Evaluation of Screening and Risk Reducing Surgery for Women Followed in a High Risk Breast/Ovarian Cancer Clinic [25A

Abstract

INTRODUCTION: Up to 20% of ovarian cancers are attributed to inherited predispositions, however current screening methods (Ca-125 and pelvic ultrasound) do not improve outcomes compared to risk-reducing (RR) surgery. The study objective was to evaluate surgical outcomes of women followed in an academic center’s High-Risk Breast/Ovarian Cancer (HBOC) clinic following RR surgery. METHODS: Retrospective chart review of women from the past decade who underwent RR surgery in a HBOC clinic. Surgical outcomes, pathology, pre-operative screening results, and pre-/post-operative cancer diagnoses were evaluated. RESULTS: One hundred and eighty-six high risk women were identified with a mean age of 50.2 years and a mean BMI of 28.9 kg/m2 at the time of surgery. The majority (106; 57%) had strong family history of ovarian cancer without an identified mutation but the rest had deleterious mutations (BRCA2-17.7%, BRCA1-15.1%, Lynch 3.2%, or p53 0.5%). The most common procedure was a risk-reducing bilateral salpingo-oophorectomy with or without hysterectomy (RRBSO, 88.7%). All women underwent the SEE-FIM protocol with extensive pathologic analysis which found 2 (0.8%) invasive ovarian cancers (1 ovary/tube carcinosarcoma, 1 granulosa cell), 3 (1.6%) serous tubal intraepithelial carcinomas (STIC), and 1 fallopian tube cancer (0.8%). All tubal pathology was diagnosed in women with documented BRCA mutations. No cancers were found on screening. CONCLUSION: Among all high-risk women undergoing RR surgery, about 3% are ultimately diagnosed with a STIC or an ovarian cancer of which none were identified on screening. All STIC and tubal cancers were diagnosed in women with BRCA mutations (6.6% rate).