Prophylactic Oophorectomy Research Articles

Follow-up decisions and care after BRCA testing.

52 Background: Women with a deleterious mutation in BRCA 1/2 genes have an increased lifetime risk of developing breast and ovarian cancer. A spectrum of risk reducing and early detection strategies exist including clinical and radiographic surveillance, hormonal therapy, and prophylactic surgery. Methods: We studied the pattern of clinicopreventive inclination among patients undergoing BRCA testing in our genetics center via a telephone based questionnaire. Differences in sociodemographic and clinical characteristics were identified using independent sample t-test and Fisher exact test. Results: A total of 320 individuals were seen at the genetics center between October 2007 and February 2013. Twenty-nine were eligible of which 25 agreed to participate; 20 were found to be BRCA positive and 5 were true negatives. Most participants (> 75%) informed family members they were undergoing BRCA testing and all women shared the result of their deleterious mutation. An average of 2.2 (SD: 1.28) subsequent family members were tested which led to the discovery of 1.33 (SD: 1.15) new deleterious BRCA mutation carriers. Of the 20 BRCA positive patients, 13 opted for prophylactic surgery of which 5 underwent prophylactic oophorectomy (PO), 4 had prophylactic mastectomy (PM), and another 4 combined PO with PM. The remaining chose increased surveillance. Hormonal therapy was used as a preventive program in 6 women, 4 combined it with prophylactic surgery. Data subanalysis revealed BRCA carriers who opted for prophylactic surgery were more likely to be white (> 75%), younger, multiparous, live in Detroit suburbs, and have a personal history of cancer (92% versus 83%, respectively). Screening and surveillance practices were variable in timing and modality. Conclusions: 65 % of women with deleterious BRCA mutation underwent prophylactic surgery as their cancer risk reducing method. Decisions regarding adopting least to most aggressive measures remain highly influenced by personal history of cancer as well as individual socioeconomic characteristics. Understanding factors that affect women’s decisions to adopt various risk reduction strategies will aid both mutation carriers and clinicians to decide on optimal management.

Hereditary cancer syndromes with high risk of endometrial and ovarian cancer: surgical options for personalized care.

Cancer genomics has increased our recognition of specific hereditary cancer mutations. Hereditary breast and ovarian cancer (HBOC) syndrome and Lynch syndrome are two such entities in which women carrying specific mutations may be at high risk for developing breast, ovarian, and/or endometrial cancers. Risk reducing surgery such as prophylactic mastectomy, oophorectomy, and/or hysterectomy may allow women to decrease these risks after completing childbearing. Background, indications, and consequences of these procedures are reviewed.

The role of testing for BRCA1 and BRCA2 mutations in cancer prevention.

The role of testing for BRCA1 and BRCA2 mutations in cancer prevention.

Pathologic Findings in Primary Capsulectomy Specimens: Analysis of 2531 Patients.

After breast augmentation, additional operations are often needed for revision or explantation. Although the surgeon may elect to leave the capsule in situ during these procedures, excised capsule tissue may be examined histopathologically for cancer cells. The authors assessed pathologic findings from breast implant capsules submitted for histopathologic examination and evaluated whether it is oncologically safe to leave capsule tissue in situ. The authors searched PALGA, the nationwide histopathology and cytopathology data network and registry in the Netherlands, for primary capsulectomy specimens excised between 2003 and 2012. The authors applied a sensitive search strategy with low specificity that included female and breast as the sex and anatomic location keywords, and wildcards were used to detect different spellings. Cases were excluded if previous examinations showed compatibility with a history of breast cancer, prophylactic mastectomy, or prophylactic oophorectomy. The pathologic reports were manually reviewed for relevance, and each case's diagnosis was registered. A total of 6803 reports were available, representing 4948 patients; 2574 reports from 2531 patients were included in this study. The median age of patients was 51.2 ± 12.0 years (range, 15-88 years). Invasive carcinoma was detected in 4 patients (0.16%). Four patients (0.16%) had ductal carcinoma in situ, and 1 patient (0.04%) had lobular carcinoma in situ. Metaplasia was noted in 51 patients (2.0%), calcifications in 375 (14.6%), and silicone in 701 (27.2%). The incidence of occult invasive or in situ carcinoma in capsulectomy specimens of patients with no previous breast pathology is low. Therefore, it appears oncologically safe to leave capsule tissue in situ. 3.

