome of risk-reducing salpingo-oophorectomy in BRCA carriers and women of unknown mutation status
Article first published online: 10 MAR 2011
© 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 118, Issue 7, pages 814–824, June 2011
How to Cite
Manchanda, R., Abdelraheim, A., Johnson, M., Rosenthal, A., Benjamin, E., Brunell, C., Burnell, M., Side, L., Gessler, S., Saridogan, E., Oram, D., Jacobs, I. and Menon, U. (2011), Outcome of risk-reducing salpingo-oophorectomy in BRCA carriers and women of unknown mutation status. BJOG: An International Journal of Obstetrics & Gynaecology, 118: 814–824. doi: 10.1111/j.1471-0528.2011.02920.x
- Issue published online: 12 MAY 2011
- Article first published online: 10 MAR 2011
- Accepted 13 January 2011. Published Online 10 March 2011.
- occult cancer;
- ovarian cancer;
- risk-reducing salpingo-oophorectomy;
- tubal cancer;
- unknown mutation status
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 (P = 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.