Prophylactic Bilateral Oophorectomy Research Articles

Safety and effectiveness of subtotal pelvic peritonectomy for patients with colorectal cancer with limited peritoneal metastasis in pelvic cavity.

e15587 Background: Cytoreductive surgery with extensive visceral resection and peritonectomy has shown long-term survival benefits for colorectal cancer (CRC) patients with peritoneal metastasis. However, the extent of peritonectomy remains controversial for limited peritoneal metastasis. This study modified the selective pelvic peritonectomy (SPP) to subtotal pelvic peritonectomy (STPP) for patients with limited peritoneal metastasis in pelvic cavity, and aimed to assess the outcome of STPP. Methods: CRC patients with limited peritoneal metastases in pelvic cavity and underwent R0 resection were included from a prospectively collected database. Grade III/IV morbidity rate, disease free survival (DFS) and overall survival (OS) were analyzed. Results: A total of 51 patients were included (22 in the STPP group and 29 in the SPP group). An average of 60 minutes increased in operative time in the STPP group, but no perioperative mortality occurred. Grade III/IV complication rates did not differ between two groups. At a median follow-up of 38.1 months, the 3-year-DFS was 63.0% in the STPP group and 29.3% in the SPP group ( P = 0.006). The 3-year-OS was 82.6% and 55.6% for the STPP and SPP groups, respectively ( P = 0.033). Moreover, STPP was independently associated with improved DFS. Eight (38.1%) cases with remaining ovaries developed ovarian metastasis, of whom 6 (75%) underwent a second operation. Conclusions: Subtotal pelvic peritonectomy is associated with promising long-term outcome in CRC patients with limited peritoneal metastasis in the pelvic cavity. Prophylactic bilateral oophorectomy should be strongly considered during this procedure.

Steroid hormone levels in postmenopausal hysterectomised women with and without ovarian conservation: the continuous endocrine function of the ovaries

This study aims to clarify the effect of postmenopausal bilateral oophorectomy on plasma steroid hormone levels. Women who were submitted in the postmenopausal period to hysterectomy for uterine benign conditions were divided into two groups: 18 women had isolated hysterectomy and 11 had hysterectomy with bilateral salpingo-oophorectomy. In both groups serum hormone levels were quantified by solid phase extraction and gas chromatography and tandem mass spectrometry. Differences in dehydroepiandrosterone (DHEA), testosterone, androstenedione and oestradiol were determined in both groups. The analysis revealed lower steroid levels in the bilateral salpingo-oophorectomy group when compared to the isolated hysterectomy group with statistically significant differences found for DHEA (5.8 ± 3.2 vs. 9.4 ± 4.4 ng/mL; p = 0.019) and oestradiol (0.69 ± 0.4 vs. 1.48 ± 4.3 ng/mL; p = 0.007). The results are consistent with a significant endocrine activity of the postmenopausal ovary. The clinical consequences of these findings need to be clarified and postmenopausal prophylactic bilateral salpingo-oophorectomy re-evaluated. IMPACT STATEMENT What is already known on this subject? Although it is consensual that premenopausal prophylactic bilateral oophorectomy should not be performed because it has harmful effects on women's health, the evidence regarding the effects of postmenopausal prophylactic bilateral oophorectomy is scarce and this procedure continues to be a regular practice. Few studies have demonstrated that postmenopausal ovaries still have endocrine activity that may impact older women's health. What do the results of this study add? This is the first study to compare hormone levels of postmenopausal women based on their hysterectomy and oophorectomy status using GC-MS/MS, a highly sensitive bioanalytical assay for the measurement of steroid hormones. Previous studies relied on immunoassays and did not compare DHEA levels, which according to the intracrinology theory is a precursor for androgens and oestrogens. In this study, statistically significant lower levels of DHEA and oestradiol were found after postmenopausal bilateral salpingo-oophorectomy. What are the implications of these findings for clinical practice and/or further research? This is a pilot study that may lead to further investigation in this area to clarify the impact of the prophylactic removal of postmenopausal ovaries on older women′s health and lead to changes in surgical procedures.