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.

Risk for Oophorectomy After Hysterectomy

Some clinicians have recommended prophylactic oophorectomy at the time of hysterectomy to reduce the risk for ovarian cancer. Previous estimates for risk for subsequent oophorectomy in women who have ovarian preservation at hysterectomy range from 2.9% to 7.7%. These estimates are questionable because they were derived from studies that were not population based, lacked a comparison group, and had short follow-up. The absolute risk for a future ovarian malignancy and subsequent oophorectomy after ovarian preservation during benign hysterectomy is unclear. The aim of this study was to compare the risk for subsequent oophorectomy among a community cohort of women who underwent hysterectomy for benign indications with those who did not and had intact uteri. Data from the Rochester Epidemiology Project were used to identify 4931 women who underwent ovary-sparing hysterectomy for benign indications (case group) between 1965 and 2002 and 4931 age-matched controls (referent group). The Kaplan-Meier method was used to estimate the cumulative incidence of subsequent oophorectomy. Cox proportional hazard models were used to compare the effect of hysterectomy on the risk for subsequent oophorectomy. The participants had a median duration of follow-up of 19.5 years. The respective cumulative incidences of subsequent oophorectomy at 10, 20, and 30 years after hysterectomy were 3.5%, 6.2%, and 9.2% in the case group and 1.9%, 4.8%, and 7.3% in the referent group. Overall risk for subsequent oophorectomy in the case group was slightly higher than in the referent group; the hazard ratio was 1.20, with a 95% confidence interval of 1.02 to 1.42; P = 0.03. Compared with the women who had only 1 ovary preserved, the women who had both ovaries preserved at hysterectomy had an increased risk for subsequent oophorectomy (hazard ratio, 2.15; 95% confidence interval, 1.51–3.07; P < 0.001). These data suggest that women with ovarian preservation at the time of hysterectomy are at low risk for subsequent oophorectomy, which, on average, is less than 2 absolute percentage points higher at 30-year follow-up than in women with intact reproductive organs.

A MDP model for breast and ovarian cancer intervention strategies for BRCA1/2 mutation carriers.

Women with BRCA1/2 mutations have higher risk for breast and ovarian cancers. Available intervention actions include prophylactic surgeries and breast screening, which vary significantly in cost, cancer prevention, and in resulting death from other causes. We present a model designed to yield optimal intervention strategies for mutation carriers between the ages of 30 and 65 and any prior intervention history. A Markov decision process (MDP) model is developed that considers yearly state transitions for the mutation carriers and state dependent intervention actions. State is defined as a vector comprising mutation type, health states, prior intervention actions, and age. A discounted value iteration algorithm is used to obtain optimal strategies from the MDP model using both cost and quality-adjusted life years (QALYs) as rewards. The results from MDP model show that for 30-year-old women with BRCA1 mutation and no prior intervention history, the cost-optimal strategy is a combination of prophylactic mastectomy (PM) and prophylactic oophorectomy (PO) at age 30 with no screening afterwards. Whereas, the QALYs-optimal strategy suggests PO at age 30 and PM at age 50 with screening afterwards. For BRCA2 mutation carriers at age 30, the cost-optimal strategy is PO at age 30, PM at age 40, and yearly screening only after age 56. Corresponding QALYs-optimal strategy is PM at age 40 with screening. Strategies for all other ages (31 to 65) are obtained and presented. It is also demonstrated that the cost-optimal strategies offer near maximum survival rate and near minimum cancer incidence rates by age 70, when compared to other ad hoc strategies.

Morphological and immunohistochemical study of ovarian and tubal dysplasia associated with tamoxifen.

