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Risk-reducing bilateral salpingo-oopherectomy
Transcript
Outline
- Introduction
- Familial Cancer Syndromes
- Risk-reducing BSO
- Alternatives
- Premature Menopause
Familial Cancer Syndromes
- 13-15% of invasive epithelial ovarian and fallopian tubal cancers
BRCA
Lynch Syndrome
- 70% carriers undergo rrBSO
- rrBSO also decr risk of breast cancer by 30-75%
- Prophylactic mastectomy
- Incr risk tubal and peritoneal cancers (0.6%, 1.3%)
- Lifetime Risk Ovarian Ca: 3-14%
- Avg age dx: 43-50yo
- Lifetime Risk Endometrial Ca: 27-71%
- Risk-reducing surgery incl hysterectomy
- BRCA1
- Lifetime risk Ov Ca:39-57%
- Lifetime risk Breast Ca: 57-65%
- 2-3% by 40yo
- Avg age dx: 50yo
- BRCA2
- Lifetime risk Ov Ca:11-18%
- Lifetime risk Breast Ca: 45-57%
- 2-3% by 50yo
- Avg age dx: 60yo
Introduction
Ovarian Cancer by the Numbers
- Lifetime Risk: 1.4%
- Avg age dx: 63yo
- 2nd most common gyn cancer
- Leading cause of death of gyn cancer
SEER Incidence by Age
Risk-reducing bilateral salpingo-oopherectomy
Risk-Reducing BSO
Monica Chiu, PGY-2
SJHMC
- Pre-op
- Counseling
- Timing
- completed child-bearing
- 35-40yo (BRCA)
- Eval
- Age >45yo: TVUS, CA-125
- Procedure
- Laparoscopy
- Complete abd/pelv survey
- Complete ovarian tissue removal
- IP ligament:
- skeletonize
- 2cm prox to ovary
- pref @pelvic brim
- Concurrent Hyst
- Lynch Syndrome
- Tamoxifen Use
- Estrogen use
Alternatives to Risk-Reducing BSO
- Bilateral Salpingectomy w/delayed oopherectomy
- Screening
- Pelvic ultrasound
- CA-125 (HE4?)
- q6m starting @35yo
- Early detection (sx)
- Chemoprevention
- COCP
Premature Menopause: To Hormone or Not to Hormone?
- Hormone (Estrogen) tx
- BRCA1: ER/PR neg
- BRCA2: ER/PR pos
- Osteoporosis screening
- DXA scan
- FRAX screening q2yr
- Vaginal estrogen
- Non-hormonal alternatives
References
- seer.cancer.gov/faststats
- Iodice, S., et al. “Oral Contraceptive Use and Breast or Ovarian Cancer Risk in BRCA1/2 Carriers: A Meta-Analysis.” European Journal of Cancer 46.12 (2010): 2275–2284. Web.
- Kauff, Noah D., et al. “Risk-Reducing Salpingo-Oophorectomy in Women with a BRCA1 or BRCA2 Mutation.” Obstetrical & Gynecological Survey 57.9 (2002): 574–575. Web.
- Lu, KH, et al. Endometrial and ovarian cancer screening and prevention in women with Lynch syndrome (hereditary nonpolyposis colorectal cancer). In: UpToDate. Goff B (Ed), UpToDate, Waltham, MA. (Accessed April 20, 2016)
- Muto, MG. Risk-reducing bilateral salpingo-oopherectomy in women at high-risk of epithelial ovarian and fallopian tubal cancers. In: UpToDate. Goff B (Ed), UpToDate, Waltham, MA. (Accessed April 19, 2016)
- Peshkin, BN, et al. BRCA1 and BRCA2-associated hereditary breast and ovarian cancer. In: UpToDate. Goff B (Ed), UpToDate, Waltham, MA. (Accessed April 20, 2016)
- Powell, C. Bethan. “Risk Reducing Salpingo-Oophorectomy for BRCA Mutation Carriers: Twenty Years Later.” Gynecologic Oncology 132.2 (2014): 261–263. Web.
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