Surveillance of survivors: Follow-up after risk-reducing salpingo-oophorectomy in BRCA 1/2 mutation carriers

UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA 94143, USA.
Gynecologic Oncology (Impact Factor: 3.77). 04/2011; 122(2):339-43. DOI: 10.1016/j.ygyno.2011.04.004
Source: PubMed


To characterize the post-operative care of BRCA1 and BRCA2 mutation carriers who undergo risk-reducing salpingo-oophorectomy (RRSO).
BRCA1 and BRCA2 mutation carriers from our Cancer Risk Program who elected RRSO were sent questionnaires regarding their post-surgical surveillance and treatment for menopause symptoms, primary peritoneal cancer and bone loss.
In 51 mutation carriers who were surveyed a median of 6 years after RRSO, 24 (47%) received dual-energy X-ray absorptiometry (DXA) testing, yearly CA-125 serum testing and yearly pelvic examination. Three women received none of these examinations in follow-up. Respondents reported an average of 3.5 menopausal symptoms (range 0-9). The mean number of menopausal symptoms reported by respondents using HRT was 2.8, compared to 3.9 symptoms reported by women not using HRT (p=0.06). Six of 10 (60%) subjects who reported no history of DXA bone scan, and 10 of 15 (67%) subjects who reported no post-surgical CA-125 serum monitoring noted that their physicians "did not recommend" testing. Two out of six symptomatic women who were younger than 50 (33%) who had no other contraindication to the use of HRT reported their non-use was because their care providers "advised against" HRT use.
We believe that the lack of post-RRSO health care guidelines has resulted in inconsistent care for this cohort of patients. We proposed that national guidelines be developed to standardize care with the goal of optimizing long term survival in this unique cohort of young cancer previvors.

19 Reads
  • Source
    • "Risk-reducing salpingo-oophorectomy (RRSO) is currently recommended for BRCA 1/2 mutation carriers at the completion of the childbearing years between the ages of 35 and 40 or younger in carriers with a familial cancer history of early onset [19-21]. According to the report from a research group at the MD Anderson Cancer Center, the majority of women who were at high risk for breast and ovarian cancer were satisfied with their choice of a risk-reduction strategy [22], the standard practice of RRSO according to the recommendation has increased the number of post-RRSO survivors who are at risk of primary peritoneal cancer, bone loss, and menopausal symptoms [23]. However, there is a lack of post-RRSO health care guidelines for this cohort of patients. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The annual review of 2011 comprised 11 themes of major research achievements in gynecologic oncology including breast cancer. A potential paradigm shift in the management of ovarian cancer was reviewed through comprehensive genomic analyses and a tumor-specific new intraoperative fluorescence imaging technique using folate receptor-α targeted agent, which is expected to improve intraoperative staging and more radical cytoreduction. In addition, updates of bevacizumab and poly (ADP-ribose) polymerase inhibitors, risk-reducing salpingo-oophorectomy, and risk evaluation of pelvic mass were discussed. Regarding cervical cancer, this review covered new findings on human papillomavirus vaccines and human papillomavirus tests as well as the current status of clinical trials on locally advanced cervical cancer. The promising role of sentinel lymph node biopsy in the management of early stage endometrial cancer was followed by two notable clinical researches on: exemestane, an aromatase inhibitor, for the prevention of breast cancer and eribulin, a non-taxane microtubule dynamics inhibitor for the treatment of metastatic breast cancer. Lastly, in premenopausal women with breast cancer, the effect of gonadotropin-releasing hormone analogue on the occurrence of chemotherapy-induced early menopause was discussed.
    Journal of Gynecologic Oncology 01/2012; 23(1):53-64. DOI:10.3802/jgo.2012.23.1.53 · 2.49 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Women with an inherited BRCA mutation are at significantly increased risk for breast and ovarian cancer, often diagnosed at an earlier age than sporadic cancers. Prophylactic surgery, with bilateral mastectomy and/or bilateral prophylactic salpingo-oophorectomy, represents an option for risk reduction. The purpose of this study was to explore quality of life, sexual functioning, menopausal symptoms, psychological well-being and satisfaction with risk management decisions for BRCA-positive women ages 21 to 50 (M = 38.4 years), without a personal history of cancer. A web-based, cross-sectional study design was utilized to compare women opting for any prophylactic surgery (n = 160) with those without a history of prophylactic surgery (n = 71). Quality of life (per the Quality of Life Index, Self-Anchoring Striving Scale and Body Image Quality of Life measures) and Psychological General Well-Being Index scores were essentially the same across the entire study sample. While controlling for age, prophylactic surgery (PS) predicted more severe symptoms of sexual dysfunction as measured by the Female Sexual Functioning Index (total score, Desire, Arousal, Lubrication and Satisfaction domains). Similarly, PS predicted menopausal symptoms and sleep difficulties. Women who had not undergone any prophylactic surgery had higher levels of Stigma and lower levels of Mastery, as measured by the BRCA Self-Concept scale. Prophylactic surgery also predicted higher levels of Satisfaction with Decision for hereditary cancer risk management. Findings from this exploratory study provide insight into the quality of life, sexual functioning and psychological well-being for unaffected, BRCA-positive women. Additional research is needed to examine sexual functioning prospectively, to further investigate the potential sequelae of risk-reducing surgery.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Women with germline mutations in BRCA1 and BRCA2 genes have significantly increased lifetime risks of breast and ovarian cancer. To manage both the ovarian and breast cancer risks the current recommendation is undergo a risk reducing salpingo-oophorectomy (RRSO) prior to natural menopause. To date, studies have focussed on quality of life and sexual dysfunction in women who undergo RRSO, but few have reported on the wider physical consequences. We performed a questionnaire study in women with BRCA 1 or 2 gene mutations known to the Peter MacCallum Familial Cancer Centre. We gathered information about ovarian surgery, ongoing follow-up, management of risk factors including osteoporosis, and current severity of menopausal symptoms. Two hundred and nineteen women were surveyed. One hundred and forty-three of 157 responding participants (91 %) reported having RRSO. Sixty one were pre-menopausal at RRSO. Post surgical follow-up rates were generally low, and a minority of women reported recent bone density imaging or pharmaceutical prevention or treatment of osteoporosis. Menopausal symptoms appeared generally mild. No significant differences in symptom severity were observed in women who underwent a pre-menopausal RRSO compared to RRSO after natural menopause. These data indicate that a formalised follow-up protocol is necessary to optimally manage the consequences of a RRSO.
    Familial Cancer 04/2012; 11(3). DOI:10.1007/s10689-012-9527-5 · 1.98 Impact Factor
Show more