Ovarian epithelial dysplasia was initially described in material from prophylactic oophorectomies for BReast CAncer gene (BRCA) mutation. Similar histopathological abnormalities have been revealed after ovulation stimulation. Given that tamoxifen (TAM) has a clomid-like effect and is sometimes used to induce ovulation, we studied the morphological features and immunohistochemical expression patterns of neoplasia-associated markers in adnexectomies previously exposed to TAM for breast cancer. We blindly reviewed 173 histopathological slides of adnexectomies according to three groups – oophorectomies associated with TAM exposure (n=42), oophorectomies associated with clomiphene exposure (n=15) and a spontaneously fertile non cancerous control group (n=116). Morphological features (with an ovarian and tubal dysplasia scoring system) and immunohistochemical expression patterns of Ki-67, p53 and Aldehyde dehydrogenase 1 (ALDH1 is an enzyme significantly associated with earlystage ovarian cancer) were evaluated and correlated. Mean tubal dysplasia score was significantly higher in the TAM group and clomiphen group than in controls (respectively 7.8 vs 3.5, P<0.007 and 6.8 vs 3.5, P=0.008). There is no statistical difference for the ovarian score in TAM group in comparison with the control group whereas we found a significant score for clomiphen group (6.5, P=0.009). Increased ALDH1 expression was observed in the two exposed group whereas expression patterns of Ki67 and p53 were moderate. Interestingly, ALDH1 expression was low in non-dysplastic epithelium, high in dysplasia, and constantly low in the two carcinoma.Furthemore, we confirm our previous results showing that ALDH1 may be a useful tissue biomarker in the subtle histopathological diagnosis of tubo-ovarian dysplasia.

Genomic Aberrations of BRCA1-Mutated Fallopian Tube Carcinomas

Intraepithelial carcinomas of the fallopian tube are putative precursors to high-grade serous carcinomas of the ovary and peritoneum. Molecular characterization of these early precursors is limited but could be the key to identifying tumor biomarkers for early detection. This study presents a genome-wide copy number analysis of occult fallopian tube carcinomas identified through risk-reducing prophylactic oophorectomy from three women with germline BRCA1 mutations, demonstrating that extensive genomic aberrations are already established at this early stage. We found no indication of a difference in the level of genomic aberration observed in fallopian tube carcinomas compared with high-grade serous ovarian carcinomas. These findings suggest that spread to the peritoneal cavity may require no or very little further tumor evolution, which raises the question of what is the real window of opportunity to detect high-grade serous peritoneal carcinoma arising from the fallopian tube before it spreads. Nonetheless, the similarity of the genomic aberrations to those observed in high-grade serous ovarian carcinomas suggests that genetic biomarkers identified in late-stage disease may be relevant for early detection.

Impact of Oophorectomy on Cancer Incidence and Mortality in Women With a BRCA1 or BRCA2 Mutation

The purposes of this study were to estimate the reduction in risk of ovarian, fallopian tube, or peritoneal cancer in women with a BRCA1 or BRCA2 mutation after oophorectomy, by age of oophorectomy; to estimate the impact of prophylactic oophorectomy on all-cause mortality; and to estimate 5-year survival associated with clinically detected ovarian, occult, and peritoneal cancers diagnosed in the cohort. Women with a BRCA1 or BRCA2 mutation were identified from an international registry; 5,783 women completed a baseline questionnaire and ≥ one follow-up questionnaires. Women were observed until either diagnosis of ovarian, fallopian tube, or peritoneal cancer, death, or date of most recent follow-up. Hazard ratios (HRs) for cancer incidence and all-cause mortality associated with oophorectomy were evaluated using time-dependent survival analyses. After an average follow-up period of 5.6 years, 186 women developed either ovarian (n = 132), fallopian (n = 22), or peritoneal (n = 32) cancer, of whom 68 have died. HR for ovarian, fallopian, or peritoneal cancer associated with bilateral oophorectomy was 0.20 (95% CI, 0.13 to 0.30; P < .001). Among women who had no history of cancer at baseline, HR for all-cause mortality to age 70 years associated with an oophorectomy was 0.23 (95% CI, 0.13 to 0.39; P < .001). Preventive oophorectomy was associated with an 80% reduction in the risk of ovarian, fallopian tube, or peritoneal cancer in BRCA1 or BRCA2 carriers and a 77% reduction in all-cause mortality.