Association of Premenopausal Bilateral Oophorectomy With Parkinsonism and Parkinson Disease

The association of premenopausal bilateral oophorectomy with parkinsonism and Parkinson disease (PD) remains controversial. To assess whether women who underwent premenopausal bilateral oophorectomy were at increased risk of parkinsonism and PD and whether the associations varied by age at oophorectomy and by receipt of estrogen replacement therapy. This cohort study used data from a combination of 2 independent cohort studies, the Mayo Clinic Cohort Study of Oophorectomy and Aging 1 and 2, which were based on the Rochester Epidemiology Project medical records-linkage system. A population-based sample of 5499 women from Olmsted County, Minnesota, were included; of those, 2750 women underwent bilateral oophorectomy for a benign indication before spontaneous menopause between January 1, 1950, and December 31, 2007 (oophorectomy cohort), and 2749 age-matched women who did not undergo bilateral oophorectomy were randomly sampled from the general population (reference cohort). Data were analyzed from March 1 to April 30, 2022. The date of oophorectomy was considered the index date for both groups. Medical record documentation of bilateral oophorectomy abstracted from a medical records-linkage system (Rochester Epidemiology Project). Incidence and risk of parkinsonism or PD, with diagnoses confirmed by in-person examination or medical record review. Among 5499 participants (median [IQR] age, 45.0 [40.0-48.0] years; 5312 [96.6%] White), 2750 women (2679 White [97.4%]) underwent bilateral oophorectomy at a median age of 45.0 years (IQR, 40.0-48.0 years), and 2749 women (2633 White [95.8%]) with a median age of 45.0 years (IQR, 40.0-48.0 years) at the index date were included in the reference cohort. Bilateral oophorectomy was associated with an increased risk of parkinsonism overall (hazard ratio [HR], 1.59; 95% CI, 1.02-2.46) and in women younger than 43 years at oophorectomy (HR, 7.67; 95% CI, 1.77-33.27). There was a pattern of increasing risk with younger age at the time of oophorectomy using 4 age strata (≥50 years: HR, 1.43 [95% CI, 0.50-4.15]; 46-49 years: HR, 1.55 [95% CI, 0.79-3.07]; 40-45 years: HR, 1.36 [95% CI, 0.64-2.89]; <40 years: HR, 8.82 [95% CI, 1.08-72.00]; P = .02 for trend). The number needed to harm was 53 women overall and 27 women younger than 43 years at the time of oophorectomy. Bilateral oophorectomy was also associated with an increased risk of PD in women younger than 43 years at oophorectomy (HR, 5.00; 95% CI, 1.10-22.70), with a number needed to harm of 48 women. Among women who underwent oophorectomy at 45 years and younger, the risk was lower in women who received estrogen after the procedure and through age 50 years compared with women who did not. For parkinsonism, the HRs were 1.72 (95% CI, 0.54-5.53) vs 2.05 (95% CI, 0.80-5.23); for PD, the HRs were 1.53 (95% CI, 0.29-8.23) vs 2.75 (95% CI, 0.84-9.04). However, the differences were not significant. In this study, premenopausal women who underwent bilateral oophorectomy before age 43 years had an increased risk of parkinsonism and PD compared with women who did not undergo bilateral oophorectomy. These findings suggest that a reduction in the practice of prophylactic bilateral oophorectomy in premenopausal women at average risk of ovarian cancer may have substantial benefit for reducing the risk of parkinsonism and PD.

Prevention of breast&amp;ovarian cancer in women with BRCA-1/2 mutations - A decision-analytic evaluation

Abstract Background Women who have inherited BRCA-1/2 mutations have substantially elevated lifetime risks for developing breast and/or ovarian cancer and may develop these cancers around age 30. Therefore, breast and ovarian cancer prevention should be administered relatively early in life for those women. We systematically evaluate the long-term effectiveness and cost-effectiveness of different breast and ovarian cancer prevention strategies in women with BRCA-1/2 mutations in Germany. Methods A decision-analytic Markov model simulating lifetime breast and ovarian cancer development in BRCA-1/2 carriers was developed to evaluate different strategies including intensified surveillance (IS), prophylactic bilateral mastectomy (PBM), and prophylactic bilateral oophorectomy (PBSO) alone or in combination at different ages. German clinical, epidemiological and cost (in 2018 Euro) data were used. Outcomes included cancer incidences, mortality, life years (LYs), quality-adjusted life years (QALYs), and discounted incremental cost-effectiveness ratios (ICER). Results All intervention strategies are more effective and less costly than IS alone. Prevention with PBM plus PBSO at age 30 maximizes life expectancy with 6.3 LYs gained, whereas PBM at age 30 with delayed PBSO at age 35 improves quality of life with 11.1 QALYs gained, when compared to IS alone. Both strategies are cost effective with ICER significantly below 10,000 EUR/LY or QALY gained. Conclusions Based on our results, PBM at age 30 plus PBSO between age 30 and 40 prolongs life and is cost effective in women with BRCA-1/2 mutations in Germany. Serial preventive surgeries with delayed PBSO potentially improve quality of life for women. We therefore suggest that efforts should be directed to carefully and thoroughly inform women with BRCA-1/2 mutations about their options to prevent breast and ovarian cancer. Key messages Prophylactic mastectomy at age 30 combined with prophylactic oophorectomy between age 30 and 40 may prolong lives and be cost effective in German women with BRCA- 1/2 mutations. Women’s quality of life might be improved by a delayed prophylactic oophorectomy after a prophylactic mastectomy.

