The effect of personal medical history and family history of cancer on the uptake of risk-reducing salpingo-oophorectomy.

Jessica E Van Der Aa,Jacob P Hoogendam,Ronald P Zweemer,Els S F Butter,René H M Verheijen,Margreet G E M Ausems

doi:10.1007/s10689-015-9827-7

Jessica E Van Der Aa, Jacob P Hoogendam + Show 4 more

Open Access

https://doi.org/10.1007/s10689-015-9827-7

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Abstract

Women with an increased lifetime risk of ovarian cancer are advised to undergo risk-reducing salpingo-oophorectomy (RRSO) to reduce risk of adnexal cancer. We investigated the uptake of RRSO and evaluated the influence of personal medical history of (breast) cancer, risk-reducing mastectomy (RRM) and family history of ovarian and/or breast cancer on the RRSO decision. This single center retrospective observational cohort study was performed in a tertiary multidisciplinary clinic for hereditary cancer of the University Medical Centre Utrecht, the Netherlands. Women ≥35 years old with an estimated lifetime risk of ovarian cancer ≥10 %, who had completed childbearing, were eligible for RRSO. Uptake and timing of RRSO were analyzed. Influence of personal medical history and family history on RRSO decision making, were evaluated with logistic regression. The study population consisted of 218 women (45.0 % BRCA1 mutation carrier, 28.0 % BRCA2 mutation carrier, 27.0 % with familial susceptibility) with 87.2 % RRSO uptake. The median age at RRSO was 44.5 (range 28–73) years. Of the women undergoing RRSO, 78.3 % needed ≤3 consultations to reach this decision. Multivariable analysis showed a significant difference in RRSO uptake for women with a history of RRM [OR 3.66 95 % CI (1.12–11.98)], but no significant difference in women with a history of breast cancer [OR 1.38 95 % CI (0.50–3.79)], nor with a family history of ovarian and/or breast cancer [OR 1.10 95 % CI (0.44–2.76)]. We conclude that RRSO counseling, without the alternative of screening, is effective. The uptake is increased in women with a history of RRM.

Highlights

Women carrying a BRCA1 or BRCA2 gene mutation have a life time risk of developing ovarian cancer of 31–58.9 and 6–34.5 % respectively [1,2,3,4,5]
We investigated the uptake of risk-reducing salpingo-oophorectomy (RRSO) and evaluated the influence of personal medical history of cancer, risk-reducing mastectomy (RRM) and family history of ovarian and/or breast cancer on the RRSO decision
We identified 218 women who were considered eligible for undergoing RRSO

Summary

Introduction

Women carrying a BRCA1 or BRCA2 gene mutation have a life time risk of developing ovarian cancer of 31–58.9 and 6–34.5 % respectively [1,2,3,4,5]. Risk-reducing salpingooophorectomy (RRSO) has been associated with a risk reduction of 85–96 % for ovarian, fallopian tube and peritoneal cancer [6,7,8,9]. A meta-analysis by Marchetti et al (2014), showed a hazard ratio of 0.19 (95 % CI 0.13–0.27) for the development of ovarian cancer in BRCA1/2 mutation carriers up to six years after RRSO [10]. A large metaanalysis by Rebbeck et al [11] showed a hazard ratio of 0.21 (95 % CI 0.12–0.39) for the development of ovarian or breast cancer, up to five years after RRSO. Risk reduction of breast cancer after RRSO was estimated to be 53–72 % in BRCA1/2 mutation carriers in several studies [6,7,8,9]. A recent Dutch cohort study found no evidence for a risk reduction of breast cancer risk in BRCA1/2 mutation carriers after RRSO [hazard ratio 1.09 (95 % CI 0.67–1.77)] and stated that previous data may have overestimated the risk reduction because of bias [12]

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