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.

Abstract P2-12-03: BRCA1/2 testing in an urban population of black women (BW)

Abstract Background: Current indications for BRCA1/2 testing do not vary by race or ethnicity except for Ashkenazi Jewish individuals. Uptake of BRCA1/2 testing is low in BW, despite the presence of risk factors for BRCA1/2 mutations such as diagnosis of breast cancer (BC) at a young age and triple negative breast cancer (TNBC). The prevalence of BRCA1/2 mutations in BW is not well defined. Aims: To determine the prevalence and predictors of deleterious BRCA1/2 mutations and variants of uncertain significance (VUS) in an urban population of BW, to describe preventive measures taken by BW with deleterious BRCA1/2 mutations and to describe the timing of genetic testing in BW with BC. Methods: We performed a retrospective study of all BW, defined as women who self-identified as black, African or African-American, who underwent genetic risk evaluation at two hospitals in Washington DC from 2006-2012. We collected data on age, insurance, BRCA1/2 test results, preventive measures taken after receipt of test results, oncologic history and family history (FH), defined as a first or second degree relative with BC diagnosed at age ≤ 50 and/or a first or second degree relative with ovarian cancer (OC) diagnosed at any age. Results: 211 BW received genetic counseling during this time period, 85.8% at MedStar Washington Hospital Center, and 14.2% at MedStar Georgetown University Hospital. 73% were affected (148 BC, 6 OC). Among those with BC, 14.2% had TNBC. Median age was 48 years (range 24-83). BRCA1/2 testing was performed in 70.1% (119 BC, 6 OC, 23 unaffected). Deleterious BRCA1/2 mutations were identified in 12.2% (18/148) of BW (10 BRCA1, 8 BRCA2). VUS were identified in 9.5% (14/148) of BW (3 BRCA1, 11 BRCA2). 15.2% of BW tested in 2006-2009 had VUS compared to 4.9% of BW tested in 2010-2012. 64% of VUS have been reclassified, all as benign polymorphisms except for one. BRACAnalysis Large Rearrangement Test (BART) was performed in 20.9% but did not identify any mutations. Deleterious BRCA1/2 mutations were identified in 28.5% of BW with TNBC who underwent BRCA1/2 testing, with higher prevalence among those diagnosed at younger ages (≤ age 50: 45.5%, ≤ age 60: 40%). Deleterious BRCA1/2 mutations were identified in 75% of BW with TNBC diagnosed ≤ age 50 and a positive FH. Following receipt of test results, 28% of BW found to have deleterious BRCA1/2 mutations underwent prophylactic oophorectomy and 33% underwent prophylactic mastectomy within the study time period. BRCA1/2 counseling was performed prior to definitive breast surgery in 40.5% of BW affected with BC. 11.1% of BW with BRCA1/2 mutations were underinsured and received testing under grant support. Conclusions: In this retrospective study of a large population of BW who underwent genetic risk evaluation, the prevalence of deleterious BRCA1/2 mutations was 12.2%. A very high prevalence was seen in BW with TNBC, particularly in the presence of a FH. As expected, identification of VUS decreased over time. Inadequate insurance coverage remains a barrier to genetic testing among BW. (Supported by the Familial Cancer Registry at LCCC P30 CA51008-17). Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-12-03.

Steroid cell tumor: a rare cause of hirsutism in a female

SummaryOvarian steroid cell tumors are very rare functioning sex-cord stromal tumors. They comprise <0.1% of all ovarian tumors. Previously designated as lipoid cell tumors, one-third of these tumors are considered malignant with the mean age of presentation at around 40 years. We present a case of a 28-year-old female with 2-year history of hirsutism, virilization, and amenorrhea. She was diagnosed with left ovarian tumor, for which she underwent left salpingo-oophorectomy. Histopathology revealed not otherwise specified subtype of steroid cell tumors. The patient resumed menses 2 months after the features of masculinization regressed. Within 1 year of surgery, the patient successfully conceived a full-term baby without any complications. In a young female, the neoplastic etiology of a rapid virilization or menses changing should always be kept in mind. Though commonly observed in adult females, steroid cell tumors have very good surgical outcomes if age at presentation is less and tumor is unilateral, and there are no evidences of bilateral malignancy. Bilateral salpingo-oophorectomy is not required.Learning points In a case of severe rapid hirsutism and virilization with serum testosterone level more than 200 ng/dl or more than threefold of the normal range, neoplastic conditions should always be suspected.Steroid cell tumor in young women without evidence of malignancy on histopathology has excellent surgical outcomes.Unilateral salpingo-oophorectomy is the surgery of choice.As the frequency of bilateralism is only 6%, prophylactic unaffected side oophorectomy need not be done.