Cancer Progress and Priorities: Breast Cancer.

Breast cancer is the most commonly diagnosed invasive cancer among women both globally and within the United States and the number one cause of cancer-related deaths among women globally ([1, 2][1]). Less than 1% of diagnosed breast cancers occur in men ([2][2]) and, therefore, male breast cancer is

Genetic conditions impairing female fertility.

Fertility represents a biological and psychological requirement for women. Some genetic diseases represent a rare cause of infertility, being responsible for 10% of cases of premature ovarian insufficiency. Among these, the most frequent and also those most studied by researchers are Turner Syndrome - due to a karyotype abnormality of the X chromosome pair - and the presence of fragile X premutation (FMR1). To exclude these conditions the diagnostic workup for non-iatrogenic premature ovarian insufficiency (POI) involves the performance of a karyotype analysis and the search for the FMR1 gene mutation, as well as the search for the presence of Y-chromosomal material. However, several other mutations and genetic syndromes associated with POI development have recently been highlighted, although they occur rarely, such as the GALT gene mutation in galactosemia or the FOXL2 gene mutation in BPES and many others, and further autosomal genetic testing are indicated if clinical suspicion is present. Mutations of BRCA 1 and 2 genes, make patients at genetically determined high risk of developing early ovarian or breast cancer and of getting POIs for the treatments they must undergo to prevent it (prophylactic bilateral oophorectomy) or treat it (chemotherapy). The management of impaired fertility is not less important than that of other syndromic manifestations for the quality of life of patients. Few data are available regarding the efficiency of cryopreservation of reproductive material (oocytes, embryos or ovarian tissue) in order to preserve fertility in this particular subgroup of patients, but certainly it represents a promising chance and a hope for the future.

Use of antidepressants in women after prophylactic bilateral oophorectomy: A Danish national cohort study

To investigate the association between prophylactic bilateral oophorectomy and use of antidepressants in women with a family history of cancer. Nationwide population-based cohort study using Danish National Registries including women oophorectomized due to a family history of cancer (n = 2,002) and an age matched reference group (n = 18,018). Analyses were stratified by age at time of bilateral oophorectomy and use of hormone replacement therapy (HRT). Women oophorectomized at age ≤ 45 years were more likely to use antidepressants from the first year after bilateral oophorectomy (OR = 1.34; 95 % CI: 1.08-1.65) compared to the reference group. Women oophorectomized at age 46-55 years and at age >55 years had no significantly increased use of antidepressants (OR = 0.90; 95 % CI: 0.68-1.18 and OR = 1.14; 95 % CI: 0.81-1.61). The increased use of antidepressants in women oophorectomized at age ≤ 45 years was limited to women treated with HRT (OR = 1.51; 95 % CI: 1.18-1.94) whereas women oophorectomized at age ≤ 45 years not treated with HRT had no increased use of antidepressants (OR = 1.03; 95 % CI: 0.70-1.51). Women oophorectomized due to a family history of cancer at age ≤ 45 years were more likely to use antidepressants after bilateral oophorectomy. The increased use of antidepressants was limited to women treated with HRT. The study calls for further large-scale studies to understand how bilateral oophorectomy and concomitant HRT affects risk of depression in women with a family history of cancer.

