April 2004 · Vol. 16, No. 4Preventing BRCA-related cancers:
The case for oophorectomy
The team that conducted the recent prospective trial of risk-reducing surgery versus surveillance reviews the evidence, plus surgical technique, psychosocial factors, use of estrogen after surgery, and insurance issues.
NOAH
D.
KAUFF,
MD;
DEBORAH
GOLDFRANK,
MD;
RICHARD
R.
BARAKAT,
MDDr. Kauff is clinical assistant physician on the gynecology and clinical genetics services, Dr. Goldfrank is a fellow in clinical genetics, and Dr. Barakat is chief of the gynecology service, Memorial Sloan-Kettering Cancer Center, New York City.
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KEY POINTS
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Mutations in BRCA1 and BRCA2 may be responsible for more than 90% of inherited predisposition to ovarian cancer.
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BRCA1 and BRCA2 mutations are associated with a lifetime risk of breast cancer of up to 85% and a 15% to 45% lifetime risk of ovarian cancer.
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The only prospective trial to date found risk-reducing salpingo-oophorectomy (RRSO) was associated with an 85% reduction in ovarian cancer and a 68% reduction in breast cancer.
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Because microscopic cancer may be found in 2% to 4% of RRSO specimens upon careful pathologic review, the ovaries and fallopian tubes should be sectioned in their entirety and examined by an experienced gynecologic pathologist.
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When A.M. Liber encountered a family of 5 sisters and their mother with histologically confirmed papillary adenocarcinoma of the ovary, he recommended frequent gynecologic cancer screening for all family members and suggested prophylactic oophorectomy as an option.1 The year was 1950.
Flash forward half a century or so, and prophylactic oophorectomy has gained wider acceptance for the prevention of hereditary ovarian and breast cancer, with the only prospective trial to date confirming its overall efficacy for women with BRCA1 and BRCA2 mutations. These mutations are related to the vast majority of inherited ovarian cancers.
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