Health care provider recommendations for reducing cancer risks among women with a BRCA1 or BRCA2 mutation

There is a significant variation in the uptake of cancer risk reducing options by women with a BRCA1 or BRCA2 mutation. It is currently unclear why these differences exist and it is possible that recommendations vary between providers and these influence patient decisions. Eligible health care providers who provide genetic counseling for hereditary breast and ovarian cancer families in Canada were identified. Each provider was asked to complete a study specific questionnaire that included their opinion of various cancer risk reduction options and their recommendations for specific cases. Respondents recommended prophylactic oophorectomy more often than prophylactic mastectomy or tamoxifen for women with a BRCA1 or BRCA2 mutation (p < 0.0001). Fewer than half of the respondents agreed with the recommendation for prophylactic mastectomy, and a minority of the respondents supported the recommendation for tamoxifen for chemoprevention. The majority of Canadian genetics health care providers adhere to the National Comprehensive Cancer Network (NCCN) Guideline of recommending prophylactic oophorectomy to mutation carriers, however, the minority of genetics health care providers recommend either prophylactic mastectomy or tamoxifen.

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.

Adiposity post prophylactic oophorectomy in young women at high risk for breast and ovarian cancer.

1572 Background: Bilateral prophylactic salpingo-oophorectomy (BPSO) is the current standard of care for BRCA1/2 mutation carriers and women with a strong family history of ovarian cancer. We have previously demonstrated an association between early oophorectomy, adiposity and mortality in the general population. Methods: A cross sectional study was conducted between November 2009 and January 2013 in 87 women with a family history of breast and ovarian cancer and/or BRCA1/2 mutation to identify the effect of early BPSO on multiple health outcomes. Twenty-two women who underwent BPSO within 1 to 5 years of enrollment while premenopausal and not on hormone therapy were compared to 44 premenopausal women with intact ovaries and the same age distribution and 21 postmenopausal women with intact ovaries and not on hormone therapy. Multiple anthropometric measures were taken and % body fat assessed by DEXA scan. Linear regression was used to estimate differences in these measures between the three groups. Results: The mean ages were 47, 47, and 54 years in the BPSO, premenopausal and postmenopausal groups respectively. Parity, alcohol intake, smoking and race did not significantly differ between groups. Fewer BPSO women had ever used oral contraceptives (OCP) compared to the premenopausal group (p =0.05). The BPSO group had lower mean physical activity (p = 0.05) compared to the two other groups. BMI was increased in the BPSO group but was not statistically different across groups. However, mean waist and abdominal circumference and trunk % body fat were significantly higher among women who underwent BPSO compared to both groups. In multivariate analyses adjusting for age, physical activity, and OCP use, the average waist circumference was 7.92 cm (95% CI 1.46, 14.37) higher and 8.98 cm (95% CI 0.40, 17.46) higher in the BPSO group compared to the postmenopausal and premenopausal groups, respectively. A similar pattern was seen for abdominal circumference. Association with % body fat were not statistically significant. Conclusions: This pilot study suggests that increased central adiposity, is a sequelae of BPSO in young women. Longitudinal studies are needed to confirm results and evaluate the efficacy of interventions.