The fitness to work certificate in a worker exposed to ionizing radiation with an oncological disease: criteria and assessment process

To assess the fitness to work certificate in employees both affected by neoplasia and exposed to ionizing radiation always represents a clinical and professional issue, as well as human and social. The aim of our study is to analyze the case of a 40-year-old clinician (woman, endoscopist, gastroenterologist) who underwent left mastectomy and breast reconstruction with a tissue expander, professionally exposed to ionizing radiation. Due to the presence of the BRCA1 gene mutation and the presence of breast and ovarian cancer familiarity, the patient also underwent a prophylactic right mastectomy and bilateral oophorectomy. According to Italian legislation and international guidelines, several elements and criteria have been taken into account to release the fitness to work certificate in this peculiar case of a female worker exposed to ionizing radiation, resulting in a final positive indication.

Immunodetection and quantification of enzymatic markers in theca cells: the early process of ovarian steroidogenesis†.

The association between theca cells (TCs) and granulosa cells is pivotal to steroid biosynthesis in the ovary. During the late secondary follicle stage, TCs form a layer around granulosa cells, after which their steroidogenic function falls under the control of luteinizing hormone (LH) that activates the cAMP signaling pathway via a G protein-coupled receptor. In addition to perilipin-2, a marker for lipid droplets containing esters as substrates for TCs to produce steroidogenic hormones, other essential proteins, like steroidogenic acute regulatory protein (StAR), cytochrome P450 11A1, cytochrome P450c17, 3 beta-hydroxysteroid dehydrogenase/delta 5 ->4-isomerase type 1, and 3 beta-hydroxysteroid dehydrogenase/delta 5 ->4-isomerase type 2, play a role in the cascade after luteinizing hormone-choriogonadotropic hormone receptor (LH/CG-R) occupation by LH. The aim of the present study was to assess expression levels and corresponding amounts of LH/CG-R, perilipin-2, and enzymes involved in the steroidogenic pathway of TCs based on follicle stage. Immunohistochemical analysis of each of these proteins was therefore performed on ovarian samples from nine adult women, most (n=8) with BRCA1 and/or BRCA2 mutations undergoing prophylactic bilateral oophorectomy. Pictures were taken of the theca layer of secondary, small (<3000μm), and large (>3000μm) antral follicles and corpora lutea at 100× magnification. ImageJ software was used to analyze the surface area and expression intensity of each protein at each stage, known as the staining index. Overall, our data showed that LH/CG-R, perilipin-2, and StAR expression increased in the course of folliculogenesis and luteinization. Similarly, cytochrome P450 11A1, cytochrome P450c17, 3 beta-hydroxysteroid dehydrogenase/delta 5 ->4-isomerase type 1, and 3 beta-hydroxysteroid dehydrogenase/delta 5 ->4-isomerase type 2 expression were substantially elevated in TCs during folliculogenesis, evidenced by their coordinated action in terms of area covered and expression intensity. This study, conducted for the first time on human ovarian tissue, contributes to localizing and quantifying expression of key steroidogenic proteins at both intracellular and tissue levels. These findings may shed new light on pathological conditions involving the human ovary, such as androgen-secreting tumors of the ovary and other disorders associated with ovarian TCs in patients with polycystic ovary syndrome.

Mortality and Risk of Cancer After Prophylactic Bilateral Oophorectomy in Women With a Family History of Cancer

BackgroundCurrent international guidelines recommend systemic hormone therapy (HT) to oophorectomized women until the age of natural menopause. Despite an inherited predisposition to estrogen-dependent malignancies, the guidelines also apply to women oophorectomized because of a family history of cancer. The objective of this study was to investigate the impact of HT on mortality and risk of cancer in women oophorectomized because of a family history of cancer.MethodsA nationwide, population-based cohort was used to study women oophorectomized because of a family history of cancer (n = 2002). Comparison cohorts included women from the background population individually matched on age (n = 18 018). Oophorectomized women were subdivided into three groups: oophorectomized at 1) age 45 years or younger not using HT, 2) age 45 years or younger using HT, 3) older than age 45 years, and their respective population comparison cohorts.ResultsWomen oophorectomized at age 45 years or younger using HT had increased overall mortality (mortality rate ratio [MRR] = 3.45, 95% confidence interval [CI] = 1.53 to 7.79), mortality because of cancer (MRR = 5.67, 95% CI = 1.86 to 17.34), and risk of overall cancer (incidence rate ratio [IRR] = 3.68, 95% CI = 1.93 − 6.98), primarily reflected in an increased risk of breast cancer (IRR = 4.88, 95% CI = 2.19 − 10.68). Women oophorectomized at age 45 years or younger not using HT and women oophorectomized at older than age 45 years did not have increased mortality, mortality because of cancer, or risk of overall cancer, but they had increased risk of breast cancer (IRR = 2.64, 95% CI = 1.14 to 6.13, and IRR = 1.72, 95% CI = 1.14 to 2.59, respectively).ConclusionsUse of HT in women oophorectomized at age 45 years or younger with a family history of cancer is associated with increased mortality and risk of overall cancer and breast cancer. Our study warrants further investigation to establish the impact of HT on mortality and cancer risk in oophorectomized women with a family history of cancer.

How Does Hormone Therapy Affect Breast Cancer Risk After Oophorectomy in

Prophylactic bilateral oophorectomy lowers risk for ovarian cancer in women with BRCA1 mutations; however, carriers may be reluctant to use menopausal

Bilateral ovarian micrometastatic adenocarcinoma upon prophylactic oophorectomy concurrent with low anterior resection for rectal cancer

BackgroundThis case report draws attention to the debated role of prophylactic oophorectomy in women undergoing definitive surgical resection of colon and rectal cancers. It can be challenging to discern the indications and appropriate patient population for this procedure based on the current literature. Potential benefits include treatment and prevention of metastatic disease, preventing development of primary ovarian cancer, and prolonging survival. Negative effects include an increase in operative time and potential morbidity, development of osteoporosis, the risk of cardiac events, and decreasing sexual function. Multiple patient factors such as age, menopausal status, patient preference, presence of hereditary conditions, exposure to radiation, site, and stage of disease should be considered.Case presentationWe present a case in which a premenopausal 49-year-old female underwent a prophylactic bilateral salpingo-oophorectomy concurrently with a low anterior resection following neoadjuvant chemoradiation for clinical stage III rectal cancer. On pathologic examination, resection margins and all 14 lymph nodes harvested were negative for malignancy. Interestingly, she was found to have micrometastatic adenocarcinoma in the bilateral ovaries which had appeared grossly normal at the time of surgery.ConclusionsAfter consideration of the current literature, patient preference, and our clinical judgment, our patient ultimately had a therapeutic effect after undergoing prophylactic bilateral oophorectomy concurrently with a low anterior resection for rectal cancer. The addition of prophylactic oophorectomy in a select population, specifically women 50 years of age or younger and/or women who are in the premenopausal state, may carry a survival benefit in the setting of definitive surgical resection of colon and rectal cancers.

Disparities in cancer risk management among BRCA carriers across a diverse sample of young black, Hispanic, and non-Hispanic white breast cancer survivors.

LBA1504 Background: Rates of risk-reducing bilateral mastectomy (RRM) or risk-reducing prophylactic oophorectomy (RRSO) among BRCA carriers are based on studies of non-Hispanic whites (NHW), with little known among blacks or Hispanics. Methods: A population-based sample of NHW, black, and Hispanic women diagnosed with invasive BC &lt; age 50 in 2009-12 were recruited through the Florida State Cancer Registry and completed a baseline survey. Among the subset of BRCA carriers, we compared risk management for: 1) ovarian cancer (OC) through RRSO; and 2) BC through RRM or MRI screening, by calculating percentages and conducting logistic regression to control for other variables. Results: Of 1570 participants, 884 reported BRCA testing. Of the 91 BRCA carriers, 1) RRSO was 71% (36/51) among NHW, 32% (9/28) among blacks, and 83% (10/12) among Hispanics; 2) either breast MRI or RRM was 98% (50/51) among NHW, 85.7% (24/28) among blacks, and 100% (12/12) among Hispanics. BC risk management modality differed across groups, with lower rates of RRM among blacks (67%) compared to Hispanics (83%) and NHW (94%). After controlling for age at enrollment, time since diagnosis, income, family history of BC, family history of OC and private insurance at diagnosis: 1) Hispanics and NHW were significantly more likely than blacks to have RRSO (p = 0.01 and 0.02 respectively); and 2) NHW were also significantly more likely than blacks to have RRM (p = 0.03), although Hispanic race approached statistical significance (p = 0.10). Conclusions: The racial disparities in uptake of RRSO observed among blacks is particularly concerning given that RRSO is strongly recommended as the main OC prevention option due to the absence of effective OC early detection methods. The benefit from genetic testing comes from uptake of cancer risk management options, rather from testing itself. Future studies are needed to better understand and develop methods to improve cancer risk management practices across all populations.