Understanding the Needs of Women Considering Risk-Reducing Salpingo-oophorectomy

Because of the significantly increased lifetime risk of ovarian cancer associated with inheritance of a germline mutation in the BRCA1/2 genes, women with a deleterious mutation are recommended to undergo risk-reducing salpingo-oophorectomy at age 35 years or once child-bearing is complete. Significant time is often spent by nurses trained in genetics providing counseling to improve the decision-making process. The decision to undergo surgery is complex and laden with several sources of uncertainty. We conducted a qualitative study among female carriers of deleterious BRCA1/2 mutations to address these uncertainties. Twelve qualitative interviews were conducted with women who had received a positive BRCA1/2 test result to explore their understanding of ovarian cancer risk, prevention options, and resource needs. Qualitative content analysis was performed. Significant information gaps in level of risk, other factors associated with ovarian cancer, and details of prophylactic oophorectomy were identified. Personal experience with cancer colored the degree of risk perception associated with the inherited mutation. Fear of the adverse effects of surgical menopause, both physiological and psychosocial, was common. Women expressed interest in hearing from other women facing the same decision. Women facing the decision to undergo risk-reducing salpingo-oophorectomy have several information gaps and unmet needs despite comprehensive counseling. Based on our findings, we make specific recommendations that will guide nursing practice and future research.

Influence of prophylactic oophorectomy on mood and sexual function in women of menopausal transition or postmenopausal period

To evaluate the impact of prophylactic oophorectomy on mood and sexual function in women at menopausal transition or postmenopausal period. Patients who underwent operations due to benign diseases of uterus and ovaries were included and were stratified into two groups, namely Group A with 256 patients undergoing hysterectomy and prophylactic oophorectomy and Group B with 337 patients undergoing simple hysterectomy. Follow-ups included demographic data, Self-Rating Zung Depression Scale (ZDS), Self-Rating Zung Anxiety Scale (ZAS), and Female Sexual Function of Index (FSFI). Five hundred and ninety-three patients were successfully followed. 69.27 % of patients at menopausal transition period chose ovary conservation whilst 79.22 % of postmenopausal women chose oophorectomy due to fear of potential cancer and economy issue. Ovarian cancer was not found in this cohort. Incidence of distress was higher in Group A (P = 0.001). No difference was obtained in ZAS scores between the two groups (P = 0.110). Incidence of anxiety was higher in Group A (P = 0.010). Percentage of patients scoring above 20 in FSFI was significantly higher in Group B (P = 0.003). Oophorectomy and marital status were independent factors for depression (P = 0.009 and <0.001, respectively). Adverse influence on mental and sexual status was severer in women undergoing prophylactic oophorectomy at menopausal transition or postmenopausal period. Comprehensive evaluation may contribute to better ovary conservation strategy for women with benign morbidities.

The expression of BRCA1, P53, KAI1, and Nm23 in ovaries of BRCA1 mutation carriers after prophylactic adnexectomy

IntroductionHigh mortality rate, absence of reliable methods for early diagnosis and poor prognosis of advanced ovarian cancer prompted to investigate the role of prophylactic oophorectomy in BRCA1 mutation carriers as well as evaluate the expression of BRCA1, p53, Nm23, and KAI1 proteins in ovarian tissue from these patients.Materials and methodsOvaries from BRCA1 mutation carriers underwent prophylactic adnexectomy and control group of patients were operated from other than cancer reasons. The expression of selected proteins was studied using immunohistochemical staining. The intensity of immunostaining and the number of tumor cells showing the reaction for selected proteins were analyzed.ResultsWe have analyzed ovarian tissues from 18 BRCA1 mutation carriers and 11 women included in control group. Positive expression of BRCA1 protein was presented in 83.3 % cases in BRCA1 mutation carriers and in 72.7 % in the control group (p > 0.05). Positive expression of p53 protein was observed, respectively, in 27.8 vs. 36.4 % (p > 0.05), Nm23 protein 77.7 vs. 90.9 % (p > 0.05), and KAI1 in 72.2 vs. 72.7 % (p > 0.05). Mean percent of tumor cells that showed the reaction for selected proteins as well as the intensity of immunostaining for all analyzed proteins seems to be lower in BRCA1 mutation carriers.ConclusionsHowever, any significant differences between study group and control group have not been found; there were similar trends showing reduced expression of studied proteins in BRCA1 mutation carriers.