Prophylactic ophorectomy: primum non nocere

In this invited lecture, I will provide an update on the prophylactic oophorectomy debate. Medical practices should follow the principle of “primun non nocere” (first do no harm), and bilateral oophorectomy performed electively at the time of hysterectomy for a benign indication is now under scrutiny and critical reappraisal because the long-term risks may outweigh the benefits in the majority of women. The ovaries are both reproductive and endocrine organs. They secrete hormones both before menopause (primarily estrogen, progesterone, and testosterone) and after (primarily testosterone, androstenedione, and dehydroepiandrosterone). Ovarian hormones have important reproductive actions; however, they also have important endocrine actions via receptors spread throughout most tissues and organs of the body (Rocca and Ulrich, 2012). Removal of the ovaries reduces the risk of ovarian (by 80–90%) and breast cancer (by 50–60%); however, it increases the risk of all-cause mortality (28%), lung cancer (45%), coronary heart disease (33%), stroke (62%), cognitive impairment (60%), parkinsonism (80%), psychiatric symptoms (50–130%), osteoporosis and bone fractures (50%), and impaired sexual function (40–110%). The magnitude of the risk may vary depending on the study referenced, the age at the time of oophorectomy, and the use of postoperative estrogen therapy. The scientific debate about the risks and benefits of prophylactic bilateral oophorectomy continues, and many women continue to undergo prophylactic oophorectomy in 2015 (Llaneza and Perez-Lopez, 2013; Harmanli et al., 2013; Harmanli, 2014). I suggest that the evidence is sufficient to change this practice. At the time of a hysterectomy for a benign condition, if the ovaries are normal and the woman is not carrying a high risk genetic mutation, the ovaries should be conserved. This conservative practice is particularly important in younger women (Rocca and Ulrich, 2012; Harmanli, 2014).

Presence of young children at home may moderate development of hot flashes during the menopausal transition

This work aims to determine the role of child care in hot flashes. Broad differences in vasomotor symptom experience are observed among perimenopausal women across cultures. Women in cultures where contact with young children is common report significantly fewer and less severe hot flashes than women in cultures where older women spend less time around children. Could these differences be related to the presence of young children? We surveyed 117 healthy women undergoing prophylactic bilateral oophorectomy (removal of both ovaries to reduce the risk of gynecologic cancers). Participants provided demographic information, including pre-surgical operation menopause status and number of children (younger than 13 y, 13-17 y, and 18 y or older) living at home. They were surveyed for menopausal symptoms 2 weeks before surgical operation and at 2 months, 6 months, and 1 year after surgical operation. Women who were premenopausal at the time of surgical operation experienced a significant increase in vasomotor symptoms. Within this group, participants with young children at home reported significantly fewer vasomotor symptoms across time than did women who did not live with young children. Women who were already menopausal at the time of surgical operation who had young children at home reported more vasomotor symptoms before surgical operation than did those without young children; however, this effect did not remain significant across follow-ups. These findings suggest that interactions with young children may mitigate hot flashes in women undergoing surgical menopause. These findings may be used to counsel women who are considering prophylactic oophorectomy about the likelihood of menopausal symptoms.

Use of Exogenous Hormones and Risks of Breast and Ovarian Cancers in BRCA1/2 Mutation Carriers; Methodological and Clinical Considerations

Risks of breast and ovarian cancer among BRCA1/2 mutation carriers are high, even for the young. Recommendations for use of exogenous hormones designed for BRCA1/2 mutation carriers may therefore be appropriate. Here we review studies on the associations between oral contraceptives (OC) and hormone-replacement therapy (HRT) use and the risks of breast or ovarian cancer among BRCA1/2 carriers. Almost all studies had a retrospective design. OC use reduced the risk of ovarian cancer, but high uptake of bilateral prophylactic oophorectomy (BPO) renders this protective association hardly relevant for most BRCA1/2 mutation carriers. As long as a positive association between OC use and breast cancer risk cannot be ruled out, it may be necessary to consider alternative methods of contraception. Evidence on HRT is scarce. Assuming similar associations for BRCA1/2 carriers as for the general population it may be advisable to use HRT for a short period only.

Prophylactic Bilateral Oophorectomy at Time of Hysterectomy for Women at Low Risk: Acog Revises Practice Guidelines for Ovarian Cancer Screening in Low-Risk Womena

On March 9, 2010, Richard J. Ablin phd, who was much involved in the discovery of prostate-specific antigen (psa), made national news with his quote, in an Op-Ed piece published in The New York Times and a sub-sequent March 22, 2010, U.S. National Public Radio interview, that “It’s no better than a coin toss”—de-scribing the psa test’s ability to predict prostate cancer in men[...]

Ovarian Conservation Versus Removal at the Time of Hysterectomy for Benign Gynecological Diseases

Hysterectomy for benign gynecological diseases is a common surgical procedure. Prophylactic bilateral oophorectomy is often recommended concurrent with hysterectomy to decrease the risk of ovarian cancer. Oophorectomy before menopause leads to an abrupt decrease in endogenous estrogen and androgen production leading to different health problems. So women undergoing hysterectomy for benign gynecological diseases are presented with the choice of ovarian conservation or removal. The purpose of this review article is to summarize and critically evaluate the existing evidences regarding the impact of ovarian conservation versus removal on specific health issues of the individual. Information was collected by searching pub med for related studies, abstracts and articles. Studies have shown that benefits of elective oophorectomy also include reduction of breast cancer and development of residual ovary syndrome. On the other hand bilateral oophorectomy is associated with increased risk of cardiovascular disease, osteoporosis, cognitive impairment, dementia, depression, anxiety and decreased sexual function. Estrogen was commonly prescribed after bilateral oophorectomy to treat menopausal symptoms. But recent studies have shown more harm than benefit in postmenopausal hormone therapy. So the decision making regarding elective oophorectomy at the time of hysterectomy for benign indications has become complex. The approach to such decision will include counseling regarding risks and benefits of the procedure and shared decision making between the clinician and the patient. The beneficial effect on ovarian cancer must be weighed against the risks of ovarian hormone withdrawal.

What would the experts do? Genetic testing, surveillance, and risk-reduction preferences for BRCA and Lynch syndrome.

e12542 Background: Extensive data and national guidelines are now available regarding surveillance and risk reduction options for BRCA and Lynch syndrome mutation carriers. However, most of these options are presented as choices to patients who will often ask their providers, “What would you do?” We surveyed providers from multiple specialties to learn what they would do if at 50% risk to carry a BRCA or Lynch syndrome mutation. Methods: In July of 2012 we surveyed providers from multiple specialties via internet- based surveys. Participants were obtained through the American Medical Association and the National Society of Genetic Counselors. All responses were anonymized. Results: 1,313 specialists completed the online questionnaire. Those providers who commonly treat breast, ovarian, colon and uterine cancers were grouped and compared to providers who are less likely to be the treating specialist. We found statistically significant differences in the percentage of cancer genetics specialists who would pursue BRCA and Lynch syndrome testing compared with providers in other specialties (p=0.000, 0.007, respectively). We found statistically significant differences in the percentage of providers who treat breast or ovarian cancer that would opt for prophylactic bilateral mastectomy or prophylactic oophorectomy if BRCA+ (p=0.000, p=0.004, respectively) compared to other providers. We found statistically significant differences in the percentage of providers who treat colon or uterine cancer that would have their colon or uterus removed if found to carry a Lynch syndrome mutation (p=0.000, p=0.04, respectively) compared to other specialists. Conclusions: Providers’ specialties and, possibly, disease-specific exposure to surveillance and treatment regimens impacted their personal choices with respect to cancer genetic testing, surveillance and prophylactic surgeries for BRCA and Lynch syndrome.

A Patient With Metastatic Breast Cancer 15 Years After Bilateral Prophylactic Total Mastectomy and Oophorectomy

Introduction It is estimated that 5%–10% of breast cancer is hereditary with 60%–70% of those arising from a Breast Cancer gene mutation in clinical practice (BRCA)1 or BRCA2 mutation. Women with RCA1 or BRCA2 mutations have a 55%–85% lifetime risk of nvasive breast cancer. Among women with BRCA1, 36%–63% deelop ovarian cancer and among patients with BRCA2 10%–27% evelop ovarian cancer. BRCA1-related breast cancers tend to be of he basal subtype, with predominant lymphocytic infiltration, and re often more aggressive and associated with negative prognostic actors. They are usually Estrogen (ER)/Progesterone (PR)/ ER2neu negative. BRCA2-related breast cancers tend to be of the uminal type, and are usually ER/PR positive. The median age of reast cancer onset ranges from 40 to 50 years in BRCA1 and RCA2 carriers compared with 60–70 years in sporadic cases.